A message from Alan Levine: Reflecting on where we are as a health system, and what lies ahead

NOTE: This email was sent to all Ballad Health team members from our chairman and CEO, Alan Levine, on Sunday, Feb. 2, and we are repeating it here to make sure everyone has a chance to read it. While the message is very long, it contains a lot of important and helpful information, so even if you can’t read it while you’re at work, it’s worth reading whenever you have the time.

Dear Colleagues:

Last Friday marked the official two-year anniversary of the creation of Ballad Health. I would like to take a moment and reflect on some of the important things that have happened, and also to acknowledge the challenges we have dealt with, many of which remain and lay ahead for us to overcome together.

This is a very long email, and I really am sorry about this. But these issues are complex, and frankly, I believe if you want to know the information, it is best to provide it to you, and let you decide if you want to read it. If you are interested in where we sit as an organization, I think you would benefit from taking this home, or sending it to yourself, and reading it when you have time. This is my honest assessment of where I believe we are, and I share my optimism of what I believe we have the opportunity to do together.

There is a lot of good news, and I think we know the environment presents us with many challenges as well. I will do my best to acknowledge both. My goal here is not to overstate the positive and ignore the challenges – quite the opposite. I think if I dwell on the positive, but not be clear-eyed about the challenges, it will only serve to diminish the credibility of the organization.

Our No. 1 opportunity:

Everyone on our team is a caregiver – whether you are a physician, a nurse, a cook, an IT professional or yes, even an administrator. We all are part of a team attempting to create an environment where our patients get the best possible care. As we have worked to integrate the two health systems, the external challenges of our environment that caused the need for the merger have not gone away. In fact, they’ve worsened. Every week (and I’m not exaggerating), there are more stories about hospitals closing. Last week, a hospital in East Kentucky announced its closure, putting 1,000 people out of work.

We have sent our human resources team to Eastern Kentucky to attempt to recruit some of their nurses, as we believe wherever a hospital closes, there is opportunity to recruit people to our region where our hospitals are not only NOT closing, but we are opening new ones.

National nursing shortage

There is a national nursing shortage that is predicted to hit its worst peak in 2024. We are not immune to this shortage. If you are a bedside nurse, you know that the shortage has a direct effect on you and your colleagues. One year ago, the average turnover for nurses in hospitals was 17.2%. Ours was right at the national average. Today, our nursing turnover has declined to 15.6%. Our efforts have been to try and reduce the turnover while continuing to hire more nursing staff. This is why we made the investment in increased nursing salaries a few months ago – a more than $100 million commitment over the next 10 years.

Last week, I had the opportunity to meet with nurses from throughout our health system, and they provided me with excellent input to better understand how we can help provide additional support for our nursing team. There are many steps our chief nursing executive, Lisa Smithgall, will be taking in consultation with our chief nursing officers of each hospital to further our efforts to combat the shortage and place us in a good position. Our primary effort is to ensure we provide the support and environment where our nurses feel supported, valued and competent. If we do this well, I believe we will be a place where nurses want to locate and remain.

I am providing you here with a link to an informative website about the nursing shortage, because I think you deserve to understand what we are facing together. We are working with our local academic institutions to help increase the supply, and there will be more to come on that. www.aacnnursing.org/news-information/fact-sheets/nursing-shortage

One of the most important things I’ve heard from our nursing staff, and all staff generally, is that you have a strong connection to your supervisors and managers, and to the colleagues you work with each day. This is very positive, and something we know we should continue investing in. Our efforts to communicate with you will focus on enhancing that relationship.

Daily safety huddles:

One best practice that we have implemented, and one which is designed explicitly to ensure our caregivers have daily input into issues within our care sites, is our daily safety huddles. These are intended to provide our caregivers with an opportunity to be heard each and every morning, regarding issues that affect you and your patients. You are encouraged to participate, and discuss any issues which will enhance the care you are able to provide.

Quite literally, if those issues cannot be addressed in your morning huddle, they will be elevated to the next level, and eventually, to the highest level of Ballad Health by 9:30 each morning. I’m not saying that every issue can be resolved immediately, but what I am saying is that we cannot be a zero-harm system (which remains our goal) if we don’t provide a venue to discuss patient and team member safety each day. If you feel there are equipment issues, staffing issues, or anything that you feel merits the attention of management, PLEASE participate. It is incumbent upon your manager to elevate those issues.

