Tennessee Gives This Hospital Monopoly an A Grade Even When It Reports Failure

Published

6 months ago

May 29, 2024

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A Tennessee agency that is supposed to hold accountable and grade the nations largest state-sanctioned hospital monopoly awards full credit on dozens of quality-of-care measurements as long as it reports any value regardless of how its hospitals actually perform.

This story also ran on States Newsroom. It can be republished for free.

Ballad Health, a 20-hospital system in northeast Tennessee and southwest Virginia, has received A grades and an annual stamp of approval from the Tennessee Department of Health. This has occurred as Ballad hospitals consistently fall short of performance targets established by the state, according to health department documents.

Because the states scoring rubric largely ignores the hospitals performance, only 5% of Ballads final score is based on actual quality of care, and Ballad has suffered no penalty for failing to meet the states goals in about 50 areas including surgery complications, emergency room speed, and patient satisfaction.

It doesnt make any sense, said Ron Allgood, 75, of Kingsport, Tennessee, who said he had a heart attack in a Ballad ER in 2022 after waiting for three hours with chest pains. It seems that nobody listens to the patients.

Ballad Health was created six years ago after Tennessee and Virginia lawmakers waived federal anti-monopoly laws so two competing hospital companies could merge. The monopoly agreement established two quality measures to compare Ballads care against the states baseline expectations: about 17 target measures, on which hospitals are expected to improve and their performance factors into their grade; and more than 50 monitoring measures, which Ballad must report, but how the hospitals perform on them is not factored into Ballads grade.

Ballad has failed to meet the baseline values on 75% or more of all quality measures in recent years and some are not even close according to reports the company has submitted to the health department.

Since the merger, Ballad has become the only option for hospital care for most of about 1.1 million residents in a 29-county region at the nexus of Tennessee, Virginia, Kentucky, and North Carolina. Critics are vocal. Protesters rallied outside a Ballad hospital for months. For years, longtime residents like Allgood have alleged Ballads leadership has diminished the hospitals theyve relied on their entire lives.

Its a shadow of the hospital we used to have, Allgood said. Protesters gather in opposition to the closure of the neonatal intensive care unit at Holston Valley Medical Center, a Ballad Health hospital, in 2019. (Dani Cook) Email Sign-Up

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And yet, every year since the merger, the Tennessee health department has reported that the benefits of the hospital merger outweigh the risks of a monopoly, and that Ballad continues to provide a Public Advantage. Tennessee has also given Ballad an A grade in every year but two, when the scoring system was suspended due to the covid-19 pandemic and no grade issued.

The departments latest report, released this month, awarded Ballad 93.6 of 100 possible points, including 15 points just for reporting the monitoring measures. If Tennessee rescored Ballad based on its performance, its score would drop from 93.6 to about 79.7, based on the scoring rubric described in health department documents. Tennessee considers scores of 85 or higher to be satisfactory, the documents state.

Larry Fitzgerald, who monitored Ballad for the Tennessee government before retiring this year, said it was obvious the states scoring rubric should be changed.

Fitzgerald likened Ballad to a student getting 15 free points on a test for writing any answer.

Do I think Ballad should be required to show improvement on those measures? Yes, absolutely, Fitzgerald said. I think any human being you spoke with would give the same answer.

Ballad Health declined to comment. Tennessee Department of Health spokesperson Dean Flener declined an interview request and directed all questions about Ballad to the Tennessee Attorney Generals Office, which also has a role in regulating the monopoly. Amy Wilhite, a spokesperson for the AGs office, directed those questions back to the health department and provided documents showing it is the agency responsible for how Ballad is scored.

The Virginia Department of Health, which is also supposed to perform active supervision of Ballad as part of the monopoly agreement, has fallen several years behind schedule. Its most recent assessment of the company was for fiscal year 2020, when it found that the benefits of the monopoly outweigh the disadvantages. Erik Bodin, a Virginia official who oversees the agreement, said more recent reports are not yet ready to be released.

Ballad Health was formed in 2018 after state officials approved the nations biggest so-called Certificate of Public Advantage, or COPA, agreement, allowing a merger of the Tri-Cities regions only two hospital systems Mountain States Health Alliance and Wellmont Health System. Nationwide, COPAs have been used in about 10 hospital mergers over the past three decades, but none has involved as many hospitals as Ballads.

The Federal Trade Commission has warned that hospital monopolies lead to increased prices and decreased quality of care. To offset the perils of Ballads monopoly, officials required the new company to agree to more robust regulation by state health officials and a long list of special conditions, including the states quality-of-care measurements.

Ballad failed to meet the baseline on about 80% of those quality measures from July 2021 to June 2022, according to a report the company submitted to the health department. The following year, Ballad fell short on about 75% of the quality measures, and some got dramatically worse, another company report shows.

