The Tennessee Department of Health has updated its terms of certification covering the Certificate of Public Advantage agreement that allowed hospital systems Mountain States Health Alliance and Wellmont Health System to merge into Ballad Health in 2018.
The revisions to the terms address the company’s performance in key health care areas, prioritizing quality of care, overall system scoring, rural hospitals, charity care and listening sessions, according to a Wednesday news release. The changes come after more than a year of negotiations between Ballad and state officials.
Specific items in the revised COPA terms applicable to Ballad include increasing the weight of quality improvements from 20 percent to 40 percent in overall scoring and implementing a “pass or fail” overall score for better public transparency. The terms also include memorializing Ballad Health’s commitment to maintain its patient financial assistance policy implemented after the COPA was granted.
In addition, the department will prepare a “narrative review” for the assessment of Ballad’s performance through the end of the company’s 2025 fiscal year on June 30, 2025 in order to allow Ballad time to implement the new COPA performance scoring process for the 2026 fiscal year beginning in July.
“We will continue to be active in our supervision of the COPA, to make changes to the TOC where and when they are needed, and to listen to those in the region the COPA directly impacts,” Tennessee Department of Health Commissioner Ralph Alvarado said in a public statement. “These goals guide us, and we do not take our role lightly as we remain committed to transparency in our COPA oversight.”
The state issued the COPA in 2018 when Northeast Tennessee’s two largest health systems, Mountain States Health Alliance and Wellmont Health System, merged under the name Ballad Health. The department has since been responsible for COPA oversight to ensure that the controversial merger “provides a public advantage to the citizens of Northeast Tennessee.”
A Wednesday statement from Ballad Health called the recent changes “thoughtful and reasonable,” adding that they “take into consideration feedback the State and Ballad Health have received” from stakeholders.
“Our goals are the same. At a time when 150 rural hospitals have closed throughout the nation, and 700 more have been identified as being in danger of closure, keeping rural hospitals open for our communities is at the core of why the COPA was created,” the statement read. “Access to high quality care is a goal everyone shares.”
Moving forward, Ballad officials said the company will continue to prioritize hiring and retaining nurses to address “dangerous labor shortages” that were exacerbated by the COVID-19 pandemic.
“We are pleased that Ballad Health nursing turnover, at 12.7 percent, is now substantially lower than the national average, and our lowest in the history of Ballad Health and its predecessor organizations,” Ballad’s statement read. “Our priority remains hiring great new nurses who are committed to the values of our region and share the goals of our 12,000-team members to honor those we serve by providing the best possible care.”
This is the fifth time the state has amended and revised the COPA terms since 2018.