And then, it is important for the information to loop back to you so you know you have been heard. This is important, as any organization that wants to be successful must listen to the people who experience, every day, the strengths and weaknesses of the system. Some issues are easier to resolve than others, but they will never resolve if we are not discussing them. This is honestly the most collaborative way to manage our system, and our board believes in this model.

We all agree:

I think we all agree that getting more nurses, and retaining them, is our No. 1 goal. We all must work together to make this happen. There are reasons why rural and non-urban hospitals, like ours, have a more difficult struggle from this perspective. First, the payment system is designed to work against us. Under Medicare, the payment for a patient at one of our hospitals is designed to be 15-30% lower than for the same patient that goes to a hospital in Atlanta, Asheville, Nashville, Charlotte, Boston or New York. In fact, in our region, Medicare payments are among the lowest 5% in the nation. Rural and non-urban communities are deeply affected by this, and it affects those communities’ ability to retain staff.

Second, the payer mix for hospitals in our region is 70% uninsured, Medicare and Medicaid (all of which we lose money providing care for). Only 25% of our payer mix is commercially insured. This places us among the lowest commercially insured payer mixes in the United States. Contrast this with Nashville, where more than 50% of some hospitals’ payer mix is commercially insured. And even though only 25% of our payer mix is commercially insured, the vast majority of our commercially insured patients cannot afford the high deductibles their insurers hit them with. In our region, the median income for a family of 3 is $38,000. Under our Charity policy, a family in our region who makes the median income is likely to qualify for free care – meaning we write off the cost of the care we provide. Even if they have insurance, we will write off or discount their high deductible.

Obviously, in a region like ours, with little population growth, low median incomes, and with 70% of our payer mix being either uninsured or government price-fixed at below our costs, this payer mix creates challenges that are very unique. Top this off with an increasingly higher acuity of patients, and an effort to reduce the number of lower acuity admissions, and it creates significant challenges.

Back to what I started this paragraph with – we all agree that we need to hire more nurses and to retain them. Given all the efforts over the past two years to integrate our systems, and with the pending upgrade to Epic system-wide, we do believe we all need to focus even more on the experience of our nurses. As you recently saw with our upgrade to our new information technology network, the current Epic hospitals have seen an improvement in computing times. Once we roll Epic out, the Soarian hospitals will see incredible improvement in both reliability of the network, and ease of use of the system. This was a $200 million investment.

We’ve done some very special things already

Over the coming year, you will see more of a focus on how we can innovate to make the nursing experience more meaningful for our team. We will need to invest in efforts to expose you to opportunities to enhance competencies. We will certainly continue, with assertion, our efforts to hire more. And we want continued feedback from you on how we can help you feel more valued. At the end of the day, if we all agree the goal is to have more nursing support, there are things we can all do to help. You can help us by telling the story to your colleagues around the nation that they should give us a look, and they can be part of something special here, as evidenced by:

The people in our region are incredible, the culture is second to none, education is top-notch, and it’s a great place to raise a family.
This is a system that has invested in standing up residential care for women who are pregnant and who suffer from addiction or homelessness. This idea is so innovative that even the state of Tennessee announced they are expanding Medicaid for women postpartum so facilities like ours can help them get their children off to a strong start, while the mom remains safe.
We funded and started the largest Accountable Care Community in the nation, and we plan to focus on ensuring every child born in our region gets off to a strong start (we will be announcing something within the next few weeks that will, I believe, make you proud to be a part of it).
We have become nationally known for our efforts to implement Trauma Informed Care for children.
We are one of the few rural regions in the nation with a robust children’s hospital, and have been recognized nationally for our efforts to combat neonatal abstinence syndrome.
We have one of the nation’s top 50 heart programs at Holston Valley Medical Center. And despite all the financial headwinds faced by a rural health system like ours, all four of our larger hospitals are among the highest performing in their states, with two of our hospitals being ranked by U.S. News as among the top 7 in Tennessee – moving UP since our merger.
Forbes named Ballad Health as the 29^th-best employer for diversity in the United States! Our system provides more opportunity for inclusion and an environment for success for people from all backgrounds, and this makes us more attractive as a place to invest in a career. We plan to share this broadly.
The nation’s largest health Insurer and Harvard University held Ballad Health up as one of four systems in the nation that is an example for Value-Based Health Care.
While most hospital systems are increasing the cost and price of health care, we actually implemented a 17% price reduction for all our physician and urgent care sites. We did this as part of our strategy to reduce unnecessary ER visits, and to make healthcare more affordable for people who are paying more out of pocket due to their income or high insurance deductibles.

