Part 3 of a four-part series examining how competing truths over consolidation impact a health system and its community.
JOHNSON CITY, Tenn.—In just over a week, Ballad Health will make some of the most significant changes since its formation.
On Oct. 1, Holston Valley Medical Center in Kingsport, Tenn., will become a Level 3 trauma center—downgraded from Level 1 and requiring fewer specialists. Once it’s all said and done, Johnson City Medical Center a half-hour south will emerge as the region’s only Level 1 trauma center and neonatal intensive care unit.
Ballad has said the two hospitals, owned by its predecessors Wellmont Health System and Mountain States Health Alliance, built up duplicative services that would be safer if delivered from fewer high-volume centers.
“Every study on trauma says if you dilute volume, you have poor outcomes, particularly for head injuries,” said Ballad’s CEO, Alan Levine.
But there is concern over whether Johnson City can handle the load.
“Neither one of those hospitals can swallow the overall care of both of those hospitals,” said Dr. Oscar Guillamondegui, a surgery professor at Vanderbilt Trauma and Surgical Care Clinic and chair of Tennessee’s committee on trauma, in reference to the planned trauma changes.
Formed in February 2018 through a controversial state maneuver that allowed it to avoid a federal lawsuit, Ballad is aggressively consolidating services across its 21-county region in northeast Tennessee and southwest Virginia. Many residents say they're concerned the changes are leading to unsafe conditions and higher bills, claims Ballad refutes.
In interviews discussing the trauma changes, several Ballad executives repeated Levine's belief that it’s safer to consolidate high-level services into one tertiary center, and added that very few cases would transfer from Kingsport to Johnson City.
“The majority of our trauma will still be cared for here,” said Lindy White, CEO of Ballad’s Kingsport market, which includes Holston Valley. “That’s the message we’ve done our best to integrate in the community. But not everyone has been able to grab on to that concept.”
Despite Ballad’s assurance that the changes should lead to safer care, some local residents and medical providers are deeply concerned they’ll have the opposite effect. They routinely cite the so-called “golden hour” rule in trauma medicine, which states that a patient’s odds of survival are largely determined by the care provided within the first hour. Data show Holston Valley’s coverage area extends far into southwest Virginia, where curving roads wind up and down rolling hills.