Protesters gather in opposition to the closure of the neonatal intensive care unit at Holston Valley Medical Center, a Ballad Health hospital, in 2019. (Photo: Dani Cook)
Tennessee’s health department will hold its annual public hearing on Ballad Health’s state-sanctioned monopoly agreement as the hospital faces a new round of eroding public support.
The hearing — scheduled for July 18 from 5 to 8 p.m. at Northeast State Community College in Blountville — is the public’s latest opportunity to comment on the Tri-Cities region hospital monopoly created by Tennessee and Virginia lawmakers in 2018 through a law known as the Certificate of Public Advantage, or COPA.
Ballad, formed from the merger of Mountain States Health Alliance and Wellmont Health System, is a 20-hospital system headquartered in Johnson City, Tenn. It’s the only hospital choice for over a million residents in a 29-county region that spans Tennessee, Virginia, Kentucky, and North Carolina.
In the six years since lawmakers bypassed anti-monopoly laws to allow the hospital system to exist, ER wait times for patients sick enough to be hospitalized have grown more than three times as long and now far exceed the criteria set by state officials, according to an investigation by KFF News into the dangers of hospital monopolies published over the past year.
These Appalachia hospitals made big promises to gain a monopoly. They’re failing to deliver.
The investigation also found Ballad failed to meet 80% of the benchmarks designed to improve quality care and has yet to fulfill nearly $148 million in charity obligations agreed to as part of the COPA agreement with lawmakers.
As ER times and quality of care have worsened, Ballad has also closed, shrunk, or removed many of the emergency, intensive, and other health care services at several of the hospitals it runs as it tries to consolidate services at its flagship facility.
“It’s a symptom of bad choices Ballad Health and its CEO, Alan Levine, have made,” said Rep. David Hawk, a Greeneville Republican and frequent critic of the hospital.
“After these hearings, they never accept that they may need to do better,” Hawk added. “Ballad is essentially run with very few checks and balances.”
When Ballad formed, the company’s leadership sold it to the public as a way to prevent hospital closures and keep local control over the system. But over the years, the hospital has closed many facilities while increasing its revenue, profits, and compensation for employees like Levine.
Ballad Health turned a combined profit of $206 million in 2021 and 2022, according to an independent analysis from S&P Global Ratings. Levine made $4.3 million in the last year reported by the hospital, doubling his salary as head of Mountain States Health Alliance before the merger.
The consolidation of hospital services is not unique to Ballad. A similar situation is happening in rural West Tennessee, as nonprofit rural hospital systems believe the best way for them to remain financially viable is through consolidation and service cuts.
Ballad officials have contended that the merger likely prevented even more closures and stopped a for-profit hospital system from entering the market, further degrading health care services.
Levine has deep ties to top Republican politicians across several states. He served on health care transition teams for Virginia Gov. Glenn Youngkin and Florida Govs. Ron DeSantis, Rick Scott, and Jeb Bush.
Gov. Bill Lee appointed Levine to the Tennessee Charter School Commission. Since 2018, Levine, his wife, and Ballad’s political action committee have donated $85,500 to Lee and his inaugural fund.
But Ballad’s initial approval predates Lee.
State Sen. Rusty Crowe, a Johnson City Republican, sponsored and helped navigate the COPA agreement through the Tennessee General Assembly as chairman of the Senate’s Health and Welfare Committee.
At the same time, Crowe was a contractor with Mountain States Health Alliance and has continued to report Ballad Health as an income source on his disclosure statement. Tennessee law doesn’t require officials to report the amount of income received.
Overall, COPAs are rare, with only 10 in existence, according to information collected by The Source on Healthcare Price & Competition, a website by the University of California College of the Law-San Francisco.
In Tennessee, Ballad’s agreement has created a vacuum, as officials in the Health Department and Attorney General’s Office can’t agree on who regulates the hospital system.
When asked who was enforcing the obligations in the COPA agreement, Tennessee Department of Health spokesperson Dean Flener told KFF News that it was the Attorney General’s Office’s responsibility. But Amy Wilhite, a spokesperson for the AG’s office, provided the news organization with documentation that it was the Health Department’s responsibility.
The Lookout contacted a Health Department spokesperson but had not heard back by the time of publication. A Ballad Health spokesperson declined an interview request.
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by Adam Friedman, Tennessee Lookout
July 1, 2024
by Adam Friedman, Tennessee Lookout
July 1, 2024
Tennessee’s health department will hold its annual public hearing on Ballad Health’s state-sanctioned monopoly agreement as the hospital faces a new round of eroding public support.
The hearing — scheduled for July 18 from 5 to 8 p.m. at Northeast State Community College in Blountville — is the public’s latest opportunity to comment on the Tri-Cities region hospital monopoly created by Tennessee and Virginia lawmakers in 2018 through a law known as the Certificate of Public Advantage, or COPA.
