Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I read this article a week or so ago, and was astonished that the issues with the Tri-Cities regional healthcare system were finally making industry news. This article was also picked up by USA Today - it's behind a paywall, so didn't link it, but you can easily Google it.
I worked for Ballad for many years before and after the merger in a position that allowed me to see many aspects of hospital operations from a sort of birds-eye point of view. While both systems had issues prior to the merger, those have compounded and snowballed.
Holston Valley, Kingsport's tertiary hospital, used to be very well-regarded. The trauma center was downgraded by Ballad Health. The NICU has been eliminated. Other aspects of care have been cut back or eliminated.
My grandmother had a stroke earlier this year. She was sent to HVMC after the stroke was suspected, but was in the ER about ten hours before being seen. I had worked with certain processes that would have directly impacted stroke coverage, and those were tested before I left. Curious, I did some checking, and it turns out that dedicated stroke coverage appears to have been quietly eliminated in those intervening months. Basically, if you have a stroke in Kingsport, the nearest dedicated stroke coverage team is in Johnson City at JCMC.
The coverage for other specialities has also been eliminated in Kingsport.
If something serious happens to you in much of southwest VA north and west of Kingsport, that is likely a medflight to JCMC as there is no closer coverage available. Regular medical insurance doesn't cover this, which is something the average personal probably doesn't know.
There is a Facebook page called "Scannerfood" that posts police and EMS radio traffic throughout the region. It's very common to see "patient needing medflight to higher echelon facility." This was almost never seen, even as recently as a few years ago.
Sycamore Shoals ICU was recently closed. Mountain View in Norton, VA is now closed. Greeneville Community Hospital West, formerly Takoma Regional, is now an addiction treatment facility.
All of these services being folded into JCMC is resulting in even greater strain on an already overtaxed and undermanned JCMC. Staffing issues have gone on for years pre-COVID, but it's even worse now, and system-wide.
I don't have any serious health issues, but saw how poor the care was at BRMC and JCMC with my ex who had numerous admissions. CMS quality scores and other quality metrics have consistently declined post-merger.
Local surgeons wouldn't do a hip replacement on a complicated mid-20s autoimmune patient. Anything more than a sniffle was an ambulance ride to Vanderbilt. I've moved all of my healthcare to Asheville. Mission/HCA has their own issues, but there are at least more options in that area, and they are better than Ballad.
Many of the people who left were top level individual contributors who had been there for years, and even some management who dropped back to be individual contributors in other organizations. I know a VP who left to be an individual contributor at a vendor we worked with - that had to be a huge pay cut. There was no effort to try to retain departing employees, no real sense the leadership cared why or even that people were leaving.
For corporate roles, at least first level manager and below, pay grades are no longer competitive - a former colleague was promoted to the same grade I was when I was hired in back in 2016 makes about 15% less now than I did back then. I know probably a dozen former fairly close coworkers who left the organization and often made much better money elsewhere - 30%+ seems very common. Remote work has been a game changer for many office jobs where people are no longer limited to local employment options.
At least where I was, director level and above leadership had basically no knowledge of what their individual contributors did. Everything was in a consistent state of crisis and flux. Big money went to projects where there were essentially one or two people who had the expertise to lead the project - if those people left, the project sank.
Everything in this article seems to confirm virtually everything I saw. Constant turnover has led to no institutional knowledge. Poor pay and working conditions have led to the exit of many experienced FTEs to greener pastures - RN/BSN starting pay was $18/hr pre-COVID - who would work for that when they were making $5-$10/hr more with Mission or Covenant, even back then? For now, Ballad is augmenting with travel nurses and contractors throughout the organization, but the latest figure I saw was that they lost ~$20 million in FY23 - how long can they continue to augment with contractors at that burn rate?
Care continues to go down the tubes with this management. I don't see "Ballad as we know it" making it five more years.
I'm no Ballad apologist but realistically, what can the system do other than be acquired by an entity with more resources? Ballad's service area is largely uninsured or underinsured and also less healthy than many other parts of the country and this puts a significant financial strain on Ballad. Staffing shortages are an issue nationwide but are compounded in a system like Ballad where it is more difficult to pay competitive wages. I don't know what the answer is but the most likely scenario is acquisition by a larger hospital system with greater resources.
Keep in mind that a lot of these financial issues are largely self-inflicted.
