Latest news with #CertificateofPublicAdvantage
Yahoo
6 days ago
- Business
- Yahoo
Ballad Health's Hospital Monopoly Underperformed. Then Tennessee Lowered the Bar.
The Holston Valley Medical Center in Kingsport, Tennessee, is part of the Ballad Health hospital system. (Brett Kelman/KFF Health News) Despite years of patient complaints and quality-of-care concerns, Ballad Health — the nation's largest state-sanctioned hospital monopoly — will now be held to a lower standard by the Tennessee government, and state data that holds the monopoly accountable will be kept from the public for two years. Ballad is the only option for hospital care for most of the approximately 1.1 million people in a 29-county swath of Appalachia. Such a monopoly would normally be prohibited by federal law. But under deals negotiated with Tennessee and Virginia years ago, the monopoly is permitted if both states affirm each year that it is an overall benefit to the public. However, according to a newly renegotiated agreement between Ballad and Tennessee, the monopoly can now be considered a 'clear and convincing' benefit to the public with performance that would earn a 'D' on most A-to-F grading scales. And the monopoly can be allowed to continue even with a score that most would consider an 'F.' Six years into an Appalachia hospital monopoly, patients are fearful and furious 'It's an extreme disservice to the people of northeast Tennessee and southwest Virginia,' said Dani Cook, who has organized protests against Ballad's monopoly for years. 'We shouldn't have lowered the bar. We should be raising the bar.' The Ballad monopoly, which encompasses 20 hospitals and straddles the border of Tennessee and Virginia, was created in 2018 after lawmakers in both states, in an effort to prevent hospital closures, waived federal antitrust laws so two rival health systems could merge. Although Ballad has largely succeeded at keeping its hospitals open, staffing shortages and patient complaints have left some residents wary, afraid, or unwilling to seek care at Ballad hospitals, according to an investigation by KFF Health News published last year. In Tennessee, the Ballad monopoly is regulated through a 10-year Certificate of Public Advantage agreement, or COPA — now in its seventh year — that establishes the state's goals and a scoring rubric for hospital performance. Tennessee Department of Health documents show Ballad has fallen short of about three-fourths of the state's quality-of-care goals over the past four fiscal years. But the monopoly has been allowed to continue, at least in part, because the scoring rubric doesn't prioritize quality of care, according to the documents. Angie Odom, a county commissioner in Tennessee's Carter County, where leaders have clashed with Ballad, said she has driven her 12-year-old daughter more than 100 miles to Knoxville to avoid surgery at a Ballad hospital. After years of disappointment in Tennessee's oversight of the monopoly, Odom said she was 'not surprised' by Ballad's new grading scale. 'They've made a way that they can fail and still pass,' she said. Virginia regulates Ballad with a different agreement and scoring method, and its reviews generally track about one or two years behind Tennessee's. Both states have found Ballad to be an overall benefit in every year they've released a decision. Neither Ballad Health nor the Tennessee Department of Health, which has the most direct oversight of the monopoly, answered questions submitted in writing about the renegotiated agreement. In an emailed statement, Molly Luton, a Ballad spokesperson, said the company's quality of care has steadily improved in recent years, and she raised repeated complaints from the hospital system about KFF Health News' reporting. The news organization has reviewed every complaint from Ballad and has never found a correction or clarification to be warranted in the coverage. Tennessee Health Commissioner Ralph Alvarado, who has more than once described the regulation of Ballad Health as a matter of national importance, has declined or not responded to more than a dozen interview requests from KFF Health News to discuss the monopoly. 'Our effort and progress serve as a model for health care in Tennessee, the Appalachia Region, and the entire nation,' Alvarado said in a May news release about the monopoly, adding, 'We do not take our role lightly as we remain committed to transparency in our COPA oversight.' Tennessee's revised agreement was negotiated behind closed doors for more than a year and announced to the public in early May. As part of that announcement, Tennessee said it wouldn't score Ballad next year, to give the company time to adjust to the new scoring process. Under that process, the minimum score Ballad needs to meet to show a 'clear and convincing' public benefit has been lowered from 85 out of 100 to 70 out of 100. The new agreement also awards Ballad up to 20 points for providing Tennessee with data and records — for example, a report on patient satisfaction — regardless of the level of performance documented. The state can also raise or lower Ballad's overall score by up to 5 points in light of 'reputable information' that is not spelled out in the scoring rubric. Therefore, Ballad can score as low as 65 out of 100, with nearly a third of that score awarded for merely giving information to the state, and still be found to be a 'clear and convincing' benefit to the public, which is the highest finding Tennessee can bestow, according to the agreement. And Ballad could score as low as 55 out of 100 without the monopoly facing a risk of being broken up, according to the new agreement. The agreement also increases how much of Ballad's annual score is directly attributed to the quality of care provided in its hospitals, from 5% to 32%. But the agreement obscures how this will be measured. Tennessee sets 'baseline' goals for Ballad across dozens of quality-of-care issues — like infection rates and speed of emergency room care — and then tracks whether Ballad meets the goals. The new agreement resets these baselines to values that were not made public, leaving it unclear how much the goals for Ballad have changed. Health department spokesperson Dean Flener said the new baselines would not be disclosed until 2027. Cook, the longtime leader of protests against Ballad, said she believes Tennessee is attempting to silence data-supported criticism until the final year of the 10-year COPA agreement, which ends in 2028. By then, any outrage would be largely moot, she said. 