Ballad, formed from the merger of Mountain States Health Alliance and Wellmont Health System, is a 20-hospital system headquartered in Johnson City, Tenn. It’s the only hospital choice for over a million residents in a 29-county region that spans Tennessee, Virginia, Kentucky, and North Carolina.
In the six years since lawmakers bypassed anti-monopoly laws to allow the hospital system to exist, ER wait times for patients sick enough to be hospitalized have grown more than three times as long and now far exceed the criteria set by state officials, according to an investigation by KFF News into the dangers of hospital monopolies published over the past year.
These Appalachia hospitals made big promises to gain a monopoly. They’re failing to deliver.
The investigation also found Ballad failed to meet 80% of the benchmarks designed to improve quality care and has yet to fulfill nearly $148 million in charity obligations agreed to as part of the COPA agreement with lawmakers.
As ER times and quality of care have worsened, Ballad has also closed, shrunk, or removed many of the emergency, intensive, and other health care services at several of the hospitals it runs as it tries to consolidate services at its flagship facility.
“It’s a symptom of bad choices Ballad Health and its CEO, Alan Levine, have made,” said Rep. David Hawk, a Greeneville Republican and frequent critic of the hospital.
“After these hearings, they never accept that they may need to do better,” Hawk added. “Ballad is essentially run with very few checks and balances.”
When Ballad formed, the company’s leadership sold it to the public as a way to prevent hospital closures and keep local control over the system. But over the years, the hospital has closed many facilities while increasing its revenue, profits, and compensation for employees like Levine.
Ballad Health turned a combined profit of $206 million in 2021 and 2022, according to an independent analysis from S&P Global Ratings. Levine made $4.3 million in the last year reported by the hospital, doubling his salary as head of Mountain States Health Alliance before the merger.
The consolidation of hospital services is not unique to Ballad. A similar situation is happening in rural West Tennessee, as nonprofit rural hospital systems believe the best way for them to remain financially viable is through consolidation and service cuts.
Ballad officials have contended that the merger likely prevented even more closures and stopped a for-profit hospital system from entering the market, further degrading health care services.
Levine has deep ties to top Republican politicians across several states. He served on health care transition teams for Virginia Gov. Glenn Youngkin and Florida Govs. Ron DeSantis, Rick Scott, and Jeb Bush.
Gov. Bill Lee appointed Levine to the Tennessee Charter School Commission. Since 2018, Levine, his wife, and Ballad’s political action committee have donated $85,500 to Lee and his inaugural fund.
But Ballad’s initial approval predates Lee.
State Sen. Rusty Crowe, a Johnson City Republican, sponsored and helped navigate the COPA agreement through the Tennessee General Assembly as chairman of the Senate’s Health and Welfare Committee.
At the same time, Crowe was a contractor with Mountain States Health Alliance and has continued to report Ballad Health as an income source on his disclosure statement. Tennessee law doesn’t require officials to report the amount of income received.
Overall, COPAs are rare, with only 10 in existence, according to information collected by The Source on Healthcare Price & Competition, a website by the University of California College of the Law-San Francisco.
In Tennessee, Ballad’s agreement has created a vacuum, as officials in the Health Department and Attorney General’s Office can’t agree on who regulates the hospital system.
When asked who was enforcing the obligations in the COPA agreement, Tennessee Department of Health spokesperson Dean Flener told KFF News that it was the Attorney General’s Office’s responsibility. But Amy Wilhite, a spokesperson for the AG’s office, provided the news organization with documentation that it was the Health Department’s responsibility.
The Lookout contacted a Health Department spokesperson but had not heard back by the time of publication. A Ballad Health spokesperson declined an interview request.
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Tennessee Lookout is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Tennessee Lookout maintains editorial independence. Contact Editor Holly McCall for questions: info@tennesseelookout.com. Follow Tennessee Lookout on Facebook and X.
Our stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our website. AP and Getty images may not be republished. Please see our republishing guidelines for use of any other photos and graphics.
Adam Friedman is a reporter with the Tennessee Lookout. He has a particular love for data and using numbers to explain all kinds of topics. If you have a story idea, he’d love to hear it. Email him at [email protected] or call him at 615-249-8509.
Tennessee Lookout is part of States Newsroom, the nation’s largest state-focused nonprofit news organization.
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© Tennessee Lookout, 2024
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Now more than ever, tough and fair journalism is important. The Tennessee Lookout is your watchdog, telling the stories of politics and policy that affect the people of the Volunteer State.
We’re part of States Newsroom, the nation’s largest state-focused nonprofit news organization.
Our stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our website.
© Tennessee Lookout, 2024
