Wellmont Health System and Mountain States Health Alliance got what they wanted out of the Tennessee Department of Health, a Certificate of Public Advantage (COPA) that will allow them to merge in the state and become Ballad Health.
The two systems are seeking a Cooperative Agreement from the Virginia Department of Health (VDH) to merge their Virginia assets.
They aren’t speculating about a possible Plan B if VDH, under the administration of Democratic Gov. Terry McAuliffe, turns them down later this month.
In other words, would they sell their Southwest Virginia assets to another hospital system if the Cooperative Agreement fails? Or continue to operate them separately? Or wait until 2018 when a new governor takes office and then take a shot at another Cooperative Agreement?
“We trust that Virginia will see the same benefits for their citizens and will also render a positive decision,” Wellmont spokesman Jim Wozniak said in an email. “We don't want to speculate about any other possibility.”
A summary of an August meeting between VDH Commissioner Dr. Marissa Levine, Wellmont/Mountain States’ leaders and other state officials indicates the Cooperative Agreement is getting a lot of scrutiny. More than 20 people were in the room, according to the summary.
Allyson Tysinger, senior assistant attorney general in the Virginia Office of the Attorney General, explained some of the key differences between Virginia and Tennessee law concerning proposed cooperative agreements. She explained that according to Tennessee law, prior to granting a COPA the parties and the Tennessee Department of Health agree upon terms of certification and specific conditions that assure public advantage. Tennessee uses more of a contractual approach. In Virginia, the law states the health commissioner may “reasonably condition” the approval of the proposed cooperative agreement upon the parties’ commitments.
She explained if the commissioner approved the cooperative agreement, it would be done in an order with conditions imposed within the order.
Dr. Levine, meanwhile, told the Wellmont/Mountain States contingent that several members of Virginia’s application review team recently traveled to the Remote Area Medical Clinic (RAM) in Wise County in order to solicit additional public comment concerning the proposed merger. This was done in lieu of holding an additional public hearing. Dr. Levine told the applicants the RAM participants were eager to provide feedback.
VDH received comments from 189 individuals. Among the 189 comments, 70 expressed support for the merger and 95 expressed opposition with the remainder providing other types of comments.
Alan Levine, Mountain States’ president and CEO, expressed in the meeting some frustration with the Federal Trade Commission (FTC), which opposes the merger. He said that throughout this process, every consultant the FTC engaged submitted opinions without first speaking to Mountain States. Alan Levine mentioned, in particular, a letter stating there was no benefit associated with a common information technology platform.
Marissa Levine said her advisers are telling her that there is “not enough meat on the bone” concerning Ballad’s planned population health improvement plans.
Aside from that meeting, Virginia’s gubernatorial candidates are now weighing in on the merger.
Democrat Ralph Northam, the current lieutenant governor and a pediatric neurologist, said: "As a doctor and as your next governor, I will ensure that promises made are promises kept, and there are three essential elements to this proposed merger that must be upheld for hard working Virginians if it were to go through: That is does not restrict access, inflate the cost or hurt the quality of health care that our residents receive. This proposed merger is not happening in a vacuum — since January 2014, Virginia has given back to Washington, D.C., $10 billion of our own tax dollars that we have already paid and that would go towards expanding Medicaid coverage for 400,000 working Virginians and create 30,000 new jobs in our health care system. This lack of expansion is disproportionately hurting rural Virginia and has resulted in rural hospitals closing and mergers like this being proposed. … There are concerns that this merger may affect cost, access and quality of health care — and those concerns have been made to us by residents of Southwest Virginia who feel that this is a Tennessee centric merger.”
Republican Ed Gillespie, a business owner and former Republican National Committee chairman, said through a spokeswoman: "Hospitals provide critical services to Virginians across the commonwealth. As governor, Ed will work to increase access, affordability and quality of care. He is hopeful this merger will work to that end."