In Bristol, Virginia, a small city in the Appalachian Mountains, City Councilman Neil Osborne left a meeting on the morning of January 3 and rushed to the hospital.
Osbourne, 36, has type 1 diabetes. When her insulin pump malfunctioned, depriving her of a steady supply of this essential hormone, Ms. Osborn's blood sugar levels spiked and her body began to fail.
Osborn went to the nearest hospital, Bristol Regional Medical Center. He said he settled into his wheelchair in the emergency room waiting room and spent the next several hours in and out of consciousness, vomiting, bile, and coughing up blood. After spending 12 hours in the waiting room, he was transferred to an ER bed, where he remained until he was sent to the intensive care unit the next day, Osborn said. In total, the deputy was in the ER for about 30 hours.
Osborne said his ordeal reflects the stories he has heard from constituents over the years. When Mr Osborne's next crisis comes, he plans to leave Bristol to go to an emergency hospital about two hours away, he said.
“I want to go to Knoxville or Roanoke because I don't want to risk my life anymore and die in a hospital in Ballard,” he said. “The wait time to get into the ER and see a doctor has increased exponentially.”
Ballad Health, a 20-hospital system in the Tri-City region of Tennessee and Virginia, benefits from the nation's largest state-chartered hospital monopoly. Ballard's report found that in the six years since Ballard was founded after legislators in both states waived antitrust laws, the length of emergency room visits for patients sick enough to be hospitalized has more than tripled; That far exceeds the standards set by state authorities. Announced by the Tennessee Department of Health.
So far, Tennessee and Virginia have not announced any measures to reduce the length of time spent in the Ballard ER. The Tennessee Department of Health, which has a more direct role in regulating Ballad, releases a report each year that finds the agreements that gave Ballad monopoly “continue to serve the public interest.” Department officials twice declined to comment to KFF Health News about Ballard's performance.
According to Ballard's latest annual report released this month (covering the period July 2022 to June 2023), the median time patients spend in Ballard's ER before being admitted is nearly 11 hours. There is. This statistic includes both wait time and treatment time in the ER and excludes patients who were not admitted or who left her ER without receiving treatment.
The federal government used to track ER speeds the same way. When compared to the latest corresponding federal data from 2019, which includes more than 4,000 hospitals, Ballad ranks among the 100 hospitals with the slowest ERs. More up-to-date federal data is not available because the Centers for Medicare and Medicaid Services retired this statistic in 2020 in favor of other measurements.
The new data shows the same thing. The Joint Commission, a nonprofit organization that accredits healthcare organizations, collected the same measurements in 2022 from about 250 hospitals that provided data and found that the median ER speed was 5 hours and 41 minutes. I understand. That's about five hours faster than Ballard's most recent annual report.
Ballad Health spokeswoman Molly Luton said in an emailed statement that Ballad avoids “overwhelming” staff by admitting patients to the ER and observing them while waiting for a bed. . Luton said ER delays are also being caused by two national crises, she said. A shortage of nurses and a decline in admissions at nursing homes and similar facilities could lead to a backlog of patients waiting to be discharged.
Luton added that in the months since Ballard's most recent annual report, inpatient emergency room time has decreased to about 7 1/2 hours.
“With respect to these issues that Ballard Health has direct control over, our performance has rebounded since 2022 and is now among the best in the nation,” Luton said.
Luton also noted that Ballard performs better than or close to national averages on several other measures of ER performance, including fewer patients being discharged without treatment. also mentioned. The national average is about 3%, according to CMS data. Ballad reported 1.4% in its latest annual report.
Bristol City Councilor Mr Osborne claimed the statistics were due to Ballard's monopoly.
“Just because they're not out of the ER doesn't mean they're happy where they are,” he says. “It means they have no other place to be.”
Ballad monopoly
Ballard Health was formed in 2018 after state regulators approved the nation's largest hospital merger under a so-called Certificate of Public Interest (COPA) agreement. He said COPA has been used in about 10 hospital mergers over the past 30 years, but none have involved as many hospitals as Ballad.
Tennessee and Virginia state legislatures waived federal antitrust laws to allow competing hospital systems Mountain States Health Alliance and Wellmont Health System to merge into a single, non-competitive company. Currently, Ballard is the only option for hospital care for most of the approximately 1.1 million residents in the 29-county region of Tennessee, Virginia, Kentucky and North Carolina.