Ballad might be out $40/hr. all-inclusive with benefits for a typical RN, but they end up paying an agency $100-$125/hr. for a traveler replacement. Sure, the traveler isn't getting Ballad-paid benefits, but that spread ends up being a lot more than including the employee benefits.
Stretch that out over all of the organization, and it's easy to see where the financial damage is coming from.
That's not counting other departments. I was not clinical and we were paying an agency $300/hr. for a contract worker, when a typical employee with that level of experience would probably make $60k-$70k. That person was working at least forty hours a week, so that's $12k/week to the agency just for that one person. There were probably a couple dozen contractors in the department, and while I don't know if we were paying quite that rate for them, it had to be a lot.
I was on a high dollar project at one point that basically went belly up once the project lead left the organization. They couldn't find anyone to replace him at all, and ended up bringing him back in as a contractor at who knows what kind of money.
The director over my group would just let people go rather than letting the managers try to keep the people they have. It would have been far more economical in the long run to work with the long time staff to retain them than to start over with greenhorns. There was no focus on promoting anyone from within, so talented people generally left after a few years, leaving the people who either too scared to find something else, who couldn't find something else, or in the case of my department, a lot of people just hanging on a few more years until retirement. There's also a huge succession issue in many areas where there are a lot of older employees and no talent pipeline to replace them.
It's gotten so bad that some employees were being managed by contractors because Ballad couldn't find managers willing to take positions. There was a manager switch in my department that was announced Thursday, taking effect the following Monday. No one can be trained on anything in a day and a half. I know one team that had five different managers in under two years.
It's just dumb decision making all around.
Yes, there are systemic issues with the uninsured patients, poverty, etc., but that is going to be small town/rural anywhere. Mergers have happened in Winston-Salem and around Greenville, SC, but neither of their systems are having the same quality issues Ballad is, not even speaking of how Ballad is basically reviled by most people here.
This is not great news for the tri-cities region, but it is essentially what was expected.
Ballad's goal was to go in, consolidate, and trim services, cut costs, make a ton of money in a short few years, and sell it off or step back and wait until they can sell it.
It's sadly a numbers and money-making business for them--that's really mostly it.
Monopolies never work out for the customer. And in this case, it's patients who suffer the most.
This is not great news for the tri-cities region, but it is essentially what was expected.
Ballad's goal was to go in, consolidate, and trim services, cut costs, make a ton of money in a short few years, and sell it off or step back and wait until they can sell it.
It's sadly a numbers and money-making business for them--that's really mostly it.
Monopolies never work out for the customer. And in this case, it's patients who suffer the most.
My guess is that this is exactly what will happen. HCA, CHS, or some other national conglomerate will pick up the tertiary hospitals and any other profitable pieces, while the rest limp along for awhile, or are closed outright.
We're already seeing the consolidation of services to JCMC and elimination of services in the rural areas. That's just going to accelerate.
Meanwhile, those with the means and ability to find better medical care elsewhere will. Those who can't or won't leave the area are stuck with subpar care.
This is not great news for the tri-cities region, but it is essentially what was expected.
Ballad's goal was to go in, consolidate, and trim services, cut costs, make a ton of money in a short few years, and sell it off or step back and wait until they can sell it.
It's sadly a numbers and money-making business for them--that's really mostly it.
Monopolies never work out for the customer. And in this case, it's patients who suffer the most.
Well said!
Kingsport and Bristol were stupid to sign over their hospitals to this frankenstein creation.
I expect the Wellmont leadership walked out the door with hefty buyouts, and eventually the same will happen with Ballad.
After all, Ballad is equally stupid. As an example look at how badly they handled a small protest. And they apparently don't even know that they do not own state right of way.
Even the city of Kingsport threw its weight behind Ballad (God knows why), and passed an ordinance that likely was not constitutional. I expect it was a violation of free speech, and seemed suspiciously like a bill of attainder.
Kingsport and Bristol were stupid to sign over their hospitals to this frankenstein creation.
I expect the Wellmont leadership walked out the door with hefty buyouts, and eventually the same will happen with Ballad.
After all, Ballad is equally stupid. As an example look at how badly they handled a small protest. And they apparently don't even know that they do not own state right of way.
Even the city of Kingsport threw its weight behind Ballad (God knows why), and passed an ordinance that likely was not constitutional. I expect it was a violation of free speech, and seemed suspiciously like a bill of attainder.
Sorry for the long read, but nobody is looking good in this. The leadership cashes out (or in) and the patients - well they don't even matter.
