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

Published

4 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

Sports

Sources: Nats demote All-Star after all-nighter

Published

2 hours ago

September 21, 2024

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Sources: Nats demote All-Star after all-nighter

Jeff Passan, ESPNSep 21, 2024, 01:47 PM ET
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The Washington Nationals demoted All-Star shortstop CJ Abrams to the minor leagues after he stayed out all night at a Chicago-area casino, leaving only hours before a Friday day game against the Chicago Cubs, sources told ESPN’s Jesse Rogers.

The 23-year-old Abrams led off for the Nationals and went 0 for 3 with a walk and strikeout in Friday’s game, which started at 1 p.m. CT. He was informed of the demotion Friday night, sources said. He will be sent to West Palm Beach, home of the Nationals’ minor league complex.

Because Abrams has been with Washington for the entirety of the season, the demotion will not affect his service time. Players earn a full year of service with 172 days on the major league roster, and Abrams already has exceeded that threshold.

Abrams could, however, file a grievance through the Major League Baseball Players Association to fight for lost pay if he believes the demotion unjust. He would lose around $30,000 of his $752,000 salary for missing the season’s final week. Abrams will be arbitration-eligible this winter, entering the system for the first of four times as a Super 2.

Acquired as one of the centerpieces of the Juan Soto trade two years ago, Abrams parlayed a breakout first-half into an All-Star selection, hitting .268/.343/.489 with 15 home runs and 15 stolen bases over the Nationals’ first 89 games. He struggled significantly in the second half, slashing .203/.260/.326, and Abrams’ defense has been a weakness throughout the season.

Still, the Nationals did not intend to send him to the minor leagues until they learned of his time spent at the casino, which was first reported Friday by CHGO.

“I just want it to be known it wasn’t performance-based,” Nationals manager Dave Martinez told reporters Saturday. “It’s an internal issue. I’m not going to give specifics.”

World

At least 44 people killed in Israel strikes on Lebanon and Gaza in last 24 hours

Published

2 hours ago

September 21, 2024

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At least 44 people killed in Israel strikes on Lebanon and Gaza in last 24 hours

At least 44 people have been killed in Israeli strikes on Lebanon and Gaza in the last 24 hours.

A strike on the Lebanese capital Beirut killed at least 31 people including three children and seven women, the country’s health minister Firas Abiad said.

Fifteen of the 68 wounded in the attack remain in hospital.

Ali Harake, the head of the rescue team searching through the rubble, told Sky News his team is still looking for between 17 and 18 missing people – though he fears none have survived.

Follow the latest updates on the Middle East

It is understood two apartment blocks in a densely populated southern neighbourhood collapsed in the strike – the deadliest attack on Beirut in decades.

Top Hezbollah commanders are believed to have been meeting in the basement of one of the buildings.

Hezbollah has confirmed two of its senior commanders, Ibrahim Aqil and Ahmed Wahbi, died in the strike while an Israeli military spokesperson said that at least 16 Hezbollah militants were killed.

Wahbi oversaw the military operations of the Radwan special forces – a commando unit that seeks to infiltrate and carry out attacks in Israel – until early 2024. Aqil was also a top commander for the Iran-backed group.

The Palestinian militant group Hamas has described the killing of Aqil as a “crime” and a “folly”, adding Israel will “pay the price”.

Meanwhile, at least 13 people have been killed in Israeli strikes on Gaza City, according to a local report.

The strikes are believed to have hit several schools sheltering displaced people in the southern part of the city.

The strikes come after Hezbollah launched one of its most intense bombardments of northern Israel in nearly a year of fighting, largely targeting Israeli military sites.

Israel’s Iron Dome missile defence system intercepted most of the Katyusha rockets.

Hezbollah said its latest wave of rocket attacks was a response to past Israeli strikes on southern Lebanon.

It came days after mass explosions of Hezbollah pagers and walkie-talkies killed at least 37 people, including two children. Some 2,900 others were wounded in the assault which has been widely attributed to Israel.

World

Fire rips through arms depot deep inside Russia after huge Ukrainian drone attack – as Zelenskyy prepares to meet Trump

Published

2 hours ago

September 21, 2024

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Fire rips through arms depot deep inside Russia after huge Ukrainian drone attack - as Zelenskyy prepares to meet Trump

A fire has ripped through a Russian missile depot in the Tver region deep inside the country after it was targeted in a Ukrainian drone attack, the defence ministry in Moscow has said.

Footage shows a second Ukrainian drone attack on the southwestern Russian region of Krasnodar also triggered a fire and caused a series of explosions.

Russia’s defence ministry has claimed its forces shot down 101 Ukrainian drones over Russian territory and occupied Crimea during the overnight attacks.

The drone strikes were carried out as Ukrainian leader Volodymyr Zelenskky said he is hoping to meet Donald Trump next week when he travels to the US – where he will present US President Joe Biden with a “victory plan” in relation to the war.

Meanwhile, Ukraine’s foreign minister said Russia appears to be planning strikes on Ukrainian nuclear facilities before the winter.

Posts on local Telegram channels said a Ukrainian drone attack struck an arms depot near the town of Toropets, in Russia’s Tver region – which is about 380 kilometres (240 miles) northwest of Moscow and about 500 kilometres (300 miles) from the Ukrainian border on Saturday.

Russian authorities closed a 100-kilometre (62-mile) stretch of a highway and evacuated passengers from a nearby rail station.

The depot appeared to be just miles from a Russian weapons arsenal storing missiles, bombs and ammunition in Tver that was struck by Ukrainian drones early Wednesday, injuring 13 people and also causing a huge fire.

Meanwhile, at least 1,200 people were evacuated from Russia’s southwestern Krasnodar region after an ammunition depot and missile arsenal were struck in the second drone attack overnight, the local governor has said.

Most of those evacuated were staying with friends and relatives, Veniamin Kondratyev, the governor of Krasnodar region, said on the Telegram messaging app.

There were no immediate reports of casualties in either Tver or Krasnodar.

Ukraine warning of attacks on nuclear sites

It comes as Kyiv is urging the International Atomic Energy Agency (IAEA) and Ukraine’s allies to establish permanent monitoring missions at the country’s nuclear plants as it warns they could be targeted in Russian attacks.

“In particular, it concerns open distribution devices at (nuclear power plants and) transmission substations, critical for the safe operation of nuclear energy,” foreign minister Andriy Sybiha wrote on X.

Zelenskyy prepares for US trip

Meanwhile, the Ukrainian leader has said he plans to meet Republican presidential candidate Mr Trump on either Thursday or Friday next week.

During the trip, Mr Zelenskyy will present Mr Biden with a so-called victory plan as he hopes to bring about an end to the conflict.

The Ukrainian president has said the plan will include long-range striking capabilities and other weapons long sought by Kyiv, and will serve as the basis for any future negotiation with Russia.

He is also expected to push Washington to lift restrictions on long-range missile strikes inside Russia.

Mr Zelenskyy will attend sessions of the UN Security Council and General Assembly and also plans to meet vice president Kamala Harris, the Democratic candidate in this year’s US election, in separate meetings on 26 September.

The developments come as three sources have told Reuters that Iran did not include mobile launchers with the close-range ballistic missiles that Washington has accused Tehran of delivering to Russia for use against Ukraine.

The sources – a European diplomat, a European intelligence official and a US official – said it was not clear why Iran did not supply launchers with the Fath-360 missiles, raising questions about when and if the weapons will be operational.