Tag Archives: Carol J. Bova

The Ballad Merger V: the Pandemic

Ballad Health nursing promotion

by Carol J. Bova

The nursing shortage was a top issue for Ballad Health from the moment the health system was created in 2018 from a merger of Mountain States Health Alliance and Wellmont Health System. The new health system, which served far Southwest Virginia and neighboring parts of Tennessee, laid out a plan in its first annual report to tackle the burgeoning workforce crisis that was afflicting much of rural and small-town America.

The annual report noted the following initiatives:

  • Putting $10 million annually into increasing nursing wages which affects one-third of [the] work force. The first two classes of the ETSU/Holston Valley accelerated BSN program graduated in May and August, 2018, producing a net gain of 34 additional nurse graduates above previous program capacity.
  • Contracting with Northeast State Community College (NESCC) for admission of 20 additional associate degree nursing students each spring semester starting January, 2019. … This provides an additional 20 new graduate nurses annually above current capacity at NESCC program.”

These measures were clearly stop-gap. First, while the $10 million annual increase to nursing wages might have helped retain nurses, it did nothing to train or recruit new nurses. Second, educating 52 new nurses (only 34 in Virginia) over two years was a positive but only a fraction of the number needed— even assuming they all wound up working for Ballad. Continue reading

Ballad Merger IV: Has Quality Improved?

Ballad Health signage at Lonesome Pine Hospital. Photo credit: WCB

by Carol J. Bova

As a condition of the merger between Mountain States Health Alliance and Wellmont Health System in 2018, the combined entity, Ballad Health System is required to periodically update Virginia regulators on health metrics for its far Southwest Virginia service territory. Those quality measures and actual performance must be accessible to the public on the Ballad website as well.

The reporting was suspended during the COVID-19 emergency before year-to-year comparisons for Fiscal Year 2020 were available. But Ballad did publish an Annual Report for Fiscal Year 2020 that contained partial data through February 2020.

The bottom line: Quality measures have been a mixed bag. Some measures have improved; a few have declined. As detailed in Parts II and III of this series, Ballad met expectations for cost cutting and restructuring. What isn’t clear from the limited data available is why there is “slippage” in some numbers from one year to the next. Important questions arise. Continue reading

The Ballad Merger III: Reshuffling, Reconstruction and Repurposing

Norton Community Hospital

by  Carol J. Bova

When Mountain States Health Alliance and Wellmont Health System merged to create Ballad Health in 2018, the healthcare companies justified the consolidation with the argument that the ability to cut costs and rationalize delivery of health services would yield tangible benefits to patients in Southwest Virginia and Northeastern Tennessee.

The previous article in this series, “Cuts and Consolidations,” detailed how  Ballad Health bolstered finances through shared value-based payment savings, bond refinancing, staff reductions and closures of off-site facilities. This article, Part III, shows how the company acted to lower costs and enhance revenue by consolidating medical services, repurposing hospitals, introducing telemedicine, and implementing a new IT system.

The Virginia Cooperative Agreement, which outlined the requirements of Virginia regulators, allowed repurposing as long as certain “essential services” were retained. Deploying telemedicine and rotating specialty clinics in rural hospitals would help it meet the requirement. Continue reading

The Ballad Merger II: Cuts and Consolidations

by Carol J. Bova

Upon the merger of Mountain States Health Alliance and Wellmont Health System in 2018, the first order of business for the newly created Ballad Health was shoring up its finances. If Ballad wasn’t successful at this, it would not have the resources to invest in the new services, facilities, programs, and equipment to improve community health it had promised as a condition of the merger.

Not all of Ballad’s actions were well-received. Some changes triggered community protests and county objections in its Tennessee and Virginia service territories. But the company did achieve its aim of bolstering cash flow. Here’s how Ballad went about it.

Job cuts. Financial conditions were adverse from the beginning. In an April 16, 2018 letter to the Tennessee Commissioner of Health, ten weeks into the merger, Ballad wrote that “due to the increased cost of labor, pharmaceuticals and supplies, and the continued shift to the outpatient setting from inpatient, operating income of the combined systems has declined by 123% since the same time in the prior year.” Continue reading

The Ballad Merger — A Leap of Faith by Two States

Ballad Health hospital market area in Tennessee and Virginia

by Carol J. Bova

In April, 2015, two Tennessee-based not-for-profit hospital organizations with a 75% market share in Southwest Virginia said a merger would allow them “to address the serious health issues affecting the region and to be among the best in the nation in terms of quality, affordability and patient satisfaction.” The merger  would involve 21 hospitals in 21 counties in two states, and about 960,000 people.

The FTC opposed the merger. The commission said that courts and antitrust agencies view an increase of more than 200 points on a standard measure of market concentration — the Herfindahl-Hirschman Index (HHI) — as likely to be anticompetitive. The new company’s post-merger score would increase 2,441 points.

