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.

    • anon6789
      17•8 months ago

      Thanks for the links. I like reading stories like this when someone more familiar with the situation can fill the rest of us in a bit more.

      From an article linked in the second reference you give:

      The merger was profitable for Levine [Ballad CEO] too. His total compensation has nearly doubled to about $4.3 million since the merger, including some deferred retirement payments, according to reports filed with the IRS. Prior to Ballad, Levine worked as a high-level health official in Florida and Louisiana and was an executive at two larger hospital corporations, HCA Healthcare and Health Management Associates. Federal prosecutors accused both companies of widespread health care fraud during some of the years when Levine was one of their leaders, claims the companies denied but later paid hundreds of millions of dollars to settle.

      Nothing to see here…

      But then there is this:

      Nationwide, the COPA model is uncommon but gaining momentum. COPAs have been used in about 10 hospital mergers over the past three decades, including two in Texas and one in Louisiana in just the past three years, and another is being proposed in Indiana. Nineteen states have laws on the books allowing for COPAs, although not all have approved a specific merger…

      “Our critics say, ‘No Ballad. We don’t want Ballad.’ Well, then what?” Levine said. “Because the hospitals were on their way to being closed.”

      So what do we do about this? This seems to go back to red states being propped up financially by blue states. By nature of population and development, that seems to be the order of things, and I don’t mind that in general principal. It seems like nationalized healthcare would allow quality hospitals to exist in unprofitable areas, just like post offices don’t go out of business there. But if people there keep voting for reps that keep going on about “socialism evil!” how do we get these people care? In a capitalist system, how do we force businesses to provide service when it is unprofitable, leaving only unscrupulous people to provide those services like slumlords of healthcare?

      It really sucks and I feel bad for the people affected, but what can really be done since it seems that is the path they choose?