The Southwest Virginia Health Authority’s eight-member Cooperative Agreement Task Force held its organizational meeting on Monday at the Southwest Virginia Higher Education Center as it caught up with three years of history leading to Ballad’s creation and the authority’s role in state oversight of Ballad.
Presentations from staff and Ballad officials on progress in the year-and-a-half since the merger of Wellmont and Mountain States Health Alliance began left task force chairman and Virginia Delegate Todd Pillion, R-4th, concerned about some health care access for Southwest Virginia residents.
“We’re sending patients into Tennessee to a NICU, to a Level 1 trauma center, which we’ve been doing that for a long time,” Pillion said after the meeting, “but some of the pediatric patients were actually getting care in Virginia hospitals and now it seems we’re shipping them all to Tennessee. Call me a Commonwealth protectionist, but I want to make sure that any care that can be given in a community in Virginia should be given in a community in Virginia.”
Pillion also questioned the application of a 2 million population standard for Level 1 trauma centers in the East Tennessee-Southwest Virginia region because of geography.
“I grew up in the western end of Lee County,” Pillion said. “I recognize that it’s a long way to Kingsport, but it’s a further distance to Johnson City from there and most people can’t afford a helicopter ride there, and that’s very concerning.”
Interim task force chair and Virginia Delegate Terry Kilgore, R-1st, opened the meeting by recommending the task force members select a new chair since Kilgore is already chair of the Health Authority.
The task force members selected Pillion, a pediatric dentist, as chairman; Lenowisco Health District Director Sue Cantrell as vice chair and former Bristol, Virginia, Mayor Catherine Brillhart as secretary. Pillion, University of Virginia’s College at Wise Chancellor Donna P. Henry and Brillhart agreed to serve as a subcommittee to recommend three additional people from the region as task force members.
Authority attorney Jeff Mitchell, in explaining the authority and task force’s roles in Ballad oversight, said that the state Commissioner of Health has full responsibility for the Virginia cooperative agreement.
The memorandum of agreement between the state Health Department and the Southwest Virginia Health Authority, Mitchell said, has the Authority advise the state commissioner on supervision of the Ballad agreement.
“You may not have the ability to supervise, but you have a loud voice,” Mitchell told the task force.
Task Force merger monitor Dennis Barry, during a presentation on his role for the group, told members that he would be meeting frequently with Ballad officials and would be receiving proprietary information on company business plans and strategies.
Barry, whose experience as a lawyer includes working with hospital corporations, said that Tennessee’s establishment of its own certificate of public advantage, or COPA, predates the Virginia agreement on Ballad and has dictated much of Ballad’s planning.
Barry also advised the task force to read critical public comments on Ballad’s merger as part of the process leading up to the Tennessee and Virginia agreements to get a sense of “community sentiment” in some parts of Southwest Virginia.
Monitoring plans include monthly reports after each visit with Ballad officials and facilities, Barry said, special reports on specific issues and an annual report for the Health Authority’s December meeting.
“I’m not here as Ballad’s spokesman, but there’s some good stuff happening too,” Barry said.
Barry said that Ballad has moved to a single “charge master,” or guide to hospital service billing charges, for all 21 hospitals in Tennessee and Virginia.
“Previously vigorously competing managers are now cooperating,” Barry said, referring to integration of Wellmont and MSHA personnel under one company.
Barry said that Ballad’s efforts to announce consolidation of trauma centers and neonatal intensive care services have been a problem with public opinion in Virginia. He said that the typical national standard for numbers of Level 1 trauma centers is one to serve about 2 million population. The service area for Ballad’s switch to Johnson City Medical Center as the region’s Level 1 center is about 970,000, he said.
“What oversight did Virginia have in this?” Pillion asked Barry, who referred the question to state Health Department staffer Kevin Meyers
“Overall, Virginia didn’t have a lot to say about it,” Meyers said.
“Do we have any enforcement power?” Pillion asked.
“That’s part of the Tennessee COPA,” Meyers said.
Virginia is still trying to develop its own standards to measure Ballad’s compliance with the state’s cooperative agreement, Barry said.
“There’s a lot of strengths, but we’re hearing weaknesses as well,” Pillion later said.
“I think, as a task force, we need to tell (Barry) what we want to know,” said task force member Dixie Took-Rawlins of the Edward Via Virginia College of Osteopathic Medicine. “We can be as much an advocate for Ballad as the opposite, but we need the metrics.”
Barry and Ballad Chief Administrative Officer Marvin Eichorn each mentioned in their presentations that Ballad is trying to address new mothers with substance abuse problems with a planned Greene County, Tennessee, treatment facility.
Eichorn also pointed to Ballad’s planned reopening of Lee County Hospital in fall 2020 as well as opening of an urgent care facility at that site on Tuesday. He also cited $185 million in capital investment in facilities in Tennessee and Virginia along with new telemedicine facilities in all Lee County schools.
“On research and academics, I’d like to see more of that on the Virginia side with our colleges and universities,” Kilgore said.
Pillion later said he was grateful for the Lee County urgent care opening and planned 2020 hospital opening, but still questioned Southwest Virginia’s place in the two-state oversight.
“My hope is that Virginia keeps pressing forward and increasing their seat at the table,” Pillion said.