'If you are going to wait until the last year to tell us the new measurements, why bother?' Cook said. 'It is clear, without a shadow of a doubt, that the Tennessee Department of Health is putting the needs and concerns of a corporation above the health and well-being of people.' KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Yahoo
14-05-2025
- Business
- Yahoo
TennCare change would aid Ballad's rural hospitals
JOHNSON CITY, Tenn. (WJHL) — A revenue boost that could guarantee Ballad Health's rural Tennessee hospitals stay open until at least 2028 is inching toward federal approval, but the tweak to TennCare reimbursement for hospitals isn't yet assured. RELATED: Tennessee, Ballad Health agree to changes in COPA terms The proposed change would hike TennCare hospital reimbursement rates to the average paid by commercial insurance and could net Ballad around $100 million a year. Without it, Ballad's commitment to keep its rural hospitals open — part of the 'Certificate of Public Advantage' (COPA) that governs the inpatient hospital monopoly — would end in 2026. The 2026 date is already an extension beyond the initial (2018) five-year commitment that would have lifted the restriction in 2023, and beyond a six-year pledge Ballad made a couple years ago. But it's earlier than the 2028 date the Tennessee Department of Health (TDH) wanted when it floated numerous changes to the COPA's 'Terms of Certification' early last year. 'I think that would basically wipe out what would be our annualized operating loss,' Ballad CEO Alan Levine said of the proposed change. 'Our operating loss for the first half of the year was $50 million, just about.' Hospital systems nationally are struggling in the post-COVID environment. Ballad, which has increased nursing salaries by about $200 million over the past several years, lost $34 million in fiscal 2023 and only avoided a 2024 loss thanks to a lawsuit settlement. Even with a just-released third quarter that was barely in the black ($543,338), Ballad has lost $44.9 million so far this fiscal year. 'We anticipate that the amount we would get from this state-directed payment model would probably help offset a good chunk of that $200 million (in salary increases),' Levine said. Financial reports back that up. Through the first three quarters of fiscal 2021, Ballad spent $622 million combined on salaries, contract labor and employee benefits. Through the same period of fiscal 2025 (to March 30), that total was $849 million. Kids with TennCare face major hurdles finding dentists With those realities and a TennCare reimbursement that pays about half of the cost and hadn't been increased in years, according to Levine, Ballad countered TDH's proposal last year. The system called for the state to approve an increase in the 'provider tax' on hospitals that could then be put into the TennCare program and matched 2:1 by federal funds, allowing for the reimbursement increase. 'You can't sit there and look at the state and say, 'oh, yes, by goodness, we're going to commit to keeping them open for five more years when in two years, I may have to go back to the state and say, 'I can't, I don't have the financial resources to do it.'' Levine said maintaining the area's rural hospitals was a primary reason Ballad formed in the first place through a merger of previously competing systems, Wellmont and Mountain States. Closing them, he said, would impact not just the communities they're in but the hospital system as a whole. 'We have three tertiary facilities, (Kingsport's) Holston Valley, Bristol and Johnson City Medical Center. If those rural hospitals closed, those three tertiary hospitals would get overwhelmed because you lose … access in those communities that keeps people in their community. 'If those access points are gone, you're going to end up with these three hospitals getting overwhelmed,' Levine said of the larger facilities. 'If people are concerned about wait times, they really have to be concerned about wait times if those hospitals get overwhelmed. So we have every reason, irrespective of the COPA, to keep those hospitals open.' The proposal gained state approval this year, but it also has to get two levels of approval at the federal Centers for Medicare & Medicaid Services (CMS) because TennCare is Tennessee's Medicaid program. Levine said that process is nearing completion. But Congress also has to approve the change, and the proposal has reached that stage just as Medicaid cuts are on the table during budget talks and 'wasteful spending' is on many lips in the nation's capital. The provider tax, which is used to some extent in every state save Alaska, has drawn criticism as a way for states to receive federal matching funds without expending their own money. Levine said the Tennessee request, which would increase the state's hospital provider tax to the legally allowed maximum of 6%, is a legitimate effort to address a problem for systems with high numbers of low-income and rural patients. Even if Congress changes the provider tax law, he said, it's looking like they would grandfather in existing arrangements, including the new proposal. 