Ballad Health announces added investment for nursing, direct care team to ensure availability during possible COVID-19 surge

and other steps to assist team members and mitigate losses due to severe volume disruption

Increased investment in direct bedside care team part of surge plan; other funds invested in helping certain team members access enhanced federal benefit while containing cost during significant destruction to service volumes.

Citing severe volume disruptions at hospitals and other care sites as a result of the coronavirus disease 2019 crisis, Ballad Health officials announced Wednesday several steps to ensure the availability of critical staff which may be needed during a potential patient surge, while also assisting team members and mitigating losses sustained by Ballad Health. These steps include investing in guaranteed hours for certain bedside positions, and, among other things, the temporary furlough of some corporate and volume-dependent positions and salary reductions for senior leaders.

“As we have shared publicly several times over the last few weeks, the COVID-19 crisis has placed a strain on our team members and our organization that is unlike anything we’ve ever seen before,” said Alan Levine, chairman and chief executive officer of Ballad Health. “We are all experiencing the anxiety, stress and uncertainty this pandemic has unleashed. Businesses large and small, families, churches, schools, governments and healthcare organizations are each struggling with the sudden and traumatic structural changes that have rocked our lives and our livelihoods.”

Over the past two weeks, a cascade of health systems throughout the nation have increasingly taken steps to address the current reality that there is not enough patient volume to support the current healthcare workforce. Whether in urban areas of economic prosperity or poorer rural and non-urban communities, a large number of systems are implementing a variety of actions to mitigate the impact, ranging from furloughs to reduced pay to closed services.  Rural and non-urban health systems, struggling even before the pandemic, are facing catastrophic financial challenges, with one major system announcing its plans to seek bankruptcy protection as recently as last week. Due to its unique nature and financial stewardship, Ballad Health has been able to avoid such extreme financial challenges, but the pandemic-related volume decline is too significant to ignore.   

“As Ballad Health has planned and implemented our response, we have done so with the safety and well-being of our team members, partners and community in mind. We have taken aggressive steps to bolster our PPE, limit exposure within our facilities, provide real-time information and updates to our team members and the public, conduct testing beyond what has been seen in most other places in the nation, and extensively plan for what could be an eventual surge in volumes related to COVID-19,” said Levine. 

“In addition to these steps, we complied with the President’s and Governors’ recommendation to limit elective procedures in our facilities – virtually bringing our business to a halt. Many of our team members have been called off or had their hours reduced over the past few weeks because of volume declines of up to 70% in many of our services. At the same time, we are facing these challenges, Ballad Health must also ensure critical staffing can meet the ongoing needs of the communities we serve.”

The actions announced by Ballad Health Wednesday address three critical goals:

• Meet critical staffing needs for bedside care, registered nurses, as well as respiratory therapists, nursing assistants and licensed practical nurses who support bedside nursing and direct patient care during the current period, and in the event of a surge in volume related to COVID-19;
• Provide relief for certain team members who have faced reductions in worked hours due to the severe disruption in patient volumes; the federal stimulus package is intended to provide relief to these individuals by providing access to temporary benefits paid for, in part, by Ballad Health, and in part, by the federal government; and
• Reduce the fixed administrative cost of sustaining the operations of Ballad Health in order to mitigate losses associated with the severe disruption in volumes. Ballad Health is projecting losses in cash flow in the next 90 days to be in excess of $150 million.

To meet critical staffing needs, Ballad Health will provide guaranteed work hours for each pay period for certain direct patient care roles, including bedside nursing, respiratory therapy, and nursing assistants and licensed practical nurses who support bedside nursing, until further notice. This guarantee will ensure, despite the reduced volumes we are experiencing, we can keep our bedside team in place in the event we face a surge of COVID-19 cases. During guaranteed work hours, if the team members are not needed for direct patient care due to low volumes, they may be asked to perform other functions that are within their scope of practice and/or which they are qualified to perform, or they may simply be called off without a reduction in pay. 

Temporarily, direct care bedside nurses typically working 1.05 FTE, will be guaranteed full employed status of .9FTE. While overtime will not be required, it is certainly encouraged if there is a need. Respiratory therapists, nursing assistants and licensed practical nurses who support inpatient nursing units and the emergency department for direct patient care during the current period will be guaranteed their full employed status.  For example, if the team member is in the system as .9 FTE, they will be guaranteed .9 FTE.  If they are in the system as .6 FTE, they will be guaranteed .6 FTE.  These guaranteed hours are intended to ensure stability in available staffing, and to ensure these critical professionals are available in the event of a surge in volumes related to COVID-19. During this time, we are also limiting travel of this critical workforce to ensure we do not lose them to illness or a mandatory quarantine upon their return.   

To provide relief for other team members who have faced reductions in work hours due to severe disruption in patient volumes, Ballad Health will implement a temporary furlough that will allow those individuals to take advantage of unemployment benefits funded in part by Ballad Health and in part by the federal government through the recently passed stimulus bill. Many team members whose work hours are traditionally scheduled based on patient volumes have seen a devastating reduction in hours worked due to the severe disruption in patient volumes imposed by (a) the government requirements to cease all elective procedures and services and (b) consumer-imposed reductions in volume during the spread of COVID-19. These team members have suffered from reduced hours and income, and in many cases, have utilized their accrued paid time off. These team members need relief. The federal stimulus bill provides significant relief for team members in this category by enabling the use of unemployment benefits in certain circumstances. In Tennessee, the typical unemployment benefit is up to $275 weekly, while in Virginia, the weekly amount is up to $378. The stimulus bill provides an additional $600 weekly on top of the state benefit.