For example, the median time Ballad patients spend in the ER before being admitted to the hospital has risen each year and is now nearly 11 hours, according to the latest Ballad report. That’s more than three times what it was when the monopoly began, and more than 2.5 times the state baseline.

And yet Ballads grade is not lowered by the lack of speed in its ERs.

Fitzgerald, Tennessees former Ballad monitor, who previously served as an executive in the University of Virginia Health System, said a hospital company with competitors would have more reason than Ballad to improve its ER speeds.

When I was at UVA, we monitored this stuff passionately because and I think this is the key point here we had competition, Fitzgerald said. And if we didnt score well, the competition took advantage.

Midwest correspondent Samantha Liss contributed to this report.

Brett Kelman: bkelman@kff.org, @BrettKelman Related Topics Health Industry States Hospitals Tennessee Virginia Contact Us Submit a Story Tip

World

Joe Biden allows Ukraine to begin firing US rockets deep into Russia – as politician warns it ‘risks World War Three’

Published

38 mins ago

November 18, 2024

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Joe Biden allows Ukraine to begin firing US rockets deep into Russia - as politician warns it 'risks World War Three'

Joe Biden has authorised Ukraine to begin firing US-supplied rockets deep into Russia – as Sir Keir Starmer prepares to push for “further support” for Kyiv at the G20 summit.

Mr Biden’s policy shift means Kyiv will now be able to use Army Tactical Missile Systems (ATACMS) for long-range attacks, two American officials have told Sky News’ US partner network NBC News.

Follow latest: Ukraine war live updates

Ukraine plans to conduct its first such attacks in the coming days, the sources said, without revealing details due to operational security concerns.

The US has eased restrictions on the use of ATACMS, which have a range of up to 190 miles, after Russia began deploying North Korean ground troops to supplement its own forces in the conflict.

Kremlin spokesman Dmitry Peskov said such a move would deepen America’s involvement in the war.

“It is obvious that the outgoing administration in Washington intends to… continue adding fuel to the fire and provoking further escalation of tensions around this conflict,” Peskov said.

The development was also condemned by Biden officials as a possible expansion of the war.

A Russian politician and the son of President-elect Donald Trump have both likened the move to risking a third world war.

Maria Butina told the Reuters news agency: “These guys, Biden’s administration, is trying to escalate the situation to the maximum while they still have power and are still in office.

“I have a great hope that Trump will overcome this decision if this has been made because they are seriously risking the start of World War Three which is not in anybody’s interest.”

Meanwhile, Donald Trump Jr wrote on X: “The Military Industrial Complex seems to want to make sure they get World War 3 going before my father has a chance to create peace and save lives… Imbeciles!”

The outgoing Biden administration’s move comes as there are concerns about the level of support the Trump White House may be willing to give Ukraine.

Mr Trump has previously vowed to limit US support for Ukraine and end its war with Russia.

In an evening address after Kyiv was given permission to fire deep into Russia, Ukrainian President Volodymyr Zelenskyy said: “Today, there’s a lot of talk in the media about us receiving permission for respective actions. But strikes are not carried out with words. Such things are not announced. Missiles will speak for themselves. They certainly will.”

Back in September, Russian President Vladimir Putin said if the US were to lift the ban on long-range missile use it would be seen as NATO’s “direct participation” in the war.

He added: “This, of course, will significantly change the very essence, the very nature of the conflict.”

Meanwhile, the UK prime minister has said he has “no plans” to speak with the Russian president as world leaders gather for the G20 summit in Rio de Janeiro.

Mr Putin will not be attending the two-day summit which starts on Monday after saying in October that his presence would “disrupt the normal work of this forum”. Russia’s foreign minister Sergei Lavrov will be attending instead.

It will take place days after German Chancellor Olaf Scholz spoke to Mr Putin on what was the Russian leader’s first publicly announced conversation with the sitting head of a major Western power in nearly two years.

Asked if he had any plans to make a similar call, Sir Keir said: “It’s a matter for Chancellor Scholz who he speaks to. I have no plans to speak to Putin.”

Speaking to reporters while on his way to the summit, he added: “We are coming up to the 1,000th day of this conflict on Tuesday.

“That’s 1,000 days of Russian aggression, 1,000 days of huge impact and sacrifice in relation to the Ukrainian people and recently we’ve seen the addition of North Korean troops working with Russians which does have serious implications.

“I think on one hand it shows the desperation of Russia, but it’s got serious implications for European security […] and for Indo-Pacific security and that’s why I think we need to double down on shoring up our support for Ukraine and that’s top of my agenda for the G20.

“There’s got to be full support as long as it takes and that certainly is top of my agenda, shoring up that further support for Ukraine.”