In the hope that this merged company might solve overwhelming regional health disparities, Virginia and Tennessee ignored the FTC and took a leap of faith. Both states passed legislation to allow cooperative agreements for a merger of the two systems. To confer immunity from federal and state antitrust laws, the legislation provided for state regulation and active supervision to ensure that the benefits would outweigh any disadvantages. Continue reading

Northam’s Vaccine Quotas

by Carol J. Bova

Reporter Sabrina Moreno asked Dr. Danny Avula at a Virginia Department of Health (VDH) teleconference on March 26 if Virginia planned to do what Maryland’s governor had done a few weeks previously in reserving a portion of doses at each of its COVID-19 vaccination sites “for priority populations, you know, Black and Latino populations, lower income areas, to kind of help with that equitable distribution.”

Dr. Avula, who is state vaccine coordinator, said:

We’ve been doing a lot of that in a lot of our mass vaccination events… We do a combination of weighting our pre-registration… Say for example, if we have a 2,000-person event in Richmond, we would set a certain number of those slots for people that are on the wait list, and then a certain number of those slots for people on the wait list who are African-Americans, so that we can more mirror the demographics of the population.

He went on to say that different health districts might vary in their weighting methodology, “but we definitely have been weighting the preregistration lists for African-American and Latino communities. And I think it’s made a difference.” Continue reading

Shhh! Don’t Ask! COVID-19 Equity Analysis Is for Governor’s Eyes Only

by Carol J. Bova

The Virginia Department of Health (VDH) blog posted March 16 that the department and the Virginia Department of Emergency Management (VDEM) would open community vaccination centers in Danville, Portsmouth, Petersburg and Prince William. “The sites were selected after the Virginia Department of Emergency Management conducted an equity analysis to determine the communities with the largest number of vulnerable populations and communities with the largest percentage of vulnerable population and greatest COVID-19 impact.” (See Steve Haner on March 26.) I sent a FOIA request to VDEM for a copy of the equity analysis.

While waiting for the VDEM reply, I wrote on Bacon’s Rebellion March 17 that VDH should target vaccination efforts to neighborhoods with high rates of poverty where COVID-19 risk factors were most likely to be found rather than basing the sites on VDH’s flawed virus statistics of racial demographics.

I received a response from VDEM denying my request. Continue reading

VDH Cleans Up COVID Deaths Stats

by Carol J. Bova

Anecdotes and social media comments have insisted that the Virginia Department of Health (VDH) has counted deaths from suicide, gunshot or motor vehicle accidents as COVID-19 deaths.

On March 19, VDH announced on its COVID-19 Dashboard that it had reviewed more than 10,000 reported COVID-19 deaths using the Virginia Case Definition for COVID-19 Associated Mortality. The announcement said of the reviewed deaths:

Among these, less than 1% (99 deaths) were determined to not qualify as “COVID-19 associated” deaths per the case definition and [were] re-classified to be a COVID-19 case that did not result in death. Today (3/19/21), a decrease in total net number of COVID-19 deaths is being reported on the VDH COVID-19 dashboard (more COVID-19 deaths were removed than added on 3/19/21).

Since the net change was -90, that would mean only 9 deaths were recorded on March 18.

Lies, Damn Lies, and Race-Obsessed Statistics

by Carol J. Bova

A March 3 Virginia Department of Health (VDH) blog post discusses racial/ethnic “health and disease” disparities in light of the COVID-19 epidemic. It states that COVID case rates and hospitalization rates for blacks and Hispanics in the United States and Virginia are substantially higher than for whites.

“Social determinants of health are maldistributed,” concludes the blog post. “These disparities will continue health problem by health problem until there is more equity in the distribution of social determinants of health across racial/ethnic groups.”

Not so fast. There are two problems with this framing of the issue. First, the Northam administration’s obsessive focus on the color of peoples’ skin distracts from targeting the real factors influencing COVID mortality such as rates of obesity and diabetes. The second is that, ironically, VDH isn’t even doing a good job of measuring race. The assertions about differential case and hospitalization rates are based on deficient data. Continue reading

Virginia Ranks 40th of 53 in Nursing Home Ratings

by Carol J. Bova

One of three nursing homes receiving Medicare payments in Virginia (35.3%) scored below average or much below average in the latest Medicare ratings found in the new Care Compare website.

On February 1, 2021, the Centers for Medicare and Medicaid (CMS) updated its ratings report for nursing homes in the United States, District of Columbia, Puerto Rico and Guam. Compared to the ratings before the COVID-19 pandemic, Virginia has reduced the number of facilities with the low 1- and 2-star ratings. Still, Virginia nursing homes ranked 40th of 53 for below and much below average overall quality.