Team members qualifying for benefits in Tennessee, and whose gross annual income is $45,500 or less, and team members qualifying for benefits in Virginia, and whose gross annual income is $50,856 or less, will likely benefit more from accessing these benefits, which have been enhanced by the federal stimulus bill. As a self-insured organization, Ballad Health will be charged for the state portion of each team member’s benefit. This expense will be borne by Ballad Health to help these team members recover lost income and to create a financial bridge intended by the federal stimulus bill. To provide access to these benefits for team members whose work hours are variable and have been severely impacted by the severe volume disruption, Ballad Health has identified team members who will be furloughed effective April 9.

During this furlough period, Ballad Health will continue to make certain benefits available to the affected team members. Specifically, health insurance and pharmacy benefits will be continued, and Ballad Health will waive the team member premium contribution during the period of furlough. Premiums for continued health/medical benefit coverage, including pharmacy, Employee Assistance Program, employer-paid basic life and accidental death and dismemberment (AD & D) and basic long-term disability in effect on the initial day of the furlough period will be paid by Ballad Health during this period. The team member’s accrued paid time off and major medical leave bank will remain in place.   

Team members may not utilize paid time off while receiving unemployment benefits. Additional paid time off and major medical leave hours will not accrue during the period of furlough. Team members will be permitted to exercise a one-time cash-out of up to 80 hours of accrued paid time off prior to commencing the unemployment period.

Furloughed team members may be recalled by Ballad Health at any time. In the event a team member is recalled, due to the needs of the organization, it is expected the team member will provide the service requested for which they are qualified and is appropriate based on the needs of the organization. If the team member chooses not to return, it will be considered a voluntary resignation by the team member, and all benefits will cease in accordance with policy and the state unemployment authority will be notified. A determination about the team member’s qualification for unemployment assistance would be made by the relevant state at that time.

When furloughed team members are called back to work, there will be no break in service time related to seniority or benefit accruals.

Furloughed team members who have extraordinary needs should notify Human Resources. Certain cases may be referred to the Ballad Health Foundation’s Team Member Assistance Fund for possible assistance.

Human Resources will work directly with the State of Tennessee to auto-enroll affected team members who are eligible for benefits in Tennessee. In this case, the team members will need to certify each Sunday that they are still part of the temporary furlough, which will secure their funds for the following week. Instructions for how to certify with the state will be sent to each affected team member. 

Because the Commonwealth of Virginia does not offer an auto-enroll option, team members who are eligible for unemployment benefits in Virginia will need to file their own claim for unemployment by visiting the Virginia Workforce Connection – or calling 866.832.2363. Team members must then certify the claim each week by calling 800.897.5630. Team members who need assistance may contact Human Resources.

To reduce fixed administrative costs during this period of severe volume disruption, team members in certain support departments, administrative functions and non-critical locations of service will be placed on furlough as well. These team members will have access to the same unemployment benefits as furloughed team members in volume-dependent positions. Any team member furloughed may be recalled based on the needs of the organization, and these furloughs will be constantly evaluated to ensure Ballad Health can meet the needs of its patients and the region.  

The federal stimulus bill provides certain exceptions to penalties for withdrawal from retirement savings. Human Resources will provide team members with information on how to access these dollars, which is at the discretion of the team member. 

Ballad Health is taking several other steps to reduce overall costs and ensure critical services are available for a potential COVID-19 surge, including:

• The compensation for all individuals who serve as senior vice presidents or above shall be reduced by 20% for 60 days, with such action being reviewed in 60 days.
• The compensation for all individuals who serve as assistant vice president or vice president shall be reduced by 10% for 60 days, with such action being reviewed in 60 days.
• The chairman/chief executive officer shall forego 100% of his compensation for 60 days. 
• Under the direction of the physician-led board of Ballad Health Medical Associates, the medical group will take immediate action to reduce certain physician and advanced practice provider compensation by 20% during this period where volumes are reduced. Frontline staff working in our physician practices or urgent cares who are not furloughed will not see any reduction to their compensation for the hours they work. Such steps shall be overseen by the board of Ballad Health Medical Associates and approved by the chairman/chief executive officer.
• Overtime in non-clinical departments may not be approved unless specifically authorized by the executive vice president responsible for that department.
• All spending on COPA-related plans is suspended pursuant to the suspension of the Terms of Certification approved by the Commissioner of Health and Attorney General.
• All capital spending is suspended unless specifically authorized by the chairman/chief executive officer.  Exceptions to this are spending related to the conversion to Epic and the completion of the new access drive and helicopter access for EMS at Johnson City Medical Center.
• Any spending on outside consultants is to be suspended, unless specifically approved by the chief financial officer. “Consultants” is not intended to apply to physicians consulting on patient care issues.
• Due to the reduced volumes, all supply inventory par levels shall be evaluated and reduced under the oversight of supply chain leadership.
• Ballad Health will suspend retirement contributions for the remainder of FY20.
• All paid time off accruals for the remainder of the FY20 will be foregone for managers and above. Except for those noted above who are affected by the furlough, paid time off cash-outs will not be approved. For those affected by the furlough, the paid time off cash-out policy will allow a one-time cash-out of up to 80 hours prior to filing for unemployment benefits.
• Other steps may be taken on a market-by-market basis to consolidate low-volume services. These steps will be approved by the market chief executive officer and chief operating officer of Ballad Health.