Ballad seeking state approval for proposed pediatric changes

Zach Vance • Nov 23, 2018 at 11:39 AM

In its newfound role as a hospital regulator, the Tennessee Department of Health is facing its first big oversight decision with a proposal made by Ballad Health to alter its pediatric and neonatal intensive care services.

On Nov. 12, Ballad Health CEO Alan Levine sent a letter to Tennessee Health Commissioner John Dreyzehner officially notifying him that the hospital system wants to consolidate Level III NICU services and pediatric inpatient services. If the plan is approved, those services will no longer be offered at Holston Valley Medical Center in Kingsport, and all patients needing them will be treated at Niswonger Children’s Hospital in Johnson City.

“As the state regulator of the Certificate of Public Advantage (COPA) granted to Ballad Health, the department’s role in these proposals is clear: The changes to the regional trauma system, specifically designating Johnson City Medical Center as the region’s Level I trauma center, is a decision that Ballad has the authority to make based on the COPA Terms of Certification without specific state approval,” according to a statement posted on the Department of Health’s website.

“The department is required, however, under the Terms of Certification to decide whether to approve or disapprove Ballad’s proposed changes to pediatric services in the region within 90 days. Ballad has submitted a request to the department, and that information is currently under review.”

The statement also noted that Northeast Tennessee residents have been contacting the Department of Health with a variety of questions, concerns and feedback.

In determining whether to approve Ballad Health’s proposal to alter its children’s health services, Dreyzehner and other state health officials are required to consider whether the changes will have any negative impact on access to health care services, quality of care or employees.

“For example, if (Ballad Health) proposes to eliminate a service line demonstrated to be redundant, or otherwise duplicative of other service lines and would repurpose employees associated with that service line, then such factors may weigh in favor of the department’s approval of such action,” the Terms of Certification specifically states.

In his letter to Dreyzehner, Levine said the average daily census at Holston Valley Medical Center’s NICU has decreased from nine to eight, while the average daily census for the inpatient pediatric unit at Holston Valley has remained at three for the 2017, 2018 and 2019 fiscal years.

“Prior to the merger, (Holston Valley) competed with (Indian Path) and Niswonger for neonate services in the Kingsport market. This led to redundancies of neonatologists and significant subsidies to support the duplicate coverage,” Levine wrote.

“Now that (Holston Valley), Niswonger and (Indian Path) are all part of Ballad, there is an opportunity to align the neonate services in the Tri-Cities area with the actual demand for services. In doing this, Ballad seeks to provide coordinated, efficient care to babies born at any Ballad facility.”

In addition to consolidating its Level III NICU services from two locations to one, Ballad also wants to implement a “Newborn Care Model,” which involves maintaining Level I nurseries at six locations. The model also involves the development of new policies and procedures.

For example, Levine wrote in his letter to Dryzehner that if an imminent high-risk delivery occurs at any Ballad facility, a transport team at Niswonger will be notified and deployed as soon as possible to that location.

Other pediatric changes proposed by Ballad include new Niswonger Children’s Hospital pediatric emergency rooms in Kingsport and Bristol; investment in new pediatric subspecialties and connecting all hospitals to Niswonger via telemedicine.

Ballad Health also announced on Nov. 14 that it planned to form a regional trauma and emergency system, however this decision does not require state approval.

As outlined in the Terms of Certification governing the merger, the state pre-approved the consolidation of Level I trauma centers, as well as the consolidation of duplicative urgent care centers, surgery services at Indian Path and Holston Valley Medical Center and non-medical support services.

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