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Why one hospital merger stands out among the rest

Two rival hospitals in Terre Haute, Ind., seeking to merge are the first to test the state's certificate of public advantage (COPA) law, The Washington Post reported July 3. 

Five things to know:

1. In September, Union Health announced plans to acquire Terre Haute Regional Hospital, which is part of Nashville, Tenn.-based HCA Healthcare. 

2. The Indiana Department of Health will decide whether to permit the deal under the state's COPA law, which passed in 2021. Under the law, the department can issue a certificate "only if it finds that there is clear evidence that the proposed merger would improve the health outcomes, healthcare access, and the quality of healthcare provided to the population currently served by the hospitals, and those benefits must outweigh any potential disadvantages that result from the proposed merger."   

3. More than a dozen states have enacted COPA laws, which allow state regulators to approve deals that the Federal Trade Commission would otherwise consider illegal because they reduce competition, according to the report. 

4. Stipulations for Indiana's COPA law include that the hospitals must be located in a predominantly rural county that has a population of less than 140,000 and is not contiguous to a county with a population of more than 250,000. 

5. The largest COPA-created health system in the country is Johnson City, Tenn.-based Ballad Health, which resulted from the merger of Mountain States Health Alliance and Wellmont Health System, according to the report. Ballad has reported the time patients spend in its ERs in Tennessee and Virginia before being hospitalized has more than tripled since it was formed. A Ballad spokesperson told the Post that the system's performance has improved since the statistics were collected for the 2023 fiscal year, which ended June 30, 2023, and said ER wait times have shortened. 

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