I can go on, and the list is very long of accomplishments you’ve made. Sharing our story is a very important thing you can do to help. And you are not just helping Ballad Health when you do this. You are helping yourself, your colleagues and the region, because by attracting more nurses, we can improve the workload issues you feel due to the shortage.

Now, I’ve told you what you can do to help, but that means we, as leaders, must do our part as well. Recently, we asked for your input, and you’ve provided it. Over the next several months, we will be taking the input you provided, and we will be acting on it wherever we can. We believe our caregivers want to feel valued, and that we are investing in your growth and competencies. This is absolutely fair, and it is something a health system should do. Our ultimate goal is to be fully staffed, and to make sure when you come to work, that you feel you have the resources you need to optimize your skills. That’s the goal, and that’s the journey we are on together.

Transparency in financials:

Often, we talk about quality and other issues, but we don’t do so in the context of resources. In a nutshell, here are some facts that I think you should be aware of.

Two years ago, Wellmont and Mountain States had a combined operating income of $12 million, and cash flow of $200 million. This sounds like a lot of money, but what it amounts to is a .006% operating margin. It is widely accepted that anything less than a 3% margin for hospitals means those hospitals are in financial jeopardy. And this was true for us. In fact, independently, The Tennessean (the newspaper of record for Nashville) did a special story about the death of rural hospitals. Four of our hospitals were named specifically at risk of financial collapse – Laughlin Memorial, Takoma (both hospitals in Greeneville), Holston Valley and Unicoi County. We had no input into this story, and the data they used was a valid public source. The data they used was accurate, and we were able to validate it. Here is the article for your reference: www.tennessean.com/story/news/health/2019/05/16/tennessee-rural-hospitals-closing-medicaid-expansion-ballad-health/3245179002.
Without this merger, each of the legacy systems would likely have joined larger systems based elsewhere. This recently happened in Asheville, N.C., where HCA acquired the formerly not-for-profit Mission Health. Here are a couple of articles related to this:

https://wlos.com/news/local/macon-county-citizens-register-complaints-over-hca-mission-deal

https://wlos.com/news/local/questions-about-hca-takeover-go-unanswered-residents-say

Striking to me is the article where the community was complaining about the results of that acquisition – not so much that they were complaining, because it is understandable there will be complaints when a respected for-profit health system owned by shareholders on Wall Street buys a local community hospital. What is most striking is the commentary that the local people don’t even know how to raise their concerns, because they have lost local governance. Our board remains local, and they hear when there are complaints. They expect us to be responsive. In our case, as we all know, the public has had countless opportunities to express themselves – in public. We have COPA monitors who investigate those complaints. And even The Joint Commission came to investigate complaints – finding zero validation of the quality of care complaints. The notion of the merger was to maintain local governance and to own the responsibility for the difficult decisions. We have made some very difficult decisions, indeed. We learned that we didn’t communicate so well at first, but we listened to our team members who said we should be more inclusive of them as we communicate difficult decisions. Hopefully, you feel we have gotten better about this, even if you may not like the decision we’ve had to make.

We have done an outstanding job with our finances

Why do I raise this as part of my email related to finances? Because our board has the fiduciary responsibility to consider the financial stewardship of the hospitals, so that they may remain viable. The Tennessean article was right. It was not sustainable for one of our three tertiary hospitals – an extremely important hospital – to fail financially, or for both hospitals in Greeneville to fail financially. The financial situation faced by those hospitals was not the fault of the people who work those hospitals, but rather, a history of irrational duplication of services, a poor payer mix, and carrying the cost of duplicated corporate overhead. The challenges faced by these hospitals were not the creation of Ballad Health. They already existed. And all of you who have worked in these hospitals for years, know what I mean. The day the merger closed in 2018, there were 80 contract nurses at Holston Valley – almost double the rest of the system combined. ER wait times were a problem, with LWOTS being north of 2%. Over the past two years, we have been attempting to put strong leadership in place at these hospitals, and I think most of you would agree that our CEOs and leadership teams are more operationally focused, and dedicated to solving these issues. And they must be solved.

