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State-sanctioned hospital monopoly raises concerns – KFF Health News


THE Federal Trade Commission has long argued that competition makes the economy better. But some states have blocked the agency from blocking hospital mergers that create local or regional monopolies, and the results have been disastrous.

Two dozen states at one point passed controversial legislation waiving anti-monopoly laws, allowing rival hospitals to merge and replacing competition with extended state oversight.

Six years ago, Tennessee and Virginia ushered in the nation’s largest state hospital monopoly with the creation of Health Walk. For most of 1.1 million residents of the Tri-Cities region of northeast Tennessee and southwest Virginia, the merged system became the only option for hospital care.

The argument Ballad made was that two hospital companies could not survive in the region and a merger would prevent their closure or takeover. But critics say fears of a monopoly that would endanger access and quality of care have come to fruition. For example, since the merger, patients spend three times more time in the Ballad emergency room prior to hospital admission, according to reports released by the Tennessee Department of Health.

“I don’t want to risk my life further and die in a hospital,” Ballad said Neil Osborne, a member of the city council of Bristol, Virginia. In an interview, Osborne said he spent 30 hours in Ballad’s emergency room this year while suffering a diabetic attack. “Wait times just to get in and see a doctor in the emergency room have increased exponentially. »

The legislation that created Ballad is known as the Certificate of Public Convenience, or COPA. The FTC has repeatedly warned states to be wary of COPAs, which “exist only to protect a merger that would otherwise be illegal under antitrust law.” Rahul Raodeputy director of Competition Bureau at the agency, told KFF Health News in an interview last year.

There were approximately 10 hospital mergers over the past three decades that depended on COPAs, and subsequently the federal government has seen rising prices, declining quality, reduced access and falling wages, Rao said.

Since Ballad’s COPA, the merged system has did not meet most quality of care goals set by States in recent years. He has failed to deliver on his charitable care promises made to Tennessee by approximately $191 million over a period of five years.

Ballad attributed her quality struggles to the coronavirus pandemic, her charitable shortfalls to Medicaid changes and her longer emergency room stays to staffing and layoff issues that she says are out of her control.

Ballad said emergency turnaround times for admitted patients had dropped to around 7.5 hours since its last annual report.

“On matters that Ballad Health can directly control, our performance has rebounded from 2022,” a Ballad spokesperson said: Molly Luton.

The FTC announced in 2019 that it would study the Ballad merger but has not yet issued a report.

Legislation was introduced this year to limit COPAs in Tennessee. But on Tuesday, a state legislative subcommittee I voted to kill the bill without debate, refusing to hear the testimony of Tri-Cities residents who drove five hours to Nashville for a chance to speak out against Ballad.

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