A recent report showed Johnson City, Tenn.-based Ballad Health, which benefits from the largest state-sanctioned hospital monopoly in the U.S., has a nearly 11-hour median wait time for emergency department patients, KFF Health News reported March 25.
Ballad Health was formed in 2018 after state officials in Tennessee and Virginia waived federal anti-monopoly laws so rival systems Mountain States Health Alliance and Wellmont Health System to merge into a single company with no competition. Ballad is the only hospital care option for about 1.1 million residents in its 29-county region that stretches between Tennessee, Virginia, Kentucky and North Carolina. The hospital merger was allowed under a Certificate of Public Advantage agreement, which has been used in about 10 hospital mergers in the last 30 years, but none involving as many hospitals as Ballad's, according to the report.
Recently, the 20-hospital system released an annual report that showed patients wait for a median of nearly 11 hours in the emergency department; that figure included time spent waiting and time being treated. The report spanned July 2022 to June 2023 and excluded patients who were not admitted or left without receiving care.
According to The Joint Commission, the median emergency department time for about 250 hospitals for which it collected data was 5 hours and 41 minutes, about five hours faster than Ballad's median time.
A Ballad spokesperson told KFF Health News that by holding patients in the ED, it can observe patients waiting for a bed and avoid "overwhelming" staff. The spokesperson also pointed to the nursing shortage and fewer admissions at nursing facilities as contributing to the ED delays. The emergency department time for admitting patients has dropped to about seven and a half hours in the months since the last company report.
"On those issues Ballad Health can directly control, our performance has rebounded from 2022 and is now among the best in the nation," the spokesperson said. They also said there are fewer patients leaving without being treated, with Ballad's figure at 1.4%; the national average is about 3%.
So far, neither Tennessee nor Virginia has announced steps to reduce time at Ballad emergency departments.