The Federal Trade Commission has warned that hospital monopolies lead to higher prices and lower quality of care. To offset the risk of Ballard's monopoly, officials required the new company to abide by a long list of special conditions, including dozens of quality care metrics detailed with specific benchmarks.
In its most recent annual report, Ballard improved many health care quality metrics year-over-year, including some of the company's priorities, but still missed 56 of 75 benchmarks. there were.
Inpatient emergency hours are one of them. In his original COPA agreement, the benchmark was set at 3 hours and 47 minutes. According to Ballard's annual report, the company has met or nearly met that goal for three years. After that, the paramedics slowed down.
In 2022, Ballad reported that the median inpatient ER time was approximately 6 hours.
In 2023, the same statistics were reported at 7 hours and 40 minutes.
In the latest report, inpatient emergency care time reached 10 hours and 45 minutes.
CMS, which rates thousands of hospitals across the country, says on its website that timely ER care is “essential to good patient outcomes” and that longer time spent in the ER increases the incidence of complications. It warns that this is associated with higher levels of cancer and delays in patients receiving painkillers and antibiotics. .
Ben Harder, head of health analysis at U.S. News & World Report, said longer ER times could be a sign of slowdown throughout the hospital, including the operating room.
“Significant delays in admitting patients is a risk in and of itself in that testing may not be performed quickly,” Harder said. “But this shows that the hospital is backed up and there are problems moving patients from one ward to another.”
Bill Christian, a spokesman for the Tennessee Department of Health, said the increase in Ballard's emergency time was “noted” but would not say whether the agency had taken or was considering any action. I didn't. Christian directed questions about Ballard's latest statistics to the company itself.
“A nightmare for community members”
Ballard also waived its obligation to the state of Tennessee to provide charity care, which provides free or discounted care to low-income patients, for approximately $191 million over the past five years, according to Department of Health documents and Ballard's latest report. It's less than a million dollars. The health department has waived this requirement in each of the past four fiscal years. Mr. Barad said he would request more this year.
In a two-hour interview last year, Ballard CEO Alan Levin defended his company and said the COPA merger would result in at least three He said there is a high possibility that the hospital closure could have been prevented. Levine blames Ballard's failure to meet quality standards on pressures from the coronavirus pandemic, and the charity care shortage is partially caused by Medicaid changes outside of Ballad's control. said.
“Our critics say, “We don't need ballads.'' We don't need ballads.'' Well, what do we do then?'' Mr. Levin said. “Because the hospital was closing down.”
Some residents see Ballad as a savior. John King, who runs a physical therapy clinic in the heart of the Ballard area, told a public hearing last June that during multiple visits to Ballard's emergency room, including one for a stroke, the care he received was poor. He said he felt they were prompt and considerate.
“If it wasn't for Ballard Health, I literally wouldn't be here today,” King said, according to the hearing transcript. Ballard's failure to fulfill the terms of the COPA agreement was detailed in a KFF Health News investigation last September. , and in the months that followed, the company faced a new wave of criticism.
Local leaders in Carter County, Tennessee, debated in October but failed to pass a resolution calling for more regulation or dissolution of Ballard. Tennessee Attorney General Jonathan Scrumetti (R) said in an interview with the Tennessee Lookout in November that Ballard must be constantly monitored in light of community complaints. Earlier this month, Tennessee state Rep. David Hawk (R-Greenville), who represents the exclusive Ballard area, called for Levine's resignation, according to wjhl.com.
In response, Ballad Health said in a statement that it has “strong relationships with the majority of elected officials” in Carter County and welcomed the Tennessee Attorney General's scrutiny. Ballard said Hawke's views “certainly do not reflect our broader relationships” in the region. The Tennessee General Assembly is also considering a bill that would ban future COPA mergers in the state, which Ballad said “risks putting even more hospitals at risk of closure.” .
The bill was introduced by state Sen. Heidi Campbell (D-Nashville) and state Rep. Gloria Johnson (D-Knoxville), who are running for the Senate. Johnson said the bill would end Ballad's antitrust protections.
“It's been a real nightmare for community members,” Johnson said. “And they have no other choice.”
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of KFF's core operating programs and an independent source for health policy research, polling, and journalism. Information source.
