Ballad Health — a Staffing Crisis or Chickens Coming Home to Roost?
Ballad Health is a legal, state-created, medical monopoly in Northeast Tennessee and Southwest Virginia. You may remember from a previous article the healthcare system was created through a process called a COPA, Certificate of Public Advantage, and resulted in a system that owns every hospital in a region the geographic size of New Jersey.
You may also remember that there was a significant protest against the newly created medical monopoly, including a 257 day 24/7 on-site protest outside one of their hospitals.
What you may not know is why the protest started… or why it lasted so long.
In November 2018, Ballad Health announced its plan to close the Level III Neonatal Intensive Care Unit at Holston Valley Medical Center. Now, of course, the announcement mentioned pediatric expansions including the development of a Comprehensive Regional Pediatric Center at Niswonger Children’s Hospital certified by the State of Tennessee (that never occurred and have since been dropped from their COPA requirements in Section 3.02 of the Terms of Certification).
In addition to their plan to close the Level III NICU at Holston Valley Medical Center, Ballad announced its plan to downgrade the trauma centers at both Holston Valley and Bristol Regional Medical Center. For context, Neonatal Intensive Care Units levels increase with their level number (Level III is higher than Level I and indicates a more specialized facility.). The opposite is true of trauma centers. A Level I Trauma center is a higher level facility than a Level III. I know, it can be confusing.
To understand that concern over these changes you have to look at the entire region and not just the 20–30 miles that separate Johnson City Medical Center, Holston Valley Medical Center, and Bristol Regional Hospital. Holston Valley and Bristol sit on the border of southwest Virginia and have played a critical role in the care of residents in that portion of the service region. The plan to reduce both of these trauma centers from Level I and Level II respectively to Level III trauma centers was beyond concerning. Even their own trauma surgeons, some of whom left over these changes, spoke of how potentially dangerous these changes would be for patients.
When these changes were announced and changes within the healthcare system began to take place, many employees felt as if they had no voice in the matter. Morale was greatly impacted and some staff say they were terminated for speaking out.
It appeared to be an “our way or the highway” environment at Ballad Health with some nurses stating they were told Ballad would simply replace them with travel nurses if they couldn’t get on board with the new direction of the healthcare system. Staff was told they would be fired for interacting with the protest. One nurse was even shown screenshots of her comments on one of my Live broadcasts when she was terminated.
Fast forward to January 2022.
The Ballad Health service region, largely Republican and conservative, has a particularly low vaccination rate, a significantly high positivity rate, and a healthcare system now declaring a “Staffing Crisis”.
Tennessee has had its challenges in dealing with COVID-19. Their State Health Department even fired its top infectious disease physician, Michelle Fiscus, over her efforts to inform and encourage the public to get vaccinated. Internal emails demonstrate the disconnect between public service and politics when it comes to public health and safety.
Ballad Health’s CEO, Alan Levine, has been heavily engrained in politics for years. His relationship with Rick Scott, Jeb Bush, and now Governor Bill Lee has been widely publicized. Most people would agree that the medical handling for the pandemic has been politicized. Is it possible that the healthcare CEOs political relationships have impacted employee vaccine mandate decisions?
Levine has been vocal that he supports the COVID-19 vaccine and believes that employees and the public should get vaccinated. So, why on the deadline for the first dose are 1,000+ Ballad Health employees unvaccinated and not requesting exemption? Leading healthcare systems across the country implemented their mandatory COVID-19 vaccinations for employees months ago with largely successful compliance. Mayo Clinic had approximately 99% of their employees compliant.
So, why does this appear to be such a challenge for Ballad Health?
According to Centers for Medicare and Medicaid Services, the deadline for healthcare employees to have their first dose was yesterday, January 27th. In a press conference yesterday, Ballad Health CEO, Alan Levine, announced that their deadline for employees to have the first dose would be February 11th despite the CMS deadline. He also stated that Ballad Health would be “very liberal” with their approval of exemptions for employees who did not want to get the vaccine.
These statements are of significant interest because Ballad Health has requested an exemption to the vaccine mandate from CMS. In Levine’s letter to CMS, he states that Ballad Health has “encouraged our team members and all members of the community to get the shots as soon as they were eligible.” It also states that despite their many efforts, “only about 60% of our non-physician team members are fully vaccinated.”
In an interview with WJHL earlier this month, Levine states they are facing two challenges with nurse staffing: 1) The increased number of seriously ill patients due to COVID and 2:) The attraction of nurses going elsewhere and being paid 3–4 times more. He also states that of the 600 open nursing positions at Ballad Health, 400 of them are filled by contract (travel) nurses.
That begs the question: If Ballad is forking over the higher pay rates for travel/contract staff, why not pay their direct staff a comparable rate that would incentivize them to remain on board rather than leave for contract work elsewhere? If money is the primary issue, wouldn’t paying this money to local nurses whose families would inevitably circulate it in the community be a desirable solution?
Or is the “attraction of going elsewhere” about more than the money?
Today, Indeed.com shows Ballad Health ranked at 3.1 stars out of a possible 5 with its Culture scoring 2.7, Pay & Benefits at 2.8, and Management coming in at 2.7 stars.
Based on 301 survey responses, Ballad Health’s areas for improvement are:
- Fair pay for job
- Trust in colleagues
- Sense of belonging
Are hospitals across the country and in rural communities facing tremendous challenges due to a global pandemic? Absolutely.
Do rural healthcare systems encounter unique obstacles in recruitment and retention of healthcare providers? Yes.
But…
If you are a medical monopoly, own every hospital in a geographic region the size of New Jersey, and are the largest employer in that region, one has to be curious about your inability to retain staff.
Maybe the lack of fair pay, trust, and sense of belonging indicated on those Indeed.com surveys is playing a larger role than the money Levine seems focused on.
Ballad Health’s motto is “It’s your story. We’re listening.”
Are they?
