by James C. Sherlock

Carol Bova and I have written often in this space about the largest government-sponsored hospital monopoly in America, Ballad Health in the Appalachian mountains of Tennessee and Virginia. Ballad is made up of 20 hospitals that exclusively serve 1.1 million people.

Ballad was established jointly in 2018 by a Tennessee Certificate of Public Advantage, or COPA, agreement and by a Virginia Cooperative Agreement. 

It was done for three reasons stated by Tennessee:

it is the policy of this State, in certain instances,

• to displace competition among hospitals with regulation… and to actively supervise that regulation to the fullest extent required by law,
• in order to promote cooperation and coordination among hospitals in the provision of health services; and 
• to provide state action immunity from federal and state antitrust law to the fullest extent possible to those hospitals issued a certificate of public advantage

Those charters effectively formed an interstate version of Virginia’s Certificate of Public Need (COPN) law that was created for the same reasons, but is not nearly as honest in declaring its intent.

On December 6th, Brett Kelman of KFF Health News published an expose of Ballad in the Tennessee Lookout. The article challenges the notion in the COPA that quality of care in Ballad hospitals is actively supervised by the two states and the Centers for Medicaid and Medicare Services (CMS).  

Readers perhaps will find most interesting the combative interview with Ballad CEO Alan Levine.

In it Levine disclaims Ballad’s responsibility for quality of care in its hospitals.

Levine declined to discuss specific complaints from patients. But he said that each of the complaints referenced in this article took issue with medical decisions made by doctors in Ballad hospitals — not “any policy or practice at Ballad.”

“I can understand if the patients, if the wife, was upset about the medical decisions they made if it turned out to be wrong,” Levine said. “But that has nothing to do with the merger, OK? That’s a completely different issue, and it happens in hospitals all over the country.”

Mr. Levine is inventive, if little else, for his nearly $4 million a year.  

In that same year, Ballad paid Levine’s Executive Vice President/Chief Physician nearly $1.3 million and his Chief Clinical Officer nearly $900,000. Mr. Levine forces readers to wonder what they do all day. 

Ballad’s board, which Mr. Levine chairs, presumably does not share its CEO’s attitude towards corporate responsibility for quality of care. It should urgently inquire about his suitability for the job.  

It would be useful if the Virginia Department of Health did so as well.