Virtual public hearing on Ballad Health, COPA yields just one citizen speaker


JOHNSON CITY, Tenn. (WJHL) – In sharp contrast with the previous two years, the 2021 public hearing of the COPA Local Advisory Council (LAC) was a quiet event, with just one speaker.

Dan Pohlgeers, himself a former LAC member, offered several criticisms in a brief comment period during the meeting, which was in virtual format due to COVID-19.

The verdict from Pohlgeers? Lacking any oversight authority, the LAC is rendered somewhat ineffective and TDH and/or the Tennessee legislature should consider revising its structure.

“I would really like to think that if (TDH) won’t work on this to make the COPA Local Advisory Council more relevant, that the General Assembly would,” Pohlgeers said.

He also briefly commented on concerns regarding what he called a lack of transparency about Ballad’s staff reductions post-COVID, penalties related to readmissions and hospital-acquired infections levied by the agency that runs Medicare, and questions about physician recruitment and retention.

Judi Knecht, who helps oversee the COPA (Certificate of Public Advantage) for the Tennessee Department of Health (TDH), hosted the meeting. She spoke briefly on Ballad’s annual report to TDH, as did COPA monitor Larry Fitzgerald.

Both said Ballad’s 2020 annual report — while only covering eight months of the July 2019-June 2020 period due to the pandemic — was an improvement on last year’s in terms of clarity and focus.

Knecht said changes made at the urging of TDH were “successful in producing a high quality work product for the public and for the states as active supervisors,” Knecht said.

(Her reference to “active supervision” is referenced later in this article.)

Ballad performed better than its baseline in 13 of 17 “quality target measures” that affect its annual COPA score from the Tennessee Department of Health.

Knecht noted that Ballad improved over its baseline in the majority of the COPA’s 17 “target quality measures.” Its score from TDH will be affected by worse scores than the previous year, which she said were small, in pressure ulcer rates, colon surgical site infection, hysterectomy surgical site infection and MRSA (methycillin resistant staph infection) rates.

COPA monitor Larry Fitzgerald said pages 53-55 of Ballad’s annual report (Appendix 2) contains the most useful information for the public

Fitzgerald said while the 2019 report “was a lot of data and a very small amount of information,” the state worked with Ballad to change the 2020 format and he was pleased with those changes.

“I think this report provides a lot more information as opposed to just a big data dump,” Fitzgerald said.

Ballad’s fiscal 2020 performance in 17 of 20 inpatient-related quality monitoring measures — which don’t count toward its score like target quality measures do — were worse than the previous year’s performance.

He added that quality measures are the key, and noted they can be found — with comparisons to peer system, top 10 percent rates and national averages — in Appendix 2 of the report.

“If a health system can exhibit very high quality numbers everything else takes of itself,” said Fitzgerald, who was CFO for the University of Virginia health system. “The finances, the patient satisfaction, the physician satisfaction, it really doesn’t matter. If the quality numbers are very, very high everything takes care of itself.” 

Ballad is subject to strong oversight from TDH and the Virginia Department of Health because both bodies had to approve its creation from the merger of Wellmont Health System and Mountain States Health Alliance.

That merger, finalized in 2018, essentially gave the hospital system monopoly power over hospital inpatient services stretching across a large area of close to 1 million people in Northeast Tennessee and Southwest Virginia.

It required what’s called “state action immunity” — the states accepting that the planned merger’s benefits would outweigh the disadvantages caused by reduction in competition. The Federal Trade Commission strongly opposed the merger’s approval, arguing the creation of Ballad would harm consumers.

Once the state action immunity — essentially “immunizing” Ballad from standard federal antitrust action — the states remained responsible for what is known as “active supervison” of Ballad.

The states are charged with ensuring Ballad meets its commitments and that its operations continue to provide more benefit to consumers and the community than otherwise would have occurred.

Among such a complex mandate, the LAC’s role is much more limited. It’s to determine how any penalty fines Ballad is charged (none so far) should be spent to improve community health, and to conduct the annual hearing.

The nine-member council meets quarterly. Last year’s chairman, former Kingsport mayor Dennis Phillips, has also lamented the lack of clarity about the LAC’s role and the difficulty members of the public have understanding how limited the comments at the annual public hearing are supposed to be.

State Rep. David Hawk (R-Greeneville) is an LAC member. He acknowledged following Monday’s hearing that has been frustrated about the LAC’s role and about the perception of its role.

“The LAC is referred to as an oversight board, but it has no oversight capability,” Hawk said. “The LAC currently exists as a conduit to hear COPA-related concerns expressed by citizens of our region and then relay those concerns to (TDH).”

In many cases, those comments the past two years have been outside the scope of the LAC, council members have said.

Asked whether he would support a closer look at the council’s structure by the legislature, Hawk said this:

“The formation of Ballad Health has been an extremely emotional issue for both its supporters and its detractors. (TDH_ is tasked with having unbiased oversight of Ballad Health at this time.

“If (TDH) oversight becomes jaded in one direction or the other, then we should move toward legislation to improve oversight.”

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