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

Published

1 year 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

Entertainment

Tim Davie resigns as BBC’s director-general – with CEO of BBC News also stepping down

Published

3 hours ago

November 9, 2025

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Tim Davie resigns as BBC's director-general - with CEO of BBC News also stepping down

Tim Davie has resigned as the BBC’s director-general after five years in the role.

The chief executive of BBC News Deborah Turness has also resigned.

It comes as the corporation is expected to apologise on Monday following concerns about impartiality, including how a speech by US President Donald Trump was edited in an episode of Panorama.

White House and others react to resignations – latest

The concerns regard clips spliced together from sections of the US president’s speech on 6 January 2021 to make it appear he told supporters he was going to walk to the US Capitol with them to “fight like hell” in the documentary Trump: A Second Chance?, which was broadcast by the BBC the week before last year’s US election.

Mr Davie sent a message to staff on Sunday afternoon, saying it was “entirely” his decision to quit.

Admitting the BBC “is not perfect”, he said: “We must always be open, transparent and accountable.”

“While not being the only reason, the current debate around BBC News has understandably contributed to my decision.

“Overall, the BBC is delivering well, but there have been some mistakes made and as director-general I have to take ultimate responsibility.”

Ms Turness told staff the “ongoing controversy” around the edition of Panorama “has reached a stage where it is causing damage to the BBC – an institution that I love.

“The buck stops with me – and I took the decision to offer my resignation to the director-general last night.

“In public life, leaders need to be fully accountable, and that is why I am stepping down. While mistakes have been made, I want to be absolutely clear recent allegations that BBC News is institutionally biased are wrong.”

BBC Chair, Samir Shah called it “a very difficult day”, thanking Ms Turness and crediting her with having “transformed” the corporation’s news output.

Mr Trump said Mr Davie and Ms Turness were “very dishonest people who tried to step on the scales of a presidential election”. In a post on Truth Social, he called it “a terrible thing for democracy!”

Mr Trump’s press secretary, Karoline Leavitt, posted a triumphant two-word reaction on X, using the drinking term “shot” to describe reports that the US president was “going to war with fake news”, referring to the BBC programme, and describing Mr Davie’s resignation as a “chaser” – a drink taken after the shot to soften the taste of the alcohol.

In an interview published on Friday, she had described the BBC as “100% fake news” and a “propaganda machine”.

Farage: ‘BBC’s last chance’

In a message posted on social media, Culture Secretary Lisa Nandy thanked Mr Davie for leading the BBC through a period of “significant change”.

She called the organisation “one of our most important national institutions”, adding that “now, more than ever, the need for trusted news and high-quality programming is essential to our democratic and cultural life, and our place in the world”.

Conservative leader, Kemi Badenoch, said it was “right that Tim Davie and Deborah Turness have finally taken responsibility and resigned from the BBC”.

She said: “The culture at the BBC has not yet changed. BBC Arabic must be brought under urgent control. The BBC’s US and Middle East coverage needs a full overhaul.”

Ms Badenoch said it “should not expect the public to keep funding it through a compulsory licence fee unless it can finally demonstrate true impartiality”.

Liberal Democrat leader Sir Ed Davey said Sunday’s resignations “must be an opportunity for the BBC to turn a new leaf, rebuild trust and not give in to the likes of [Reform UK leader] Nigel Farage who want to destroy it”.

Mr Farage said the pair’s resignations must be “the start of wholesale change” at the BBC.

He urged the ministers to appoint “somebody with a record of coming in and turning companies and their cultures around”, preferably someone “from the private sector who has run a forward-facing business and understands PR”.

Mr Farage said: “This is the BBC’s last chance. If they don’t get this right, there will be vast numbers of people refusing to pay the licence fee.”

As well as the Panorama show on Mr Trump, the BBC has also been accused of failing to maintain its neutrality in its coverage of the Israel-Hamas war and over trans issues.

The Campaign Against Antisemitism (CAA) called for an independent inquiry into potential bias at the BBC, saying “growing bias” had been evident for “many years across a wide array of issues”.

The group claimed that, under Mr Davie and Ms Turness, the BBC had “often served as a mouthpiece for Hamas” and “gaslit” its audience “by claiming to be a bastion of ethics and truthful journalism”.

Marcus Ryder, a former executive producer of current affairs at the BBC, called the resignations “really sad”, adding that “it shows the pressure and ethical climate that the BBC is operating in, that this edit can actually bring down the director- general”.

Dame Melanie Dawes, chief executive of Ofcom, thanked Mr Davie, saying he had led the organisation “at a time of great change and challenge”.

The Daily Telegraph reported on Tuesday that a memo by a former external adviser to the BBC’s editorial standards committee raised the issue, as well as other concerns about impartiality, in the summer.

Dealing with controversies

Mr Davie took the role in 2020, replacing Tony Hall.

