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Tennessee editorial roundup

December 5, 2018

Recent editorials from Tennessee newspapers:



Johnson City Press on votes by political entities in the region that oppose Ballad Health’s reorganization:

Votes by political entities in the region opposing Ballad Health’s reorganization ignore reality. They express a desire to keep regional hospital services much as they are, when status quo has been shown to be unsustainable.

Wellmont and Mountain States did not merge in some scheme to squeeze the region for profit as some continue to espouse. Plain and simple, it was a question of survival for both.

Both systems were financially unstable in large measure because they competed against each other throughout the region, duplicating personnel, systems and processes at enormous expense. Had they not joined forces, one or the other would have been swallowed by a bigger fish with little interest in the region’s collective opinion. And had that happened, initiatives such as Ballad’s plan for a visioning process on what health care should look like in Kingsport in the future, would not occur.

The best possible outcome for the local health systems was to come together to eliminate the competition that would have continued in any other scenario. And that is clearly demonstrated in Ballad’s reorganization proposal which improves the structure and delivery of hospital services throughout the region and, over time, will further streamline delivery right from where critical injury occurs, thus saving lives.

Opposition and more than a little hysteria centers on two issues: downgrading trauma designations at Kingsport and Bristol, and, regionalizing neonatal intensive care.

Under the plan, Johnson City Medical Center will retain a Level 1 trauma designation while Holston Valley Medical Center is realigned from Level 1 to Level 3 and Bristol Regional Medical Center from Level 2 to Level 3. The Sullivan County Commission’s premature and uninformed vote opposing that plan was based on claims this will cost lives, which cannot be demonstrated by any measure.

To maintain a Level 1 trauma designation a hospital must have general surgeons in house, 24 hours a day, every day of the year, as well as the prompt availability of specialists in such areas as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric and critical care, among others. Additionally, there are a variety of other required and costly criteria not directly related to treatment, such as leadership in prevention and public education, continuing education of trauma team members, a quality assessment program, organized teaching and research efforts, and substance abuse programs, among others.

These ancillary programs are important. But if you’ve just arrived at a trauma center in critical condition because of a motor vehicle accident, for instance, they mean nothing to you personally at that moment. What does matter is that you’re going to get the same immediate care to stabilize your condition regardless of whether you’re in a Level 1 or a Level 3 trauma center.

The impact on critically injured patients of Level 1 versus Level 3 trauma capability will have some significance in Chicago, Los Angeles or Dallas, but is negligible in the Tri-Cities. Critical patient load data in this region simply does not justify the immense cost of maintaining three Level 1 trauma centers within 20 miles of each other.

Ballad treats between 450,000 and 475,000 emergency room visits per year. Of those, but 200 would be transferred to Johnson City’s Level 1 center. That means that 99.94 percent of patients would see zero impact in Ballad’s proposal, Ballad’s 20 emergency rooms located throughout the region will continue to treat patients coming in due to stroke, heart attack or injury.

It’s the same story with neonatal care. Ballad will consolidate neonatal intensive care at Niswonger Children’s Hospital even as it creates pediatric emergency rooms in Kingsport and Bristol and invests in 10 new pediatric subspecialties, all connected to Niswonger via telemedicine.

The volume of babies requiring intensive care does not justify multiple facilities in the region. And even existing facilities do not provide the complement of pediatric specialties as are planned to be available at Niswonger.

These initiatives are all the result of a comprehensive process that included objective evaluation of health care data, including trauma care. An outside consultant worked with a Ballad Health board subcommittee which made recommendations to the entire board and management team.

Bottom line, Ballad must go forward with this plan, otherwise the company is not a sustainable business. And frankly, this region needs Ballad to be financially stable and for the company to continue to innovate, restructure and address our overall health.

The regional community is accustomed to two major hospital systems competing with each other which resulted in a dysfunctional, duplicative, unsustainable hospital health care delivery. Ballad has presented a sound, viable path forward. It merits the full support of the region.

Online: https://www.johnsoncitypress.com/


Nov. 29

Johnson City Press on safety around school buses:

It’s one of those common sense things we wouldn’t think we’d have to say, like “wash your hands after going to the restroom,” or “the other people in this movie theater aren’t interested in your telephone conversation about fantasy football.” But some people apparently haven’t quite picked up on the very clear message.

Don’t pass a stopped school bus.