'I think the fact that Congress is going down that path with this bill and CMS is working with the state is a good sign,' he said. 'It shows that I think people understand the necessity for this. I think Congress has a tough job to do, and all we can advocate for is, look, we have to make sure we're making them aware of what the consequences are of whatever actions they take.' He said First District Congresswoman Diana Harshbarger helped lead a push that resulted in all nine Tennessee House members and both its senators signing a letter in support of the change. 'She's taken a lot of time to understand this, and I think one of the things that she's been doing — I don't speak for her, but what she's been doing is asking the questions and trying to make sure that whatever policies Congress implements, it doesn't harm our region.' Levine said if the change is approved, it won't be a 'windfall' for Ballad given the increased expenses from labor and the need to 'cross-subsidize' rural hospitals that consistently lose money. 'I think one thing most of your viewers would agree on is that we want to pay nurses as much money as we can to retain nurses, and that's what we've done. This is simply trying to get us back to where we're financially stable.' Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
09-05-2025
- Business
- Yahoo
Union Health responds to attorney general's merger opposition
Union Hospital on Thursday shared its response to a letter from Indiana Attorney General Todd Rokita in which the state officer opposed the proposed merger between Union Hospital and Terre Haute Regional Hospital. Union argues the merger is a critical next step to secure health care for the Wabash Valley for years to come. It says state approval — known as a Certificate of Public Advantage, or COPA — 'will help preserve and broaden local access to care, protect cost efficiency and build a healthier, more resilient future by leveraging combined resources.' Union says its response addresses the questions and claims made in the attorney general's letter. It also says it reinforces how the 45 commitments outlined in the COPA application are designed specifically to achieve Union Hospital's vision for a healthier and more resilient community. 'Since the late nineteenth century, Union Hospital and Regional Hospital have treated patients from the region each and every day,' Steve Holman, president and CEO of Union, said in an emailed statement. 'Union Hospital and Regional Hospital have a demonstrated history of being committed to doing what is best for the health and well-being of the people that call the Wabash Valley home,' Holman said. 'We believe the COPA is the next best step in our journey to care for the people of this community.' Union Hospital outlined its key points as to why the merger '… is the only way to change and enhance the trajectory of the future of health care in the area.' To wit: * The proposed merger will maintain and increase access to care. It says under the merger, Union Hospital is committed to investing at least $117 million in various services and community health programs and recruiting 30+ new primary and specialty care providers. * Union is committed to protecting cost efficiency. While the attorney general expresses concern that Union Hospital may raise its prices after the seven-year pricing limitation period ends, Union says little will change with respect to hospital prices in the community. Health insurance plans determine pricing for services for 98.4% of its patients, and the hospital is not free to set prices at any level. Federal government programs will continue to set rates for Union Hospital and commercial and Medicare Advantage plans will continue to robustly negotiate rates with Union Hospital as they do today. * Union acknowledges that concerns may exist with a reduction in competition, but these concerns are being addressed with specific commitments designed to protect the community. And without the merger, the community will be met with significant job losses, fewer services and worse health outcomes. Union's complete statement regard the attorney general's letter is available with this article on the Tribune-Star's website, The attorney general's letter also is available with this story at To view the merger application pending before the state, visit Union also invites the public to find more information on its COPA application and its and commitments at Union Hospital and Terre Haute Regional Hospital are seeking merger via state regulation rather than via Federal Trade Commission approval. Indiana is one of about 20 states that allow such a process. However, legislation (Senate Enrolled Act 119) signed this week by Gov. Mike Braun effectively closes down that method of approval in Indiana, which is by state issuance of a Certificate of Public Advantage, or COPA. Barring the COPA law being resurrected by future government action in Indianapolis, it appears the Union/Regional application will be the one and only COPA application to proceed in the Hoosier State. That application is now before the Indiana Department of Health, which must rule by mid-August. Rokita, the state's chief legal officer, argued the proposed merger presents monopoly concerns and could drive up healthcare costs and reduce access. Union maintains that without the merger, Regional's owners — HCA Healthcare — may well close the hospital on the south side of Terre Haute, costing the area 500 to 600 healthcare jobs and leaving Union Health hard pressed to replace all of the healthcare access lost.
