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Ballad Health defends decision to alter trauma, pediatric services

Zach Vance • Nov 29, 2018 at 9:04 PM

KINGSPORT — Ballad Health CEO Alan Levine’s passion was evident Thursday as he fought back tears to defend his hospital system’s decision to realign its trauma services and seek approval from the state to modify its pediatric services. 

“Every single decision that we are making is about what is best for the patient. When I go to bed at night, the things I think about are: Is a patient going to die because we made a mistake? Did I make a decision today about our team members that is going to affect their ability to feed their families? Because I represent the largest employer in the region. These are hefty decisions that I go to bed with every night,” Levine said during a two-plus hour discussion with the Johnson City Press and Kingsport Times News editorial teams.

“For anyone to suggest that I would make or our board would make such important decisions just purely because of the money is so irresponsible. And what it does is it feeds into this narrative that this wasn’t about patients. It doesn’t even give us a chance to really explain.”

Levine said he spent much of the Thanksgiving holiday on social media personally responding to comments criticizing Ballad Health’s plan to change Holston Valley Media Center’s trauma center status from Level I to Level III and its proposal to consolidate Kingsport’s neonatal intensive care unit into Johnson City Medical Center. 

The changes, expected to take place over the next 10 months, also involve downgrading Bristol Regional Medical Center’s trauma center from Level II to Level III, integrating emergency medical services across the region and creating pediatric emergency rooms in Kingsport and Bristol as part of the newly merged health system’s asset redistribution effort.

Ballad’s stated reasoning behind the move is to align its trauma-related and pediatric-related services into higher-volume settings where staff and physician coverage is more consistent and evidence shows quality of care is improved. 

To rebut the “all about money” narrative, Levine said Ballad Health recently moved its orthopedic and neuroscience programs to Holston Valley due to larger volumes, which research shows produces better outcomes. 

Trauma Center versus Emergency Room 

Much of the misinformation being spread is because some people have not distinguished the difference between a trauma center and emergency room, Levine said.

“Heart attacks, strokes, injuries, you go to the closest hospital and none of that is changing. People have conflated the two. There is big difference between emergency departments and trauma care,” Levine said. 

Chief Population Officer Tony Keck said Ballad Health, as a whole, sees between 450,000 and 475,000 emergency room visits per year. Of those, approximately 5,000 visits, or 1 percent, involve some type of trauma care, and just 500 of those 5,000 cases warrant a Level I trauma center. 

Keck said about 300 of those 500 Level I trauma cases are already treated at Johnson City Medical Center so the realignment would only impact 200 or so cases. 

“Literally, 99.94 percent of everything that’s going on in the emergency room is not changing,” Keck said. 

Levine said more than half of the subspecialties required for a Level I trauma center at Holston Valley have been underutilized while the hospital usually has to pay each subspecialist to be on call at all times. For example, last year, Levine said the cardiac subspecialty at Holston Valley didn’t get consulted once and neither did hand surgery, interventional radiology and ObGyn. 

Pediatric Transport Systems

Some of the most emotional condemnation of Ballad Health’s plan has revolved around longer travel times for babies in need of intensive care services due to the consolidation of the neonatal intensive care into Niswonger Children’s Hospital.

While Holston Valley will no longer operate a neonatal intensive care unit, Ballad Health plans to open a pediatric emergency room in Kingsport and Bristol; invest in 10 new pediatric subspecialties and connect all of its hospitals to Niswonger via telemedicine. 

Niswonger Children’s Hospital CEO Lisa Carter said the health system already has robust transport systems in place to respond to certain pediatric emergency situations when needed, and one of those situations arose Wednesday night. She said a pregnant woman came into Johnson County Memorial Hospital needing a caesarean section. Because that hospital offers no such service, the woman was transported to Boone, North Carolina, and before she arrived, a transport team from Johnson City was already there waiting on her. 

“Again, a lot of the information that’s come out, as Alan said, has been irresponsible, and it really has created a lot of emotion within the community when you talk about babies dying. When you talk about things that keep me up at night, I would never be able to sleep at night if I thought that I was promoting a decision that would put children at risk. I would not sign up for that,” Carter said. 

Patient volume changing.

Levine said people had expressed concern that Ballad would move everything out of Kingsport to Johnson City.

“The exact opposite is happening,” he said. “The volumes at Holston Valley and Bristol are up, while Johnson City is down. We’re actually referring patients to Holston Valley and Bristol that before weren’t referred. There has been no discussion, not one conversation by management or the board, of moving any service out of Kingsport. Not one.”

Levine said the Certificate of Public Advantage that allowed Mountain States Health Alliance and Wellmont to merge has language that explicitly says Ballad must maintain three tertiary referral hospitals. Under the terms of the COPA, the Tennessee Department of Health is reviewing Ballad Health’s request to make its pediatric changes. The state has already pre-approved Ballad Health’s desire to realign its trauma services. 

Also on Thursday, Quillen College of Medicine Dean Dr. William Block, Jr., the Children’s Hospital Alliance of Tennessee and the East Tennessee Children’s Hospital all submitted letters to the state in support of Ballad’s request to alter its pediatric services.

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