We were incredulous when police, school officials and bus drivers told Elizabethton Bureau Chief John Thompson about an uptick in the numbers of neglectful drivers illegally and dangerously passing buses as children got on or off.

Then, this week, a 10-year-old boy was struck by a car in Jonesborough while crossing the road to get on his bus.

According to the crash report, the student was hit by a car going the other direction, which knocked him into a ditch several feet away. Thankfully, his injuries were not life-threatening. Washington County Director of Schools Dr. Bill Flanary said it was a miracle he’s alive.

The woman charged with hitting him reportedly told police she didn’t see him or the stopped bus on the road that morning.

So, what more could school buses do to let people know to stop?

There are more than a dozen flashing lights on the front, back, top and sides of each bright yellow, 45-foot-long bus. A red, octagonal stop sign, a standard traffic symbol in this country for more than 60 years, also with flashing lights, extends from the side of each bus when a child is boarding or leaving. They all have 8-inch-high letters, either on reflective backgrounds or lighted, front and back, clearly announcing they are, in fact, school buses.

Barring a complete failure of these numerous safety features, which is extremely unlikely, a properly stopped school bus is adequately visible.

The issue then, appears to us to be a lack of awareness, either drivers passing those buses aren’t recognizing that the large, flashing vehicle in front of them is a stopped school bus, or they aren’t cognizant of the potential consequences for illegally passing one.

Illegally passing a bus without causing injury is itself a class A misdemeanor, punishable by jail time and a fine of up to $1,000.


Online: https://www.johnsoncitypress.com/


Nov. 26

The Daily Times of Maryville on pharmacy benefit managers:

Imagine playing a game of blackjack at a casino where the rules are set by the house. Fair enough. Their house. But what if the player doesn’t get to know their rules? Somebody’s getting gamed.

A scenario of that analogy is being played out in the U.S. health insurance system, and Blount County is a prime example. When dealing prescriptions, pharmacy benefit managers (PBMs) hold the cards.

Simply put, by flexing their fiscal power, PBMs are able to put “the squeeze” on pharmacies that depend on these mammoth companies to dispense America’s prescription dollars. They do it under the cover of secret profit margins that enable “the spread” — the markup between what they reimburse pharmacies for a drug and what they charge clients’ health plans.

Lacking serious oversight or regulation, PBMs have conducted unfettered business practices using nondisclosure agreements, blind rates and Rube Goldberg-like financial contraptions.


Let’s divide up the sides. On one team we have the top three PBMs — Express Scripts, CVS Caremark and OptumRX of UnitedHealth Group. They control 78 percent of the prescription drug market, collecting $200 billion to cover 290 million enrollees.

On the local team are Blount Discount Pharmacy, City Drug and Lowe’s Drug, independent pharmacies in Blount County. All three pharmacies say they’ve lost money doing business with the county’s PBM.

Three years ago, Blount County’s self-insured health system was hemorrhaging. More than $1 million, one-fifth of the fund, had evaporated in just 12 months. With the fund depleting, the county hired a broker, Cole Harris, of CBIZ Inc., who selected CVS Caremark among competing bids to be the county’s PBM.

With the savings guaranteed to the county by the PBM combined with increases to premiums and deductibles for employees, the county’s plan avoided collapse.

By the middle of 2016, the county’s health fund had dwindled to $736,416, a fraction of the $6 million it totaled three years earlier. The fund is in recovery, but at what cost?

Blount County is aware of the dilemma. At a called meeting of the County Commission during the summer, a Blount Discount representative informed county officials and state Reps. Bob Ramsey and Jerome Moon that the pharmacy lost $150,000 in a 12-month period from 2017 to 2018, when it filled 13,787 prescriptions for the county government’s health plan.


Harris says CVS Caremark saves the county $1 million per year. The independent pharmacies say they expect to be reimbursed by the PBM for the cost of the county’s prescription refills, but the remuneration often falls short.

What happens if independent pharmacies go under? There are other options, often facing each other in city after city. On one corner there’s a CVS pharmacy; on the other a Walgreens.

This item appeared in The Street, a financial news website: “Antitrust concerns may keep CVS from acquiring a large number of the 500 to 1,000 stores that Walgreens and Rite Aid expect to close to gain approval from the Federal Trade Commission for their planned merger.”

Ever heard of a stacked deck?

Online: https://www.thedailytimes.com/

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