Yahoo
07-05-2025
- Health
- Yahoo
Tennessee, Ballad Health agree to changes in COPA terms
JOHNSON CITY, Tenn. (WJHL) — Rules governing Ballad Health's state-authorized hospital monopoly have just undergone their biggest revision after more than a year of negotiations between Tennessee officials and Ballad. Homelessness increased in Northeast TN, according to 2025 PIT Count The Tennessee Department of Health released the fifth version of the 'terms of certification' today. Those cover everything from quality of care measures and access to care to capital spending, charity care, public input and how much Ballad can charge insurance companies. In a news release, the Tennessee Department of Health (TDH) said the revisions cover five key areas: prioritizing quality of care, overall system scoring, rural hospitals, charity care, and listening sessions with the public. News Channel 11 spoke to Ballad CEO Alan Levine during those negotiations. At that time, earlier this year, he said the final sticking points had more to do with language than significant differences. 'Fundamentally, we're all in agreement,' Levine said. 'We want to see access and quality of care be the guideposts for what we're doing here.' The Tennessee rural hospitals in Greeneville, Elizabethton, Rogersville, Erwin, Mountain City and Sneedville will now stay open at least two years longer than the previous commitment and four years longer if the federal government okays a statewide proposal to increase TennCare reimbursements. 'If you go to any rural community that's lost their hospital, first of all, mortality rates go up in that community,' Levine told News Channel 11 during a late January interview about the negotiations with TDH. 'The economy in that community suffers. Those are good paying jobs for that community. Access to physicians deteriorates dramatically because the hospital does support those physicians. So I think people in the rural communities are very concerned about the loss of their hospitals.' The terms of certification exist because Ballad operates under a 'Certificate of Public Advantage' (COPA) granted by the state of Tennessee, which enabled the 2018 merger of formerly competing hospital systems Wellmont and Mountain States. Because that created an inpatient hospital monopoly that the Federal Trade Commission (FTC) opposed, the parties had to seek what's called 'state action immunity' from both Tennessee and Virginia to avoid facing an FTC lawsuit. 'For more than a year we have worked with the Tennessee Attorney General's Office and Ballad Health to ensure the COPA continues to provide a public benefit in meeting Northeast Tennessee's health needs,' TDH Commissioner Dr. Ralph Alvarado said in a news release. 'Our effort and progress serve as a model for health care in Tennessee, the Appalachia Region, and the entire nation. It is vitally important we get it right.' TDH will prepare a narrative review for the assessment of Ballad's performance through the end of the company's 2025 fiscal year June 30, the release said. This is to allow Ballad time to implement the new, numerical COPA performance scoring process for the 2026 Fiscal Year, beginning on July 1. In a statement released immediately after the TDH release, Ballad called the changes 'thoughtful and reasonable.' 'Our goals are the same,' Ballad's release reads. 'At a time when 150 rural hospitals have closed throughout the nation, and 700 more have been identified as being in danger of closure, keeping rural hospitals open for our communities is at the core of why the COPA was created. Access to high quality care is a goal everyone shares.' This is a developing story. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. For the latest news, weather, sports, and streaming video, head to WJHL | Tri-Cities News & Weather.
Yahoo
02-05-2025
- Health
- Yahoo
Local residents voice opinion on hospital merger
TERRE HAUTE, Ind. (WTWO/WAWV) — The Indiana Department of Health held a town hall meeting regarding Union Health's proposed acquisition of Terre Haute Regional Hospital. Since the 2025 Certificate of Public Advantage was successfully submitted, the topic has been argued by many in the area. Local officials took the microphone first, including Terre Haute Mayor Brandon Sakbun. He admitted, in the early stages, he was against the acquisition but now supports it. 'Based off of that data, based off of those numbers, and based off of the unfortunate reality that my options are to support a decision to keep jobs here or to not support and have a chance of jobs leaving', Sakbun said. 'I have to advocate for jobs in our community.' Employees of both hospitals shared their experiences from the inside. One resident said she has worked at both places and is worried about a healthcare monopoly. 'As I have personally discussed this topic with hundreds of citizens, it is very clear that a healthcare monopoly is not the answer for our community. The facts in the COPA history speak for themselves and many of our community citizens are against this hospital merger. Both hospitals have had many years to prove their quality of care and have failed. Our community can do better.' One Terre Haute Regional Hospital employee said she is worried about COPA's, as many fail a few years down the road. 'While they are being monitored for the first few years, as policy from the government, results were okay. Once that timeline is gone, which is supposed to be five years but many times the monitoring stops sooner, a decline begins to take place. Quality of care goes down, employee wages decrease, while medical costs increase.' A separate employee of Terre Haute Regional Hospital said she is indifferent on the issue, but a decision needs to be made for the health of both patients and employees. 'The people that are at Terre Haute Regional Hospital are doing their jobs, but they are upset about what is going on. We have done this for 19 months. If we are going to do it then let's do it. If we are not going to do it, then we're not going to do it. It has been too long.' The Certificate of Public Advantage is currently still under review by the state. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
