Rep. Hicks voices concerns over Ballad Health during certificate of need bill talks

NASHVILLE, Tenn. (WJHL) — State Rep. Tim Hicks (R-Gray) didn’t want to limit his disappointment about a watered-down “certificate of need” (CON) bill to a meaningless “no” vote on an amendment in Wednesday’s Tennessee House Health Committee meeting.

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Hicks used the bully pulpit, with a caveat to the committee chairman that “I hate to do that,” to express serious concerns about Ballad Health.

“It’s something that I have been interested in since I got here four years ago, and I’ve supported this every single step of the way,” Hicks said of CON reform, which is designed to increase competition in health care services by eliminating hurdles.

He said expectations seemed to keep changing on the Senate side and that CON was very important to Northeast Tennesseans because they see its reform as a potential antidote to Ballad Health’s inpatient monopoly.

“The people I serve, whenever I went home, they’re over being mad,” Hicks said. “They’re over being upset. They’re sort of sad and they feel betrayed now, and that’s sort of sad when you go home.

“This is the biggest issue that we have in Northeast Tennessee. There’s no question.”

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Hicks spoke after the committee passed an amendment to keep CON requirements for outpatient diagnostic centers by a vote of 18-6. Four of the no votes came from Northeast Tennessee lawmakers Hicks, David Hawk (R-Greeneville), Gary Hicks (R-Rogersville) and Timothy Hill (R-Blountville).

A CON working group had recommended phasing out the requirements for nearly all health facilities and replacing them with licensure rules. In a nutshell, CON laws require groups wanting to establish new healthcare facilities in multiple categories to show a need for the service, and those applications can be challenged by existing providers or anyone else.

Numerous states have eliminated CON, but opposition among some Senate leaders to the whole-hog approach led sponsor Clark Boyd to make some changes.

“We’ve worked with a lot of folks to get this bill in a posture where it can move forward and it’s probably not 100% of what everyone on this committee wants, but I think it’s probably 75 or 80% of what we want,” Boyd said.

All four Northeast Tennessee reps voted “yes” on the final version that will go to the Senate, but both Hicks and Hawk took time to express their displeasure. The subject of competition carries particular weight in Northeast Tennessee partly because Ballad has a monopoly on inpatient services granted by the state in 2018.

That was when Mountain States Health Alliance and Wellmont Health System merged to create the new hospital group, enabled by a structure that requires oversight from the Tennessee Department of Health and Attorney General to ensure the system provides a public advantage.

Hicks seemed to suggest the current oversight and communication surrounding Ballad wasn’t satisfactory to him.

“I’m not gonna talk bad about people because that’s not what I’m here for, but I am here because I believe in … getting people sitting around a table and talking about issues and collectively trying to solve issues,” Hicks said.

“I want to give out a challenge to Ballad’s leadership, all the departments, the AG has a role in this, the Department of Health has a role in this, the Northeast legislators, we all have a part in this,” he continued.

Hawk, who has been increasingly critical of Ballad recently, went further.

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“Ballad Health System in particular, the healthcare system and its CEO Alan Levine have created an incredibly divisive situation in Northeast Tennessee where they are heavy-handed and they are weakening health care in our region,” Hawk said.

“That’s reflective of what you saw just a few moments ago,” he added, referencing the amendment on outpatient diagnostic centers.

Boyd, the House sponsor, said he wished the bill reflected the working group’s recommendations.

“To quote Clint Eastwood in one of his Dirty Harry movies you have to, you gotta know your limitations, and this was very fragile how we put this together, and in order to get something passed we have worked with the different stakeholder groups,” Boyd said.

“I hear the grief and I hear the concern from my colleagues from East Tennessee, and I want you to know that I don’t disagree with you at all.”

Neither did Dan Bragg, Chief Administrative Officer for State of Franklin Healthcare Associates (SoFHA) — at least when it came to the desire for a stronger CON reform.

“We’re very concerned that services are being left under CON and the time frames that are in there are long for moving things out of CON,” said Bragg, whose provider practice group recently became employee-owned. Several of the measures don’t take effect until 2027 and 2029.

“Our support was for the original proposition … because our position is we want to provide great care for our patients, that’s always the number one thing, and we are trying to remove barriers to that,” Bragg said.

Ballad CEO Levine offered a written response to questions about Hicks’s comments in particular, saying Ballad agrees “(I)t’s important for everyone to listen to each other.”

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“I applaud Rep. Hicks for taking the position that we all need to work together,” Levine wrote. “First to understand the problem, and then to focus together on the solutions.”

Levine said when it comes to CON — the system wasn’t originally allowed to oppose applications under the merger terms, but now is — Ballad hasn’t opposed a single diagnostic center in Hicks’s home county of Washington.

Levine also wrote that Ballad has not opposed any surgery centers except a Karing Hearts cath lab, which was granted a CON by the Tennessee Health Facilities Commission.

“So, I’m not sure what the frustration is there. There are more competitive diagnostic centers, urgent care centers and surgery centers in the Ballad Health footprint today than there were when Ballad Health was formed. So, I’m unclear what the issue is there, as there is more competition, not less.”

Levine did acknowledge that the frustrations he said are common throughout the country over wait times, hospital closures and health care generally “is happening all over the place” including Northeast Tennessee.

Levine ended his response by saying Northeast Tennessee’s legislative delegation made the right choice in supporting the 2015 law change that allowed for the creation of Ballad.

“Frankly, if not for the legislative delegation supporting the creation of the (Certificate of Public Advantage), our region today would have fewer hospitals, and very likely our health care would be controlled by people who live somewhere else,” Levine wrote. “That was the path we were on, and I can only point to the evidence related to hospital closures, which continue to occur almost weekly.”

The Tennessee Senate has yet to finalize its version of the CON reform bill, which is sponsored by Republican Shane Reeves.

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