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How a leg infection and a meeting of the hole-in-the-wall gang led to one of the largest hospital systems in the country

Nathan Baker • Updated Sep 23, 2017 at 11:01 PM

Bill Greene showed up at the Johnson City Press’ offices in August 2014 unscheduled, with a tie on and a folder under his arm.

He asked to speak to news editors and a business reporter about what he said was the “biggest story in the Tri-Cities,” maybe ever.

He handed a thick packet from the folder to editorial staff. In it were his planned remarks at a public forum scheduled in Kingsport, written in large type for easy reading. On the two-dozen pages, Greene laid out a proposal to merge the region’s two health care systems, which, for decades, had been locked in fierce and sometimes expensive competition.

“I’ll never forget, you all looked at me like I was on drugs,” he said last week, a few days after Mountain States Health Alliance and Wellmont Health System received approval from the Tennessee Commissioner of Health and Attorney General to merge. “I left the office that day, and I thought, ‘They don’t think this is the biggest story, the biggest economic engine in the region.’ As time passed, you all began to come around on it.”

The story of the multi-billion dollar merger started months before, when Greene was undergoing 10 days of treatment at a Johnson City hospital for an especially painful case of cellulitis in his leg.

Greene’s cardiologist came to visit him in the hospital as a friend, but when Greene asked him to take a look at his chart to make sure everything was in order, the physician said he couldn’t.

The cardiologist was a Wellmont-affiliated physician, and Greene was being treated in a Mountain States hospital. Strict rules prevented the doctor from the competing system from looking over the work of the Mountain States doctors without prior written approval from the patient.

“We live in the same region,” Greene said “This isn’t Friday night football. He can’t look at my chart because the hospitals are across the street from each other.

“So, I spent a couple of days in hospital thinking ‘This needs to change.’ ”

After recovering, Greene said he mentioned the problem to Mountain States CEO Alan Levine at a golf outing in Banner Elk, North Carolina.

At the beginning of the year, Wellmont’s board of directors announced it was searching for a “strategic partner,” likely a buyer, and both men were concerned what the arrival of an outside health system would mean for the region.

Levine said he’d seen it happen before — he’d been on the acquiring end before — new out-of-state systems generally swoop in, buy regional systems and siphon patients and resources out of communities while cutting thousands of administrative jobs.

Facing a larger, multi-state competitor would likely drive Mountain States to sell as well, bringing another health organization with no sense of the region’s history into the area and erasing most of the local control of health care.

Levine told Greene there were three options: do nothing and lose Wellmont and maybe Mountain States; try for a straight merger, which would likely be challenged by the Federal Trade Commission and face the agency’s 70 percent success rate for antitrust actions; or enter into a certificate of public advantage, or COPA, agreement, a so-far unused state mechanism that put price and competitive controls in place and shielded health system mergers from FTC scrutiny.

Greene said he pondered the COPA option for a while, did some research on it and then called a meeting of what he called the “hole-in-the-wall gang,” a group of about 15 business, education and community leaders that managed some 65 percent of the Tri-Cities workforce.

The group isn’t especially secretive, but it’s not a public forum either.

Greene listed a handful of people instrumental to the hole-in-the-wall gang’s COPA campaign: East Tennessee State University President Brian Noland; Scott Niswonger, founder of Greeneville’s Landair Transport, Inc. and board of directors member of First Horizon National Corp. and First Tennessee Bank National Association; David Golden, senior vice president, chief legal and sustainability officer, and corporate secretary for Eastman; John Tickle, chairman of the board of Bristol, Virginia, manufacturer Strongwell Corp.; and Roy Harmon, chairman and CEO of Bank of Tennessee. Greene is chairman of BancTenn Corp., which owns Bank of Tennessee, Carter County Bank and Mountain Community Bank.

“We sat there for four or five hours and debated whether this issue was worth going after,” Greene recollected. “Alan was there, and he explained what it was all about and went over the financials of Mountain States, and eventually, we decided, ‘Hey, this is worth taking on.’ ”

Greene first visited Wellmont’s board to push for the merger, but didn’t feel like he and the gang were making much progress.

They next decided to make a public plea, booking Kingsport’s Center for Higher Education for a panel and prompting the impromptu meeting at the Press.

The group put up a website at saveyourhospitals.com, but didn’t advertise the event other than the visits to local media. The audience for the panel filled the auditorium in which it was held.

“That was the night the world changed,” Greene said. “The public was aware that they were going to lose Wellmont. It shocked the board, but they figured it out.

“Over a very short period of time, the board said, ‘Wait a minute, maybe there is something to this.’ Now we had the Wellmont board thinking, ‘This might make some sense,’ and Alan was leading the charge. It looked like it was becoming real.”

Over the next nine months, Greene and other hole-in-the-wall gang members met with Mountain States’ and Wellmont’s boards to discuss the merger proposal. He credited the systems’ board members and CEOs: Levine at Mountain States and Bart Hove at Wellmont as being “smart as hell” and realizing the merger was the best option for the region and its people.

In April 2015, the two health nonprofits signed an agreement to pursue agreements with Tennessee and Virginia allowing the merger.

The process was in the hands of attorneys and health system leaders, but the hole-in-the-wall gang remained active advocates of the merger.

Levine said the merger was not possible without the support of Greene and the other leaders from the community.

Attorney General Herbert Slatery told Levine he was inspired by the amount of local support for the merger.

“These are the people who are paying the bills,” Levine said. “They’re employing the people and buying the insurance and paying for the health care bills. It’s really unprecedented to see a merger like this with the amount of support from the business community we had.

“I give Bill Greene a lot of credit. There was nothing in it for him other than he was a man born here, he grew up here and he was concerned about the stability of the region. He didn’t want to see the local systems acquired by outside systems.”

Niswonger said Greene was “right on point” when he unified the Tri-Cities business community behind the merger idea.

“He was this was going to have to be a regional effort, we were all going to have to agree on this to convince the state it was really in the best interest of upper East Tennessee, its residents and children. I’ve been in the region for 45 years, and I have never seen a larger economic development opportunity in our region than this one.”

Noland said the hole-in-the-wall gang was really more of a loose coalition of people concerned with the well-being of the region.

Had Wellmont sold to an outside system, then Mountain States, ETSU could have lost its residency positions in area hospitals, important tools medical colleges use to recruit new students.

“We all kept focusing on the public good,” Noland said. “That’s what helped keep up the momentum.

“As I look back on what has transpired and look at the work to come, I see a great opportunity in front of us to put aside the competition and look at things truly as a region.”

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