Editorial: Ballad’s plan merits full support of the region

Editorial Board • Updated Dec 3, 2018 at 1:53 PM

Votes by political entities in the region opposing Ballad Health’s reorganization ignore reality. They express a desire to keep regional hospital services much as they are, when status quo has been shown to be unsustainable.

Wellmont and Mountain States did not merge in some scheme to squeeze the region for profit, as some continue to espouse. Plain and simple, it was a question of survival for both.

Both systems were financially unstable in large measure because they competed against each other throughout the region, duplicating personnel, systems and processes at enormous expense. Had they not joined forces, one or the other would have been swallowed by a bigger fish with little interest in the region’s collective opinion. And had that happened, initiatives such as Ballad’s plan for a visioning process on what health care should look like in Kingsport in the future would not occur.

The best possible outcome for the local health systems was to come together to eliminate the competition that would have continued in any other scenario. And that is clearly demonstrated in Ballad’s reorganization proposal, which improves the structure and delivery of hospital services throughout the region and, over time, will further streamline delivery right from where critical injury occurs, thus saving lives.

Opposition and more than a little hysteria centers on two issues: downgrading trauma designations at Kingsport and Bristol, and regionalizing neonatal intensive care.

Under the plan, Johnson City Medical Center will retain a Level 1 trauma designation, while Holston Valley Medical Center is realigned from Level 1 to Level 3 and Bristol Regional Medical Center from Level 2 to Level 3. The Sullivan County Commission’s premature and uninformed vote opposing that plan was based on claims that this will cost lives, which cannot be demonstrated by any measure.

To maintain a Level 1 trauma designation, a hospital must have general surgeons in house 24 hours a day, every day of the year, as well as the prompt availability of specialists in such areas as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric and critical care, among others.

Additionally, there are a variety of other required and costly criteria not directly related to treatment such as leadership in prevention and public education, continuing education of trauma team members, a quality assessment program, organized teaching and research efforts, and substance abuse programs, among others.

These ancillary programs are important. But if you’ve just arrived at a trauma center in critical condition because of a motor vehicle accident, for instance, they mean nothing to you personally at that moment. What does matter is that you’re going to get the same immediate care to stabilize your condition regardless of whether you’re in a Level 1 or a Level 3 trauma center.

The impact on critically injured patients of Level 1 versus Level 3 trauma capability will have some significance in Chicago, Los Angeles or Dallas, but is negligible in the Tri-Cities. Critical patient load data in this region simply does not justify the immense cost of maintaining three Level 1 trauma centers within 20 miles of each other.

Ballad treats between 450,000 and 475,000 emergency room visits per year. Of those, but 200 would be transferred to Johnson City’s Level 1 center. That means that 99.94 percent of patients would see zero impact in Ballad’s proposal. Ballad’s 20 emergency rooms located throughout the region will continue to treat patients coming in due to stroke, heart attack or injury.

It’s the same story with neonatal care. Ballad will consolidate neonatal intensive care at Niswonger Children’s Hospital even as it creates pediatric emergency rooms in Kingsport and Bristol and invests in 10 new pediatric subspecialties, all connected to Niswonger via telemedicine.

The volume of babies requiring intensive care does not justify multiple facilities in the region. And even existing facilities do not provide the complement of pediatric specialties as are planned to be available at Niswonger.

These initiatives are all the result of a comprehensive process that included objective evaluation of health care data, including trauma care. An outside consultant worked with a Ballad Health board subcommittee, which made recommendations to the entire board and management team.

Bottom line, Ballad must go forward with this plan. Otherwise the company is not a sustainable business. And frankly, this region needs Ballad to be financially stable and for the company to continue to innovate, restructure and address our overall health.

The regional community is accustomed to two major hospital systems competing with each other, which resulted in a dysfunctional, duplicative, unsustainable hospital health care delivery. Ballad has presented a sound, viable path forward. It merits the full support of the region.

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