Hospital monopoly in Appalachia doesn't meet benchmarks; some residents say they're scared to seek care

Ballad Health's Indian Path Community Hospital has an
average ER wait time of 43 minutes. (Ballad Health photo)

The lack of choices for hospitals in parts of northeastern Tennessee and southwestern Virginia has left some residents fearful of getting care at its facilities, but hospital officials deny many patient complaints and tie their quality of care troubles to Covid-19 and nursing shortages, reports Brett Kelman of KFF Health News. "Ballad Health is the only option for hospital care in a large swath of Appalachia. . . .Lawmakers in both states "waived federal antitrust laws so two rival health systems could merge," which made Ballad Health the "largest state-sanctioned hospital monopoly in the nation."

Six years ago, lawmakers allowed the merger to prevent more hospital closures. To than end, Ballad Health has kept most of its facilities open; however, the system has "fallen short of about three-fourths of the quality-of-care goals set by the states over the last three fiscal years," Kelman explains. Those shortcomings include "failing to meet state benchmarks on infections, mortality, emergency room speed, and patient satisfaction."

Ballad's lack of consistent care has left "residents wary, afraid, or unwilling to seek care at Ballad hospitals. . according to written complaints to the Tennessee government and state lawmakers, public hearing testimony, and KFF Health News interviews," Kelman reports. "Many of those who submitted complaints or were interviewed allege that paper-thin staffing at Ballad hospitals and ERs is the root cause of the monopoly’s quality-of-care woes."

Ballad Health CEO Alan Levine defended the system's record and "said the hospitals are rapidly recovering from a quality-of-care slump caused by Covid-19 and a subsequent rise in nursing turnover and staff shortages," Kelman adds. "These issues affected hospitals nationwide, Levine said, and were not related to the Ballad merger or the monopoly it created."

Local government officials from Tennessee joined Levine during his KFF Health News interview. "As Levine spoke in a boardroom at Ballad’s hilltop headquarters, he was flanked by three local mayors who voiced support for the hospitals and said complaints came from a vocal minority of their constituents," Kelman reports.

But not every government entity echoes that support. Kelman explains, "The Tennessee Department of Health, which has the most direct oversight over Ballad Health. . . has attempted to hold Ballad more accountable for its quality of care in closed-door negotiations." The TDH declined all of KFF's requests to discuss Ballad's record.

Given the system's long list of woes, some residents wish the merger had been rejected. "Joe Macione, who for years was on the board of Wellmont Health System, one of the rival companies that became Ballad, once publicly advocated for the merger. . . . Macione said state leaders should have admitted years ago that the monopoly was a mistake," Kelman reports. Macione told him, "It has not worked."