People forget this, but originally, Alan Levine, and Bart Hove, who was then the current Wellmont CEO, were supposed to serve as dual CEOs. Hove resigned on day one of Ballad, but continued to be paid for years based on the data from Ballad's tax returns.
The way the city of Kingsport treated the HVMC protestors was atrocious. I have issues with the way Dani Cook does things, and ultimately, I think she uses the Ballad situation to up her own marketability and clicks while working from mostly outside of this area now, but her heart is mostly in the right place.
The city of Kingsport deserves special scrutiny for effectively selling their residents out with what became a movement of most critical services from HVMC to JCMC. HVMC administration has turned over so often that no one there today had any responsibility for the original merger situation, but that certainly doesn't today's management is competent.
The only Wellmont executive who seemed to come out on the upside after all this was Eric Deaton. He took over as EVP of operations (or similar) at Ballad, which was a bigger position than he had at Wellmont. Most of the former Wellmont C/E/S level staff at the time of the merger have either retired, and at least a couple that I know of are now deceased.
The bottom line is that none of this is going to change. Dani can advocate her heart out, but it won't make any difference. The local and state politicians decided which "side" they were on years ago. The best people can do is prepare themselves for when they need healthcare outside of this area.
I couldn't even get a proper sleep apnea diagnosis through Ballad. I've since moved all of my healthcare outside the area, but many people don't have that luxury, and are stuck with the local crummy options.
Kingsport and Bristol were stupid to sign over their hospitals to this frankenstein creation.
Even the city of Kingsport threw its weight behind Ballad (God knows why), and passed an ordinance that likely was not constitutional. I expect it was a violation of free speech, and seemed suspiciously like a bill of attainder.
The city of Kingsport and its historical leaders, and the attitude of folks in leadership positions in that city, falls over frontwards, backwards and sideways for any large corporation who expresses interest in the city.
They'll promise to pave over the Holston River if a company brings big money to the region, and makes a few folks really wealthy in the process.
They would shave off the top of Bays Mountain if a large greedy corporation wanted to locate there.
There is close to zero empathy for the citizens and creating a good quality of life, from the city leaders. They are motivated by the almighty dollar, and keeping a good public face by attending church regularly.
BCBS cannot leave its customers without access to the Ballad hospital monopoly, and Ballad cannot exist without money flowing in from BCBS.
About a decade ago, the same thing happened with MSHA and Cigna. At the time, Cigna was the insurance for Eastman employees. An agreement was eventually reached, and while I don't think there was a coverage lapse, it was an uproar at the time.
BCBS is probably even bigger. IIRC, Ballad employee are covered through BCBS. I'm covered through BCBS with my current employer. My parents have some big BCBS coverage along with their Medicare. About everyone I know has it.
In a time where Ballad is already revenue-starved and needs corporate insurance to help offset losses by the uninsured and Medicaid patients, this kind of seems like "cutting off your nose to spite your face." I'm sure neither one is blameless, and I had an issue with a non-Ballad local provider who was overcharging BCBS, but Ballad needs to work in good faith. Knowing how things run there, they're probably wanting more than other similar hospital systems.
Quote:
Originally Posted by jjbradleynyc
The city of Kingsport and its historical leaders, and the attitude of folks in leadership positions in that city, falls over frontwards, backwards and sideways for any large corporation who expresses interest in the city.
They'll promise to pave over the Holston River if a company brings big money to the region, and makes a few folks really wealthy in the process.
They would shave off the top of Bays Mountain if a large greedy corporation wanted to locate there.
There is close to zero empathy for the citizens and creating a good quality of life, from the city leaders. They are motivated by the almighty dollar, and keeping a good public face by attending church regularly.
It couldn't be said any better. The healthcare quality system-wide has consistently declined since the merger. Kingsport has taken the brunt of that with what is basically the complete hollowing out of Holston Valley.
I had to spend quite a bit of time in HVMC working last year. I was shocked to see how it had declined over the past several years when I was on previous projects there. Staffing levels in the department I was working with were atrocious. That department got no backing from hospital administration. They were reassigned to a different director while I was working on that project - I knew that person for years, and he's very good at that kind of work. Pay was insufficient to retain staff - he fought for raises, but was denied. I retrained staff numerous times due to turnover.
A lot of Ballad's issues would be fixed if they could solve the turnover issue. Better pay and working conditions would likely keep a lot of the staff in place, and that in turn would fix a lot of the clinical issues.
Last edited by Serious Conversation; 10-31-2023 at 04:17 AM..
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
