Tennessee Hospital Monopoly Falling Short on Quality 

By Consumers for Quality Care, on June 20, 2024

Ballad Health is a large 20-hospital system serving over 1 million residents in northeast Tennessee and southwest Virginia. The system was established six years ago, when Tennessee and Virginia lawmakers agreed to waive anti-monopoly laws. But in exchange for this waiver, Ballad agreed to uphold quantitative measures of quality consumer care and to report their performance on these measures. It seems, however, that the Tennessee Department of Health has largely given Ballad Health a rubber stamp of approval, as only a fraction of Ballad’s final score depends on performance standards, such as surgery complications, emergency room speed, and patient satisfaction.  

Despite Ballad’s repeated failure to provide a certain, basic level of quality care for its patients, the Tennessee Department of Health continues to give Ballad Health an “A” grade, according to KFF Health News. 

Ballad is required to report against 17 “target” measures and is expected to improve their performance each year, but the health system has a history of failing to meet quality of care standards. Between July 2021 and June 2022, the hospital missed 80 percent of its benchmarks for quality. The next year saw only minimal improvement, with Ballad Health missing 75 percent of its quality assurance protocols. In fact, Ballad’s grade can be partially attributed to the 15 points they receive just for reporting their numbers.  

Emergency-department wait times and hospital-admission times have become a major concern for Ballad. The time that patients spend in the emergency department before admission has sharply increased year after year, leading to a median wait time of eleven hours, a number that has increased threefold since the Ballad Health monopoly was established.  

Decreased competition hurts consumers, often leading to fewer options for care and higher out-of-pocket costs. CQC urges regulators and lawmakers to promote more competition and to discourage mergers and business practices that leave consumers worse off.