Nursing Home Ratings by State

Who owns these nursing homes? Continue reading

Misplaced Priorities at VDH

by Carol J. Bova

The Virginia Department of Health (VDH) announced January 19 that it has launched a COVID-19 Outbreaks in Virginia Higher Education dashboard. The department included a disclaimer that the dashboard reports only “outbreak-associated cases and not the total number of cases at the college or university.” For more information on COVID-19 numbers, the dashboard points to a separate website hosted by eleven schools which contains information about their cases at www.covid19.va.education.

The VDH rationale for a new dashboard with incomplete information? “This dashboard helps to provide awareness of the spread of SARS-CoV-2, the virus that causes COVID-19, in colleges and universities statewide.”

This new VDH dashboard does not show the true extent of COVID-19 in colleges and universities. It is a waste of time and resources. Having this information at the beginning of the fall semester might have been useful. Citizens are already acutely aware of the spread in their communities, and efforts need to be redirected to the state’s older population.

For example, since November 1:

Colleges and universities have had 13 outbreaks involving 556 cases and no deaths.
Long term care facilities have had 490 outbreaks with 12,024 cases and 1,012 deaths.
Totals for higher ed: 55 outbreaks, 3,026 cases, zero deaths.
Totals for LTCF:  806 outbreaks, 24,935 cases, 2,795 deaths. Continue reading

COVID-19 Infections Up but Flu Infections Down

by Carol J. Bova

The 2020-2021 flu season began with the week ending October 4 – Week 40.  “There have been 2 infections in Virginia during the 2020-21 flu season to date,” the Virginia Department of Health (VDH) said on December 17. By comparison, last year Virginia experienced sporadic cases from weeks 40 through 44, local occurrences in Weeks 45-46, and jumped to widespread cases from Week 47 of 2019 into April of 2020.

According to reports from the Centers for Disease Control (CDC), this flu season, after more than 469,000 tests, there are only 789 recorded cases and 168 deaths in the entire country. News reports in mid-December noted the unusual pattern of low influenza numbers and speculated on the reasons. Continue reading

VDH Outbreak Reporting Won’t Save Lives, Inspectors Will

by Carol J. Bova

Back in June, I asked “Where Are the Other 52 Nursing Homes with Outbreaks?” because that was the number missing from the Long Term Care Facility Task Force dashboard. The Task Force explained it wasn’t involved with group homes and residential behavioral health facilities and, therefore, did not include them in their dashboard — even though those facilities are included in the numbers for the VDH Long Term Outbreaks report.

The new outbreak information dashboard the Virginia Department of Health (VDH) created to comply with HB 5048 of the 2020 General Assembly Special Session Number One will include those groups in the weekly report, VDH announced on its blog December 18. (Summer camps and K-12 Schools will  be listed also.)

The dashboard will include confirmed COVID-19 outbreaks that occurred in medical care facilities, residential or day programs licensed by Virginia Department of Health (VDH), Department of Social Services (DSS), or Department of Behavioral Health and Developmental Services (DBHDS), summer camps, and kindergarten (K)-12th grade schools.

Transparency is always good, but a new report will not address the need for inspectors whose work could actually reduce the incidence and death rates. Continue reading

Southwest VA’s Health Crisis Began Before the Pandemic

This map shows the region served by the Southwest Virginia Health Authority. (From the Virginia Letter Authorizing a Cooperative Agreement)

by Carol J. Bova

The looming COVID-19 hospital crisis in Southwest Virginia was set in motion long before the pandemic.

To begin with, the region’s health indicators and outcomes generally are much worse than the state average. Two indicators particularly impact the COVID-19 epidemic: Every county in the Southwest Virginia Health Authority service area has a higher percentage of obese adults than the state as a whole. Similarly, the diabetes rate in the counties of Lee, Scott, and Wise, and the City of Norton is 19.1%.

Against this comorbidity backdrop, a nursing shortage at the region’s largest health provider, Ballad Health, is making it impossible to staff enough hospital beds to serve Southwest Virginia’s COVID-19 patients. Continue reading

Where Have All the Heart Attacks Gone?

by Carol J. Bova

The Johns Hopkins University News-Letter published an article earlier this month asking, “Where have all the heart attacks gone?” The study questioned whether the U.S. COIVD-19 death rates are being overstated by omitting deaths usually attributed to attacks and cancer. The study was pulled four days later.

Dr. Genevieve Briand, the assistant director for the MS in Applied Economics Program at Hopkins, spoke at a webinar Nov. 11 on “COVID-19 Deaths–A Look at U.S. Data.” She meticulously detailed the facts she used and the conclusion she reached. The hour-long webinar can be viewed here.

Briand showed where and how to access the data from the Centers for Disease Control (CDC). She discussed the annual patterns of deaths in the United States and the reported number of COVID-19 deaths in relation to those annual patterns from 2014 through September, 2020.

Every year, there are recurring peaks and lows in death numbers that apply to all causes of death. She said that because of the emphasis on COVID-19, other major causes of death are being understated. She showed the percentage of total deaths by age categories and how there was no significant increase in deaths of older Americans. Continue reading