The COPA and Cooperative Agreement sealed the merger of Mountain States Health Alliance and Wellmont Health System into Ballad Health effective in January 2018.
FTC Chairman Joseph Simons disclosed the merger happened during an FTC investigation about the merger, and the FTC ultimately had to abandon it.
"We believe competition is the best way to help consumers," Simons declared.
COPAs are regulated by states and typically require hospital systems to make a number of behavioral commitments from rate regulation, price caps, to quality and community investments and promises to keep facilities open for a set time. It grants them immunity from federal anti-trust laws, according to Simons.
Janet Kleinfelter, deputy attorney general in the Tennessee Attorney General's Office, said the impact of the COPA is too soon to tell because it's only been in effect for 16 months.
"There have been some issues, there have been some hiccups," Kleinfelter said. "I think the real test of how effective this COPA is going to be probably not until years three, four, five when we see the effects of those processes and how effectively they have been implemented."
Kleinfelter's Virginia counterpart, Deputy Commissioner Joseph Hilbert with the Virginia Department of Health, noted the competition between Mountain States and Wellmont didn't improve health outcomes in Southwest Virginia.
"This is a region that has long defied attempts to improve the health of the population," Hilbert pointed out.
Ballad Health legal counsel Richard Cowart noted Ballad Health is attempting to improve health status in a tough place — Appalachia.
"There is no COPA like this anywhere in America. Not even close," Cowart said.
Before the workshop started, Ballad Health Chairman, President and CEO Alan Levine said in a Tweet: "So proud that @BalladHealth has seen measurable improvement in quality of care since our merger. @FTC."
The Tennessee Attorney General’s office supported the decision by Tennessee Department of Health (TDH) Commissioner Lisa Piercy to approve Ballad Health’s request to consolidate neonatal intensive care unit (NICU) services out of Kingsport's Holston Valley Medical Center.
"This was not an easy decision," the office said in a statement. "The commissioner and the Ballad Board of Directors engaged in a thorough and objective analysis weighing the impact of realignment with the goal of enhancing quality of care and improving patient outcomes for the community."
Holston Valley Medical Center also lost its Level One Trauma Center designation.
Holston Medical Group President and CEO Scott Fowler called the loss of the NICU and Level One Trauma Center "bad for patients, bad for the region."
Both Fowler and John B. Syer Jr., a vice president at Anthem Blue Cross/Blue Shield in Virginia, asserted the COPA shut down outpatient services that moved into more expensive hospital settings.
"We know that the financial interests of the company drive its behavior," Fowler said.
Erin Brown, associate professor of law at Georgia State University, declared COPAs are risky ventures that states must remain vigilant about.
"If things start to go south, states need another option," she concluded.