Even with those challenges, according to Ballad SWVA Chief Executive Officer Mark Leonard, the corporation had no plans to shut down any of its Norton and Wise County hospitals.
“Ballad Health is strongly committed to all three campuses,” Leonard said. “We understand what these campuses mean. The current state is not sustainable, so we’ve got to identify what that optimum model is going to be and have those conversations with those stakeholders.”
The stakeholders Leonard mentioned include school systems, area colleges, The United Way of Southwest Virginia, Mountain Empire Older Citizens and other health and social services organizations. Partnerships and dialogues with those groups can help Ballad assess the service area’s health needs, he said.
Leonard on Monday toured Norton Community Hospital and Mountain View Hospital in Norton, and he talked about issues facing Ballad since its formation 17 months ago when Wellmont Health System and Mountain States Health Alliance merged.
Nursing staff levels and local availability of specialists had been a problem before Ballad formed, Leonard said, and nursing shortages have been a nationwide problem.
He said Ballad has made progress in Wise County and Norton regarding shortages of some specialists, especially with attracting pulmonologists, cardiologists, a urologist and orthopedic surgeons to work in Norton Community, Mountain View and Lonesome Pine Hospital in Big Stone Gap.
Obstetric staffing at Norton Community and Lonesome Pine hospitals is still an issue — each has only one full-time obstetrician — Leonard said. Time off, professional education and other issues often means having to bring in obstetricians to fill in, and delivering mothers can find themselves without their regular obstetrician. He said the situation is “not sustainable.”
Leonard also said that nursing staffing levels at individual hospitals have sometimes required diverting patients to other Ballad hospitals.
“Ballad and all hospital systems across the country right now are in the midst of a nursing shortage, and some would say it’s in crisis,” Leonard said. “Our CNO and director of HR Valeri Colyer have worked very successfully with our local nursing programs. We have a very good working relationship with Mountain Empire Community College as well as UVa-Wise in order to be able to recruit from those programs as well as to establish very strong nursing internship programs.”
While Ballad is bringing on 21 UVa-Wise nursing program graduates this summer, Leonard said phasing them into area hospitals will take time as they take their state nursing board exams and complete orientation.
Health indicators among the Wise County/Norton population also drive Ballad’s planning for a health care system based on education and preventative health programs, Leonard said. Diabetes, obesity, heart disease, drug abuse/overdoses and neonatal addiction syndrome all affect how the hospitals have to use resources.
Neonatal addiction syndrome, where babies born to mothers addicted to drugs are also addicted, is a problem at Norton Community and Lonesome Pine hospitals — Ballad’s two Southwest Virginia hospitals that have obstetric units.
While the overall Virginia rate for babies with NNAS is 6.7 per 1,000 births, Leonard said, Lonesome Pine Hospital’s NNAS rate is 49 per 1,000 and Norton Community’s is 56 births per 1,000. That means that about 30 percent of babies born at each of the two hospitals suffer from NNAS, he said.
Ballad’s coordination with Johnson City Medical Center’s neonatal intensive care unit and Niswonger Children’s Hospital has helped Ballad deal with the NNAS issue, Leonard said.
Ballad is working on reopening Lee County Community Hospital as a 10-bed acute care hospital by 2020. Leonard said that could reduce patient loads at Lonesome Pine and Norton Community, since about 43 percent of Lonesome Pine’s patient load and about 8 percent of Norton Community’s load come from Lee County.
Ballad’s third Wise County hospital, Mountain View, does not have the patient load of its sister hospitals, Leonard said, Two-thirds of the hospital rooms on the third floor are kept inactive but available if needed. A ten-bed combination medical-surgical and intensive care unit can handle a mix of patients.
Mountain View’s fourth floor houses a specialized nursing and long-term care facility that recently underwent $280,000 in renovations. Leonard said Ballad is working on developing the facility and building its Medicaid rating for more use of its 44-bed capacity.
Health education programs also feature in Ballad’s planning for Southwest Virginia. A “Morning Mile” program to encourage area fifth- and sixth-graders to come to school early to walk or run a mile before classes has shown promise, Leonard said, but the key to that and any other wellness program is sustaining involvement.
Ballad has continued bringing the Wellmont and MSHA elements together, Leonard said. The SWVa. hospitals hold daily teleconferences between nursing staffs as they monitor the status of transferred patients, equipment and quality issues.
Low nursing staff levels at times may mean patients are sent to Ballad’s Tri-Cities facilities, and Leonard said that situation existed before the Wellmont/MSHA merger. Ballad has improved its patient retention in SWVa. hospitals, with 700 patients more annually kept in Wise County and Norton hospitals than during Wellmont and MSHA’s presence.
Another factor in how many patients can be admitted to the Ballad Southwest Virginia hospitals, and hospitals nationwide, is more stringent admission limitations from Medicaid and private insurance providers.
Leonard said that a patient’s condition might not meet their insurance provider’s criteria, leaving a patient to either pay full treatment cost if admitted or to wait until their condition gets worse until they meet admission criteria. Numbers of patient admissions can also decline with a declining population. Wise County has seen an 8.5 percent population decline in the past decade and could see another 8 percent drop in the next ten years, Leonard said.
While population and insurance industry factors may be putting a brake on area hospitals’ patient numbers, Leonard said operating room procedures are on the rise in Wise County by 16 percent.
“What those campuses look like is going to be different from what they are today, but I don’t see us saying we’re going to close and walk away from any of the three campuses,” Leonard said. “We don’t want to create a health care desert on any of these campuses. We believe each one of them can continue to provide a vital role in Wise County. It will likely be different than what it’s been in the past but, again, we don’t want to create a desert and do what some of the large retail operations do and say let’s just walk away from it and leave it sitting empty.”