What has the result been after two years? As I mentioned earlier, nursing turnover has decreased. We have fewer contract nurses than before. Holston Valley went from an operating loss of $12 million in 2018 to a positive operating margin in 2019 of $9 million. Greeneville’s financials have stabilized, although it remains cash flow negative.
Why has it been important to balance the financial solvency of our hospitals with the expansion of access and investment in to technology? Let me explain our cash flow to you: As I said, two years ago, we produced only $12 million in operating income and $200 million in cash flow. Last year, we produced $40 million in operating income and $250 million in cash flow. And we did this with 5,000 fewer discharges, resulting in a loss of $50 million in revenue. Keep in mind, the nursing salary increases we made amounted to $10 million annually. So we literally committed almost our entire operating income to nursing wage increases. Had we not focused on improving our efficiency, the difficult payer mix we have would have precluded us from being able to make the investment in increasing our nursing salaries. Increasing our salaries, helped us recruit more nurses, and decrease our turnover. In turn, this helps us stabilize our staffing over time, which reduces the need for contract labor. This cycle, over time, will reduce our costs, and improve our service.

Here’s how we spend our money

Now, why is our “cash flow” important? And what does it mean to you? Let me walk you through how we spend this money. Last year, we had $250 million in cash flow. Right off the top, we have to make our debt payment, which amounts to about $75 million per year. This leaves $175 million of cash flow. This year, we will spend all of that on capital expenditures: A new hybrid OR at HVMC, new patient beds at various hospitals, upgrading our computer system (Epic will cost $200 million over the two-year project), new ultrasound equipment, new cath labs, upgrading the exterior of Johnson City Medical Center, and the list goes on. As a NOT-FOR-PROFIT, any cash flow gains we have MUST be reinvested back into the health system. The stronger and more stable our financials, the more we can invest into things like salaries and capital. In case you are wondering what the difference is between operating income and Cash flow, the operating income is the net income for the system, including depreciation cost. Depreciation is an accounting mechanism designed to expense the decreased value of past capital investments. Cash flow also includes any gains or losses from our cash reserves that are invested. The cash flow is what we focus on to ensure we can properly meet the capital needs of our system.

Beware of unfair comparisons

1. Recently, some brochures were floating around on the internet that showed a local for-profit group of diagnostic centers are much less expensive than diagnostics provided by Ballad facilities. It may be true that, for some patients, Ballad is more expensive, but the pricing comparison that was done was highly misleading and bordered on being dishonest. No patient pays what hospitals charge, and any organization that represents anything to the contrary is not being responsible with the information. If Ballad is more expensive for some patients, there is a reason for it. Last year, Ballad Health provided $30 million in free care for people who cannot pay. The organization that ran the brochure with the pricing comparison had $15 million in revenue, and only provided $2,000 in free care for the poor. The playing field is not level. Our diagnostic capabilities must be available 24/7, and we must provide them to all who need them regardless of ability to pay. A for-profit diagnostic center does not have this obligation. That’s not their fault. It is just the way the system is designed. What is not fair, however, is for that for-profit center to refer the uninsured patients to our hospitals, and then to advertise the pricing disparity knowing that no one pays the price the hospitals charge.

Further, when our charity policies are applied, the fact is that many people will actually pay less at a Ballad facility than at a for-profit facility. We plan to take steps to educate the public about this, but the problem that faces ALL community hospitals is that we have a responsibility to care for the poor, and we do so enthusiastically. Some organizations will cherry pick those who can pay, and they make a handsome profit doing this. Ballad Health is disproportionally affected, because so few of our patients are commercially insured. So with a higher burden of uninsured, Medicaid and Medicare, that cost gets shifted and so, yes, at times, some patients may pay more at Ballad for these services. But the price disparity is NOT what has been advertised by our competitors. You can help dispel this by telling people the best way to find out what it will cost will be to call our scheduling department and that of our competitors, and ask what the out of pocket costs will be. Ballad is always prepared to make a commitment on what the cost will be in advance when it comes to outpatient diagnostics, and we will stand by that. Other steps are being evaluated to help improve the value of these services, and we will continue communicating those to you.

