The update came from Lindy White, vice president and CEO of Kingsport Market Operations (which includes Holston Valley and Indian Path) and Chief Medical Officer Dr. Herb Ladley. The two gave an hourlong presentation to the Board of Mayor and Aldermen during its regular meeting Tuesday night.
White, who came on board with Ballad in January, repeatedly spoke of Ballad’s commitment — to Kingsport, to a regional strategy for providing health care and to the city’s two hospitals.
“Since I’ve been on the ground, I’ve had a lot of conversations with the medical staff and our frontline staff. What I’ve heard unanimously is they really want to enhance care here in Kingsport,” White said.
Holston Valley will continue to serve as a tertiary referral hospital, White explained, which means other hospitals will refer to it for advanced services. Indian Path will serve as a community hospital, managing a wide variety of conditions.
Over the next 12-24 months, White said Ballad would be pursuing designations for heart and orthopedic centers of excellence for Holston Valley, along with plans to recruit specialties and sub-specializations for the hospital.
Within the past year, Ballad has recruited 37 providers and six ER physicians for the Kingsport market. On the nursing front, White said the goal is to hire 50-60 new nursing graduates this year. So far, Ballad has recruited 40, and they should be officially on the job in the fall.
A number of investments at Holston Valley have already taken place or are on track for later this year, including a new CT scanner, a 3T MRI, new cardiac cath labs and an expanded robotic surgery program. Indian Path will receive a new 64-slice CT scanner.
And these were being done despite the fact both hospitals are running with negative operating margins, White said.
“And we’ll continue to make commitments in the coming years,” White said. “We look at it as one hospital with two locations.”
BY THE NUMBERS
Two slides in White’s presentation were all about statistics — the number of emergency room visits, surgeries and deliveries at both hospitals. According to the information:
— Holston Valley in 2018 had 62,889 emergency room visits, 11,035 surgeries and 938 deliveries. Ballad’s projection for 2019 has ER visits at 59,004; surgeries at 10,965 and deliveries at 815.
— Indian Path in 2018 had 28,794 emergency room visits, 3,414 surgeries and 715 deliveries. Ballad’s projection for 2019 as ER visits at 28,968; surgeries at 2,900 and deliveries at 916.
White’s presentation also included some financial information on Holston Valley and Indian Path. In 2018, the Kingsport facilities saw $4.2 million in positive cash flow. In 2019, White said Ballad anticipates that number being close to $12 million.
“The good news is we’ve made some marked improvements from 2018 to 2019. The more difficult thing is when you add on $23 million in depreciation. We will have to fund this over time,” White said. “That’s the number that gets really concerning. We’re not generating enough cash from operations to fund the depreciation. We’ve made progress ... but we have our work cut out for us.”
IMPROVEMENTS AND OPPORTUNITIES
White said she is working collectively with the medical staff to take a hard look at the 20 operating rooms found in Kingsport and how the two hospitals can become more efficient. Much work is being done on how to improve care and the patient experience.
Another major issue also deals with staffing, White said. Ballad currently employs 2,600 people in Kingsport, and like other communities across the country, the company is dealing with a nursing shortage. Of the three reasons why health care professionals leave their job? Leadership, compensation and the hospital’s culture, White said.
Ballad is trying to improve that, White said.
“What we're doing, and what we’ve found to be effective is to focus on the last bullet point, to build a just culture and have more frontline engagement,” White said. “We’re committed to building a more positive culture and work environment.”
During BMA comment time, Alderwoman Jennifer Adler asked White about an update on the downgrade in the trauma level and changes to the NICU at Holston Valley.
White said a team has been working on the details of a standard of work and transition plan for the trauma center, with the change taking place “close to the first quarter of 2020.” Ballad has been working with medical professionals, the care teams and EMS on this transition plan, White noted.
“I feel confident we’re going to have a solid transition plan,” she said.
As for the NICU, White said Ballad is still awaiting the decision from the state on that designation.