After Appalachian Hospitals Merged Into a Monopoly, Their ERs Slowed to a Crawl - KFF Health News
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Ballad Health was granted the nation’s largest state-sanctioned hospital monopoly in 2018. Since then, its emergency rooms have become more than three times as slow.

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Ballad Health, a 20-hospital system in the Tri-Cities region of Tennessee and Virginia, benefits from the largest state-sanctioned hospital monopoly in the United States. In the six years since lawmakers in both states waived anti-monopoly laws and Ballad was formed, ER visits for patients sick enough to be hospitalized grew more than three times as long and now far exceed the criteria set by state officials, according to Ballad reports released by the Tennessee Department of Health.

Tennessee and Virginia have so far announced no steps to reduce time spent in Ballad ERs. The Tennessee health department, which has a more direct role in regulating Ballad, has each year issued a report saying the agreement that gave Ballad a monopoly “continues to provide a Public Advantage.” Department officials have twice declined to comment to KFF Health News on Ballad’s performance.

According to Ballad’s latest annual report, which was released this month and spans from July 2022 to June 2023, the median time that patients spend in Ballad ERs before being admitted to the hospital is nearly 11 hours. This statistic includes both time spent waiting and time being treated in the ER and excludes patients who weren’t admitted or left the ER without receiving care.

  • ErasmusEnglish
    19•9 months ago

    My parents still live in this area and have emailed me non stop about this since the beginning.

    They live in a county that HAD two large hospitals. Both got absorbed by this cancer. One got shutdown.

    All their ‘old’ reputable doctors took retirement when Ballad took over. Any younger doctors were forced to join Ballad or GTFO of town. Ballad had not only a monopoly on the heath care but if you were in any sort of field related (say you were an eye doctor) and you had your own practice but you occasionally went to the hospital to see patients - you were no longer allowed in the hospital unless you joined Ballad.

    Basically you were blackmailed to joined these assholes or else. I found this out from some friends who stayed in the area and joined the medical field.

    Seriously, the fact TN allowed this shit to pass just irritants me to no end.