During his time in charge of the broadcaster, he has dealt with a number of high-profile controversies within the corporation.

They include a row over former Match of the Day host Gary Lineker’s sharing of his political views, top presenter Huw Edwards being convicted of making indecent images of children, and the BBC’s broadcasting of Bob Vylan’s controversial Glastonbury performance.

There were also controversies surrounding some of its top shows, such as MasterChef and its former presenter, Gregg Wallace, as well as Strictly Come Dancing.

Mr Davie, who had a career in marketing and finance before joining the BBC’s marketing team in 2005, was previously acting director-general from November 2012 until April 2013.

He said his departure will not be immediate and that he is “working through” timings to ensure an “orderly transition” over the coming months.

A person familiar with the situation said Davie’s decision had left the BBC board stunned by the move.

Politics

Starmer avoided political heat at home during Brazil climate conference – but he returns to a prisons crisis

Published

3 hours ago

November 9, 2025

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Starmer avoided political heat at home during Brazil climate conference - but he returns to a prisons crisis

Sir Keir Starmer’s been on the other side of the world for most of the week – at the COP30 climate summit in Brazil, his 40th foreign trip in 16 months.

Back home, his government’s credibility has continued its painful unravelling.

Five days on from David Lammy’s disastrous stand-in performance at PMQS, the justice secretary’s ministerial colleagues are still struggling to explain why he repeatedly failed to answer questions on whether another migrant criminal had been released from prison by mistake.

Yes, Conservative MP James Cartlidge got the question wrong, as Brahim Kaddour-Cherif was an illegal migrant, not an asylum seeker.

But Mr Cartlidge argued that because the deputy prime minister failed to divulge the information he did have, he failed to act with full transparency and should be investigated by the PM’s ethics advisor for a possible breach of the ministerial code.

Culture Secretary Lisa Nandy has been defending Mr Lammy’s response.

She told Sunday Morning with Trevor Phillips she doesn’t accept that he was being evasive, insisting Mr Lammy had been carefully weighing his words to ensure that “when we do speak about matters of such significance to the public… we do so with care and make sure the full facts are presented”.

At that time, rather extraordinarily, we’re told the justice secretary did not have the full facts of the case, even though the Metropolitan Police had been informed the day before (six days after Kaddour-Cherif was accidentally freed).

How Sky correspondent found escaped prisoner

The combination of wrongly-freed prisoners and illegal migrants is a conjunction of two of the most toxic issues in British politics – the overflowing prison system and the dysfunctional asylum system.

Both are vast, chaotic problems the government is struggling to get a grip on, as the Conservatives also found, to their cost.

But ministers’ ongoing failure to bring both issues under control has only been highlighted by Mr Lammy’s sloppy handling of the situation.

Football regulator donations row

Ms Nandy has herself been at the heart of another government controversy this week – over the appointment of the new football regulator, David Kogan.

An independent investigation found she “unknowingly” breached the code on public appointments by failing to declare that Mr Kogan had previously donated £2,900 to her Labour leadership campaign – and also criticised her department for not highlighting his status as a Labour donor who had previously given £33,410 to the party.

The culture secretary has apologised and explained she had been unaware of the donations.

She also pointed out that Mr Kogan was a candidate originally put forward by the Conservatives. But again, it’s messy.

It’s yet another story which chips away at the government’s promises to clear up politics and act with full transparency and accountability.

Budget blues?

The ultimate breach of trust looks set to come with the budget on 26 November, however.

In an extraordinary early morning speech this week, Chancellor Rachel Reeves signalled that she’s likely to raise taxes in two and a half weeks – and thus breach the core promise of the Labour Party manifesto.

The rationale for her dire warnings on Tuesday was to start explaining why she will probably have to do so – getting in her excuses early about the languishing state of the economy as a result of Brexit, Donald Trump’s tariffs and her inheritance from the Conservatives.

The Tories claim Ms Reeves could sort out the finances by cutting welfare spending – something ministers dramatically failed to do when their efforts at reform were scuttled by angry backbenchers.

Governments breach their manifesto commitments all the time.

But if the chancellor goes ahead and puts up income tax, as expected (even if that’s offset, for some, by a corresponding cut to national insurance), it will be a shock – and the first such increase in 50 years.

The new deputy leader of the party, Lucy Powell, pointedly warned the government this week about the risks of breaching trust in politics by breaking manifesto promises.

Lisa Nandy didn’t shoot her comments down when Sir Trevor asked for her response, arguing instead that while “we take our promises very, very seriously”, they [Labour] “were also elected on a promise to change this country”, with a particular focus on fixing the NHS.

The impossibility of doing both – protecting taxes while also increasing government spending in such a challenging economic climate – highlights the folly of making such restrictive promises.

But voters are not in a forgiving mood.

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