We are providing value-based care

2. What impact does “value-based care” have on our financials? Ballad Health’s service area experiences about 126 admissions per 1,000 population. These use rates are declining. Why? Because we, and our physician partners in the region, are working to do that. Because the payment system has changed to reward physicians for lower cost of care, more efforts are being made to reduce inpatient utilization than ever before. We have seen, over the past two years, a decline of nearly 9,000 admissions. Why so many? Because our region has no population growth. As we have worked to reduce the number of lower acuity admissions, thus reducing the overall cost of care, the fact that we have no population growth means that reducing our inpatient use rates actually results in a decrease in our business and revenue. Places like Nashville, Atlanta, Charlotte, etc., all have had population growth. So as their inpatient use rates have declined, they’ve been able to continue growing their business. In our case, if you assume we generate $10,000 per admission – then this means we have had, with 9,000 fewer discharges over two years, a loss of $90 million in top line revenue. In order to sustain our operating income and cash flow, we have to manage to this lower revenue. This is made a bit more difficult when the cost of pharmaceuticals, particularly for cancer drugs, have increased by, in some cases, double, and certainly when we face labor market shortages. But, we have been able to do so through the hard work of our physicians, managers, and you. How do I mean? Well, in the last two years, YOU have reduced C-diff by more than 40%. That improved care for our patients, and saved significant dollars on length of stay and readmissions. Of the 17 harm measures, we have seen significant improvement on 12 of them. This clinical improvement helps reduce costs. Also, many of the lower acuity admissions are Medicare, Medicaid and uninsured, where, as I said, we generally lose money.

3. The Value Equation is simple: VALUE = QUALITY / COST. In order to improve the value of the services we provide, we have to improve our quality while also holding costs down. That’s the value equation our payers are demanding, and more importantly, the consumers are demanding. We should hold this equation up as the benchmark for all we do. And I believe we are doing this well. So does Harvard University and the nation’s largest insurer, who have literally held Ballad Health up as a model. If you are interested in learning more about Ballad Health being highlighted as an example, here is the Harvard publication: https://newsroom.uhc.com/content/dam/newsroom/Harvard%20Report_FINAL_0923.pdf

To be sustainable, we’ve adapted to a new business model, and it is working

4. Finally, with all these moving parts, what is the impact on Ballad in the future and can we sustain our business? The answer really relies upon our willingness to adapt to the environment, to be proactive, and to recognize the old model of hospitals is not what the future holds. Many people have said Ballad Health is a monopoly. THIS IS NOT TRUE. In fact, only 40%of our business is inpatient, while 60% is outpatient. While true that we have all the inpatient beds in our region, this is the part of our business that is declining – due to all the reasons I mention above. The outpatient environment is highly competitive, as evidenced by the fact there are for-profit competitors wrongly promoting inaccurate pricing differentials to generate more business for themselves. In the home health, diagnostic, laboratory, surgery center environments, and virtually every outpatient service, we have significant, strong and aggressive competitors. It is really important to understand what has happened in rural America. Hospital systems that have enjoyed a heritage of serving rural and non-urban America are dying. For profit systems like Community Health Systems, whose entire heritage sprang from serving rural America, is now selling or closing its rural assets. Lifepoint, another for-profit company springing up from rural America, has done a leveraged buy-out, and has focused its efforts on acquiring larger hospitals and health systems. HCA, the leading health system in America, long ago exited rural markets and focused only on urban and suburban markets where there was population growth and healthy payer mix. The strategy of abandoning rural and non-urban markets has served the for-profit hospital industry well. They are all doing better. What’s left are rural communities all over America that are losing their hospitals. Our efforts to merge our two rural systems to create synergy, scale and a runway to get through these difficulties was indeed unique. There are people who have very deliberately spread bad information about Ballad Health that most of you know not to be true. But what is provably true is that our rural hospitals are not closing, we are investing in new services, we have recruited more than 150 new providers (doctors and advance practice providers), and we have stabilized our financials. Our bond ratings have improved to “A” status, and most importantly, OUR MEASURABLE QUALITY HAS IMPROVED.

