Advisory council recommends COPA monitor look into Ballad Health price increases, staffing changes

Zach Vance • Mar 11, 2019 at 7:48 PM

The Certificate of Public Advantage (COPA) Local Advisory Council’s 2019 Annual Report, released last week, contains six recommendations for the monitor of the Ballad Health merger to investigate based on public submissions and comments made during a fiery public hearing last month.

As part of the supervision structure of the merger, the Local Advisory Council is tasked with facilitating input, both positive and negative, from residents impacted by the Ballad Health merger to the state and COPA Monitor Larry Fitzgerald. 

The council is required to host four meetings each fiscal year, plus a public hearing, which was held at Northeast State Community College on Feb. 7.  The council’s first report is based on nearly 200 submitted comments, as well as comments made by the roughly 40 people who spoke at that public hearing. 

“Only comments in opposition to Ballad, to Ballad’s consolidation plans, or to the COPA, were voiced (during the public hearing). Those with positive comments about the merger told (Local Advisory Council) members later that they were fearful to express their opinions in front of the highly charged crowd,” the report states. 

Moving forward, Local Advisory Council Chairman Doug Varney wrote that his group will work to develop a comprehensive public input process to “illicit a more diverse set of perspectives and to ensure everyone has an opportunity to be heard and provide feedback in a productive and constructive way.”

“We appreciate the work the local advisory committee has undertaken to synthesize public comments and review our annual report, which covers the first 5 months of our merger,” Ballad Health said in a response. “The state has a process in place to follow up on the (council) recommendations and confirm the accuracy of the public comment received. We are very proud of the improvements in quality and access our team members and physicians have made in a short period of time, and we trust that the state’s process will demonstrate the continued public benefit of the merger.”

The council’s first recommendation for Fitzgerald was to consider reviewing Ballad’s billing records to confirm it accurately reported any global price increases in its 2018 annual report, which was released in November.

This suggestion, according to the report, comes from citizens reporting price increases for a variety of conditions and services, but according to Ballad’s annual report, covering Feb. 1, 2018, to June 30, 2018, there was no across-the-board or “global” price increase. 

However, before the merger occurred, the report notes Mountain States Health Alliance implemented a 5 percent “global” price increase that excluded Critical Access Hospitals and Physician Clinics during the 2018 fiscal year. During that same period, Wellmont Health System did not institute a global price increase. 

Four of the six other recommendations directly relate to concerns or complaints raised about employees of Ballad Health pertaining to their pay, benefits, raises, training and retention of physicians. 

Those recommendations suggests Fitzgerald:

• Review Ballad’s records to evaluate whether changes in employee pay and benefits comply with the Terms of Certification governing the merger. 

• Consider asking Ballad for information concerning the departure of full-time employees and the total number of new hires between February 2018 and June 2018.

• Review the pay equalization process for “reasonableness.”  

• Compare physician retention levels at Ballad Health hospitals pre-merger and post-merger.

Fitzgerald was also asked to determine whether the proposed downgrade of Bristol Regional Medical Center’s trauma center and the relocation of the Wellmont Cancer Center complies with the Terms of Certification. 

The nine-member advisory council did commend Ballad’s efforts in creating an Accountable Care Community, a collaborative group of stakeholders spanning its 21-county service area who work to find ways to improve overall health. 

Among the seven other recommendations made to the Tennessee Department of Health, the council advises the state take an active role in supporting the efforts of the Accountable Care Community. 

The council also proposes the Department of Health refine how Ballad Health is scored based on its population health plan. 

“The number of measures in the population health plan may be too broad and too numerous for Ballad to be successful and for funding to be effective,” the report states. 

Improving communication between Ballad and the public regarding future changes was also encouraged in the report. 

“Based on feedback from the (Local Advisory Council’s) public hearing, residents and stakeholders do not believe Ballad Health is listening to them,” the report states. 

“Consider encouraging Ballad to engage local stakeholders and the community in a public input process before finalizing and rolling out plans going forward and to revisit their current communication strategy.”

The council’s members include Chairman Doug Varney, former commissioner of the Tennessee Department of Mental Health and Substance Abuse Services; state Rep. David Hawk, R-Greeneville; Gary Mayes, director of the Sullivan County Health Department; Dr. Jerry Miller, founder of Holston Medical Group; former Kingsport Mayor Dennis Phillips; Dr. Brenda White Wright, former CEO of Girls Inc. in Kingsport; Dr. Linda Latimer of East Tennessee State University’s board of trustees; medical administrator and consultant Dan Pohlgeers; and Dr. Karen Shelton, director of the Virginia Department of Health’s Mount Rogers Health District.

To read the full report, visit www.tn.gov/content/dam/tn/health/documents/copa/LAC_REPORT_2019.03.07.pdf



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