Northeast Tennessee lawmaker still concerned about whether there will actually be a hospital competitor to Ballad.
Image: The Holston Valley Medical Center in Kingsport, Tennessee, is part of the Ballad Health hospital system. Image Credit: Brett Kelman/KFF Health News
***Note from The Tennessee Conservative – this article posted here for informational purposes only.
By Adam Friedman [Tennessee Lookout -CC BY-NC-ND 4.0] –
The Tennessee House passed a measure ending Ballad Health’s monopoly hospital agreement, adding an amendment that would allow the removal of some anti-competition laws in hopes of other hospitals opening in the northeast part of the state.
The House amendment would allow an acute care hospital, which treats short-term medical emergencies, to open without needing state regulator permission. But acute care hospitals are often the least profitable healthcare service, leading to fears that the bill’s repeal of Ballad’s monopoly agreement, called a Certificate of Public Advantage, COPA, in 2028, could result in a situation with less regulation and still no competition.
“There are still numerous areas where we need oversight until we have actual competition,” said Greenville Republican state Rep. David Hawk during the debate. Hawk, despite his concerns, voted in favor of the bill that passed the House by a 79-14 vote.
Ballad was formed after Tennessee and Virginia lawmakers waived antitrust regulations in 2018, allowing two regional hospital chains to merge under a COPA, despite opposition from the U.S. Federal Trade Commission, FTC.
In exchange for creating the nation’s largest state-sanctioned hospital monopoly, Ballad promised to meet several quality-of-care goals. An investigation by KFF Health News found the monopoly has fallen short on many, including failing to meet benchmarks for infections, mortality, emergency room wait times and patient satisfaction.
When initially introduced by state lawmakers this year, the legislative plan was to end Ballad’s hospital monopoly in 2028, and pass a second bill ending the Certificate of Need, CON, for acute care hospitals in Tennessee in 2030.
Certificate of Need is a process in which other hospitals can block competitors if they can successfully prove to state regulators that the competition could hurt their bottom line and potentially lead to their closure. Nonprofit hospital chains often use the CON process, arguing that if the state allows competitors into their most profitable procedures, they will be forced to close emergency rooms.
Hawk sought advice from the FTC on the legislation, receiving a letter in late March in which officials said that, at a minimum, ending COPA without removing CON immediately could “undermine” the goal of more competition.
The FTC also warned that COPA might already be too far along, and that removing oversight would leave Ballad less regulated while still having no competitors. When North Carolina repealed a COPA in Asheville, it led to the hospital chain being sold off because as a de facto monopoly it was more appealing to buyers.
The Ballad COPA repeal bill will now head to the Senate on Monday. The Senate’s version only repealed the COPA, saying nothing about CON. If the Senate doesn’t pass the House version, the bill could head to a conference committee to work out the differeneces in the final weeks of the legislative session.
The bill repealing CON for acute care hospitals in 2030 has already passed the state Senate and is expected to be voted on in the House Monday.
One Response
Sounds like Ballad was a bad deal from the get-go.