This is not to say there are no challenges. Clearly there are. But one thing I have learned in the last two years is that the most powerful people who are able to understand and explain this are the people who have dedicated themselves to serving our patients, and that is you. This is why I am going to go to great pain to try and explain the “WHY” behind what we do. Our health system exists to serve our region. This means we have to provide high quality service, taking care of our neighbors, and we must do so while being good fiduciary stewards. I can’t ask you to deliver the best quality care and expect you to do so in a vacuum. You have a right as a member of this team to also understand the financial implications that surround us. You should ask questions of your leadership in the hospitals about the system’s financial performance, and ask them to educate you on how it translates into what goes on in our care sites. I promise you, the strongest financial performance of a not-for-profit system inures to the benefit of our patients because we do invest it back. Other than paying back our loans for significant past investment by both health systems, our cash flow does not go into the pockets of investors. It is invested in our people and our assets through operating and capital investment.

Quality:

I have highlighted a couple of important facts, such as our improvement in 12 of the 17 harm measures, with some of our results being top decile performance. Four of our hospitals are among the highest performing 30% in both Virginia and Tennessee (JCMC, HVMC, JMH, BRMC) according to U.S. News. Smyth County has the highest patient satisfaction in Virginia. Our system is the 29^th-most diverse company in the United States, ranking right alongside Disney and Johnson & Johnson. Harvard and United Healthcare have held Ballad up to the rest of the nation as a model in Value Based Care. And we have done all this in an environment where the evidence and research shows that hospitals with low commercial insurance mix generally have lower quality (we have among the lowest commercial payer mixes in the nation, and yet, two of our Tennessee hospitals, HVMC and BRMC, are among the top seven in Tennessee, according to U.S. News, and as I said, all four of our larger hospitals have top performing programs in both Virginia and Tennessee, placing them among the top 30% of all hospitals).

Beware: The star rating system is flawed

Recently, someone pointed out to me that our three tertiary hospitals – HVMC, JCMC and BRMC – when measured by the Medicare “Star Ratings,” only have one or two stars. I feel it is important to comment on this, because this is absolutely a misleading and unfair thing to do – for two reasons: First, the data used in the star ratings goes back as far as 2015. Attacking Ballad Health for data that precedes Ballad’s creation is not reasonable.

And secondly, it is widely known that tertiary referral hospitals suffer from lower star ratings, generally. Tertiary hospitals that accept referrals from community hospitals, particularly those where there are significant poverty and social determinant issues, tend to have lower star ratings. By way of example, in our system, Norton Community Hospital has 5 stars. Unicoi has 3 stars. Hawkins County has 4 stars. HVMC, JCMC and BRCM have 1 or 2 stars. This is not to diminish the incredible work at the hospitals that have 3, 4 or 5 stars. But let’s not forget that the complex patients end up at the three tertiary hospitals. Other systems, like Erlanger, Methodist in Memphis, Shands Hospital at the University of Florida, Memorial Herman in Texas, and other major tertiary and academic hospitals, generally tend to have 1 or 2 stars. This has been a major issue that the American Hospital Association has taken on, and even the Centers for Medicare and Medicaid Services acknowledges. If someone asks you about the star ratings, it is important to educate them on why they should not rely on that data alone to make their health care decisions. It can be misleading and harmful. While I applaud Norton Community Hospital for having 5 stars, it cannot be credibly said that Norton is a better hospital than HVMC, JCMC or BRMC. My argument is that they are all excellent (as evidenced by Norton’s consistently high rankings for programs like rehabilitation, etc. and our tertiary hospitals’ rankings in multiple services), and there are objective measures that prove it. The star rating system is extremely flawed. This is why a majority of Congress has asked CMS to change the system. Here is some information that may be helpful to you as you attempt to understand it:

I think we would all agree that HVMC, JCMC and BRMC serve highly vulnerable and very high-acuity patients. There is no proper way to compare those three hospitals with community hospitals that have different missions and purpose. This is why we constantly caution people NOT to rely upon simplistic tools that minimize the differences between hospitals and health systems. Rural systems with hubs like HVMC, JCMC and BRMC are unique in the complexity of patients and very difficult economics in the region. When compared with highly respected institutions with provably high quality, like Memorial Herman, Shands University of Florida, Mount Sinai, Cleveland Clinic Florida, JFK Palm Beach, Erlanger, etc., our hospitals excel in quality and performance. Using data that is as old as five years, and comparing these hospitals to community hospitals with nowhere near the complexity or population challenges faced by communities that have the social determinant and economic issues faced by our institutions, is not helpful to the public and can lead to ill-informed decisions.