The latest developments come after Russia launched a large-scale attack on Ukraine on Sunday, with Mr Zelenskyy claiming Moscow had launched a total of 120 missiles and 90 drones.

Two major strikes, which left a total of 18 people dead, hit a residential building in the northeastern city of Sumy as well as energy infrastructure across Ukraine, prompting emergency power cuts.

Hours later, Moscow mayor Sergei Sobyanin said Russia’s air defence units had destroyed a drone heading towards the city.

World

It’s a stunning shift in US policy – but Biden’s announcement will trigger fury and fresh threats from Moscow

Published

38 mins ago

November 18, 2024

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It's a stunning shift in US policy - but Biden's announcement will trigger fury and fresh threats from Moscow

Joe Biden’s belated decision to allow Ukraine to use US-supplied, long-range missiles inside Russia will be cheered by Kyiv and will almost certainly prompt the UK to follow suit.

But the stunning shift in US policy – just weeks before Donald Trump takes over as US president – will also trigger fury and fresh threats from Moscow at a time of increasing uncertainty about the future course of its war.

President Vladimir Putin has warned the West they would be playing with fire if they allowed Ukrainian forces to launch Western-supplied cruise and ballistic missiles at Russia, saying it could even trigger a global conflict.

British and US officials, though, have repeatedly advised their respective capitals not to be intimidated by Moscow’s sabre rattling.

Ukraine war latest: Biden lifts ban on Russia strikes

Yet there has been hesitancy, particularly in Washington, over the unleashing of US Army Tactical Missile System (ATACMS) ballistic missiles beyond the borders of Ukraine.

However, it seems that a move by North Korea to send thousands of its troops to fight with Russia has changed US calculations.

The New York Times, which was among the US media organisations to break news of the Biden administration’s decision on long-range missiles, reported that the first time the American weapons will be used inside Russia will likely be against Russian and North Korean troops battling a Ukrainian incursion in the Russian region of Kursk.

While a significant step up in support for Ukraine, the ability to use American long-range missiles inside Russia is not a war-winning development.

But it does expand Kyiv’s capacity to hit important military targets deliberately positioned by Russian commanders far back from the frontline. This includes stockpiles of missiles, drones and other ammunition used to strike Ukraine.

Just as important as the military impact, though, is the political signal that the US decision sends to the Kremlin about Washington’s willingness to defy Russian warnings about dire consequences should Mr Biden dare to grant Ukraine the permission it’s so long been seeking.

The dramatic move by the US comes after months of lobbying by Ukraine’s leader, Volodymyr Zelenskyy.

A key thing to watch now will be how Mr Putin reacts the first time an American missile kills Russian soldiers on Russian soil.

Moscow does not want a direct war with the United States and NATO – nuclear-armed forces with far greater combined firepower – but the Kremlin could well ramp up an already heightened campaign of sabotage and other forms of hybrid warfare across Europe.

Another important reaction to track will be how Mr Trump responds to Mr Biden’s move and whether he continues to allow Ukraine this permission once he takes over as the US commander-in-chief.

The president-elect has vowed to end Russia’s war in Ukraine quickly but he has not said how. Yet he has voiced fierce opposition to the continued gifting of vast quantities of American weapons to the Ukrainian military.

It is a reason perhaps for Ukraine to make use of its new freedoms with US missiles as quickly as possible.

World

Vladimir Shklyarov: Russian ballet star dies aged 39 after ‘fall from building’

Published

38 mins ago

November 18, 2024

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Vladimir Shklyarov: Russian ballet star dies aged 39 after 'fall from building'

An acclaimed Russian ballet dancer has died aged 39 after reportedly falling off a balcony.

Vladimir Shklyarov, one of the world’s top male ballet stars, died on Saturday night, according to the Mariinsky Theatre, where he was a principal dancer.

The St Petersburg theatre said: “It is with profound sadness that the Mariinsky Theatre announces the untimely passing of principal dancer Vladimir Shklyarov.

“Shklyarov, a beloved artist and audience favourite, died tragically on 16 November.

“His loss is deeply felt by the entire Mariinsky family and the wider ballet world.”

The Mariinsky Theatre told Sky News Shklyarov had a back injury at the time, and was due to have “complicated spinal surgery” on Monday 18 November. He was “taking serious pain medication”.

A spokesperson for the theatre was reported in Russian media at the weekend as saying he had fallen from the fifth floor of a building.

Dancers have been paying tribute to Shklyarov, who was married to fellow company dancer Maria Shklyarov, with whom he had two children.

Former ballerina Irina Bartnovskaya said Shklyarov had been at home, on pain relief, preparing for foot surgery at the time of his death.

In a post on Telegram, she continued: “He went out onto the balcony to get some air and smoke, lost his balance (a very narrow balcony) and fell down (from the 5th floor).

“Stupid, unbearable accident.”