High-quality health systems share common characteristics. They reduce per capita costs while improving the health of the population, the patient experience, and the work life of health care providers. Unfortunately, the merger of Mountain States Health Alliance with Wellmont is not meeting these objectives. As an independent physician in Norton, Virginia, I have monitored the merger since its inception. I am alarmed that Southwest Virginians are paying higher prices for lower quality and less accessible health care, and I fear that patient fatalities will increase due to the lack of local care during a medical emergency.

Ballad is increasing costs of health care in our region. At my clinic, I charged $11 for a vitamin D test, whereas a local hospital charged over $300 for the same test. Within a region, bloodwork, imaging studies, medications, IV infusions and procedures are all much less expensive when they are performed in outpatient facilities. Hospital-based systems introduce facility fees and significantly increase overhead costs, when the actual costs of many studies like lab tests are only a few dollars each. Ballad has closed outpatient options, including surgery and oncology centers, and is funneling more patients to hospitals and emergency rooms. Colonoscopies and IV drug infusions are now hundreds of dollars more expensive, and patients have no choice but to pay these higher bills. Making lower cost, comprehensive medical care inaccessible in a community is bad medicine, but this is apparently Ballad’s core strategy. Charging hospital prices ultimately makes Ballad more money. As insurers are charged higher prices, our health care premiums will increase. Patients will be left with much higher medical bills in an environment where an unpaid $500 bill could mean declaring bankruptcy or being sued by the hospital. This is happening increasingly since the merger. A recent survey after Medicaid expansion found that 70% of Southwest Virginians are not satisfied with the health care system and nearly 80% are worried about the future costs of health care, the highest in the state.

The hospital merger has not improved the health of the population, and one of those reasons is regionalization. It makes sense to regionalize health care procedures that are complex, non-urgent, and rare so that physicians, particularly interventionalists and surgeons, can sustain a sufficient volume to keep up their skills, and the health system can consolidate services. Pediatric heart surgeries should be referred to a more tertiary care center within a community. Instead, Ballad is planning to regionalize bread-and-butter health services by closing the trauma and NICU programs at Holston Valley Medical Center in Kingsport, Tennessee, and the surgical program at Mountain View Hospital in Norton, Virginia. Many health care conditions like traumas, heart attacks, strokes, and acute abdominal issues, need to be treated expediently or quality of care suffers. Appendicitis can result in rupture if surgery is not performed quickly. Mortality rates increase dramatically if trauma patients are not treated within 60 minutes. Many Southwest Virginians will now be over an hour from the closest trauma center. A geographic area the size of New Jersey needs to have more than one or two pediatric or NICU programs, and routine services need to be accessible outside of Johnson City, TN and other larger cities. As it stands, providers in small community hospitals are not given adequate resources or staffing to provide comprehensive care and are pressured to triage patients to larger hospitals. Patients are now responsible for these expensive transport costs. Thus, medical care in our rural hospitals and family doctor’s offices is more limited than years ago, and this is negatively affecting health outcomes. We cannot watch as services are actively taken out of our communities and still believe that Ballad is serious about innovating in health care and improving the health of our population.

High-quality health care systems improve the work life of health care providers. The creation of a health care monopoly has negatively impacted these providers. Providers care about our patients but are forced to work in an environment that leads to burnout. Health care personnel are seeing higher volumes of patients while working at multiple facilities for the same amount of pay. Program closures and staffing cuts at hospitals, combined with personnel voluntarily leaving since the merger, have resulted in severe staffing shortages. Sick patients are waiting longer in emergency rooms and care is being delayed. These overworked health care providers are trapped. Questioning Ballad’s practices mean they will be without a job and without alternative employment options. We have to demand changes and stand up for our health care providers.

Virginia cannot ignore what is happening in the Southwest region. Advisory committees developed since the merger need to be independent and effective and truly hold this health system accountable. First, we need to conduct an independent audit to investigate Ballad’s billing practices, comparing prices to similar markets and to prices prior to the merger. We need to look at short-term outcome data that is currently available and make this data public as soon as possible, without waiting for a committee to tell us years from now which metrics to follow. Let me make some suggestions. Each month, the rural hospitals that have had closures and staff reductions need to tell us data that includes their readmission rates, mortality rates, and rates of surgical complications, surgical site infections, hospital-acquired infections, pressure ulcers and falls. We also need to study those patients who are transferred to other hospitals, including their time to diagnosis and treatment, and any morbidity and mortality as a result. We need to look at accessibility metrics including number of same day appointments and time to first appointment in our clinics and staffing patterns and wait times at our hospitals. Finally, we need to make Net Promoter Scores public. This lets a community know if patients are satisfied with their care. After analyzing the results over a short time frame, the right answer may be to repeal the COPA and revisit the merger going forward.

Since Mountain States Health Alliance took over Wellmont, a nonprofit hospital, the CEO is making millions per year while the company has seen first quarter, tax-free revenues of $66 million. Despite the CEO’s report that profits were due to ‘reduced costs and improved quality of care’, it is evident that savings are going into the pockets of Ballad executives while patient prices increased dramatically. The system reduced costs by closing needed services in our communities and gained revenues by increasing referrals to hospital-based care. Ballad’s overarching strategy was to promise results while knowing there would not be an objective body (i.e. individuals not on their payroll) to hold them accountable when they did not deliver. I am sure many well-intentioned people were proponents of this merger. However, I do believe that a select few knew all along that this merger would make them a fortune while our community suffered. This merger should not have happened, but at a minimum, this health system needs to be held accountable. We do not have time to waste. It is imperative that community leaders, legislators, and all our citizens join with the dedicated citizen advocates outside Holston Valley to let this health system know that we will not tolerate expensive, sub-standard care. We deserve better!

For information about Dr. Kiser, visit her website at www.kiserfordelegate.com.

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