We monitor the quality metrics that we know lead to better outcomes. We continue to see where rankings based on more focused measures, that are more current and reliable, tell a clearer story. In fact, our four largest hospitals are literally among the highest performing in their states, based on this objective and focused data. For example, U.S. News, based on much more recent data, says that BRMC, JCMC, JMH and HVMC all have among the highest performing programs in 12 programs combined. Fewer than 30% of the hospitals in Virginia or Tennessee have ANY high performing programs.

We have a lot to be proud of, because since these ratings have come out, our measurable quality has actually gotten better. The only question is whether our quality has improved at a rate higher than our peers, and we will continue to monitor that. We believe it has, but real, objective data is what we must rely upon… not a jumbled mix of information from several years ago.

What’s ahead?

There are many opportunities that lie ahead. What are some of them?

We have already announced our intent to build an urgent care in Banner Elk, N.C., and a new Urgent Care off Stone Drive in Kingsport.
We plan to open Lee County’s hospital in the coming year.
We plan to add pediatric ERs in Kingsport and Bristol, with the Bristol facility opening by summer. In Bristol, they are so excited about it, a community donor stepped forward and contributed more than $1 million toward the development of the pediatric ER. Why is this service relevant? To put it plainly, 17,000 ER visits in Sullivan County last year were pediatric.
We plan to expand our emergency cardiac network to include Greene County, which we are very excited about. This will improve door-to-needle times for our many patients served by the hospitals in Greeneville.
Soon we will be announcing a major investment into orthopedics that will enhance our ability to serve patients using the most advanced technology available.
We will lead the nation in advancing cardiac care using technology that identifies the risk of a cardiac event before it happens.
We will follow the best practices in trauma care, continuing our deployment of a regional, high-performance trauma system in partnership with EMS.
We have now recruited not one but two pediatric surgeons to add to our compliment at Niswonger Children’s Hospital, which will enhance our ability to keep children here, and provide consistent trauma and emergency surgical coverage for children. This recruitment happened because of our partnership with ETSU.
Again due to our partnership with ETSU, we now have a new pediatric neurologist serving our children in the region.
We have agreed to fund the Center for Rural Health and Research, which will attract meaningful investment into our region in the area of access to rural health, and which will measure all the incredible steps we will take to improve the lives of our children through our soon-to-be-announced Strong Starts Initiative. Our investment into the Center for Rural Health and Research at ETSU drew support from the State of Tennessee, with the state matching our investment. Therefore, Ballad Health’s investment went from a $15 million commitment, to providing more than $25 million over the next 10 years. This center will contribute to knowledge nationally and internationally related to the provision of rural health and health care for underserved communities.
Our new Dental Residency Program, funded by Ballad Health, will be started in Southwest Virginia.
Of the more than 150 new providers we have recruited, many will begin their work over the next several months, while many have already begun work – expanding access to services like cardiology, orthopedics, primary care, etc., in our rural communities.
We have begun active planning for conversion of Greeneville Community Hospital West into a residential facility for women who are pregnant and whom suffer from addiction or homelessness. We believe people all over the nation will watch us to learn from what we do here.

The list is long, and there are so many things Ballad Health is doing to improve our region. Some of these things will be announced in the coming weeks and months, as I’m not yet in a position to discuss them due to their delicate nature. Suffice it to say, these things will improve the quality of life, and add jobs, for our region.

We have the opportunity to make our system and our region stronger

I’m proud of what we have all accomplished over the last couple years as we’ve come together. Bringing two systems together is not easy under the best of circumstances. But it’s done. And what lies ahead is opportunity that can only make our region stronger. We must focus inward on our team members and physicians to ensure we are able to perform our core functions, and we must ensure this is a place our team members want to be, and where our physicians want to practice. I’m confident that when we focus on things, we are successful. And this will be no different.

Thank you for all you do, and God bless each of you.

Alan

Alan Levine

Chairman and Chief Executive Officer

Ballad Health