Johnson City, Tenn.-based Ballad Health is facing scrutiny for alleged poor quality of care that critics say stem from its monopoly, KFF Health News reported Dec. 6.
The investigative report is based on KFF Health News' review of written complaints to the Tennessee government and state lawmakers, public hearing testimony and interviews with patients and family, local leaders and officials.
The 20-hospital system in Northeastern Tennessee and Southwestern Virginia was created six years ago, when lawmakers in both states waived federal antitrust laws so two health systems could merge. Ballad became the largest state-sanctioned hospital monopoly in the nation, according to the report.
Four takeaways from the report:
1. Since the system's formation, it has faced accusations from residents and local officials about care quality tied to allegations of "paper-thin staffing" at its hospitals and emergency departments. Annual reports from Ballad and the state show the system has failed to meet about 75% of the care quality goals set by Tennessee and Virginia over the last three fiscal years. This year, the Federal Trade Commission cited Ballad as a cautionary tale when opposing a similar hospital merger under consideration. Some residents also told KFF that they are wary, afraid or unwilling to seek care at Ballad hospitals, according to written complaints to the Tennessee government.
2. Larry Fitzgerald, a retired Tennessee consultant who monitored the system for more than five years, told KFF Health News that the state's grading system "allowed Ballad to succeed on paper even when it failed to meet the state's quality-of-care goals." Mr. Fitzgerald also said he is unconvinced that the monopoly has prevented any hospital closures and that the merger was "probably not" benefiting local residents overall.
However, Mr. Fitzgerald always gave Ballad high marks in his annual reports. Ballad told Becker's that Mr. Fitzgerald never expressed concerns about the quality of care at the system. The state's current commissioner of health and its former commissioner of health also documented that Mr. Fitzgerald never expressed concerns about quality issues.
3. Ballad Health CEO Alan Levine told KFF Health News that the hospitals are quickly recovering from a care quality slump caused by COVID-19 and that the issues around turnover and staff shortages are not related to the Ballad merger, but are issues hospitals are facing across the nation. Mr. Levine also noted that all of the complaints from patients were about medical decisions made by physicians, not about "any policy or practice at Ballad."
4. Each year, Tennessee and Virginia have determined that the benefits of the Ballad monopoly outweigh any negative impact and continue to approve it to continue. Ballad Health serves about 1.1 million people in a 29-county region across Tennessee, Virginia, Kentucky and North Carolina, the report said.