First quarter results: Continued quality, capital investment and operating performance

Ballad Health invests millions of dollars in new providers and capital improvements while independent parties validate high quality of care

Ballad Health today announced first quarter results from its 2020 fiscal year. Clinical quality and operational and financial results continued a positive trend.

“We are proud that independent accreditation agencies during this quarter concluded that Ballad Health’s hospitals continue providing the highest levels of quality, while at the same time, we have continued to decrease the total cost of care for our region,” said Alan Levine, chairman, president and chief executive officer of Ballad Health. “Ballad Health is doing all this while announcing major investment in increased access to care.”

Some examples of investment and activity during the quarter leading to increased access to high quality care include:

• Ballad Health’s efforts to utilize lower cost settings have been successful, with emergency department visits declining by 5,000 in the quarter and urgent care visits increasing by 4,000 over the same quarter prior year.
• The health system implemented a reduction in pricing for all physician entities, including urgent care, by an average of 17 percent, while increasing the uninsured discount for physician clinics to 77 percent.
• Leaders announced the intended transition of the former Takoma Regional Hospital toward the repurposed use as a residential facility for women who are pregnant and suffer from addiction or homelessness. Planning is actively underway.
• The Joint Commission conducted a surprise survey at one of Ballad Health’s flagship hospitals, resulting in zero findings or recommendations for improvement, underscoring Ballad Health’s commitment to quality. All of Ballad Health’s hospitals have been accredited and have performed at the highest levels during the accreditation process.
• Ballad Health continued on its “zero-harm” journey, instituting a best practice mandatory daily four-tier safety huddle initiative throughout the organization. Engaging team members from throughout the region on a daily basis regarding issues ranging from staffing to patient safety and quality of care is contributing to a systemwide journey toward becoming a top-decile performing health system.
• The Joint Commission recently provided its independent stamp of approval of the comprehensive stroke program at Johnson City Medical Center, recertifying the hospital as a comprehensive stroke center, a distinction shared by a fraction of hospitals in the United States. Bristol Regional Medical Center, Holston Valley Medical Center and Johnston Memorial Hospital, continue their service as certified advanced primary stroke centers. Recently, Bristol Regional Medical Center and Johnson City Medical Center were named among the top 10 percent of hospitals for medical excellence in stroke care by one independent organization, while Holston Valley Medical Center ranked #1 in the nation for interventional carotid care.
• Ballad Health’s accountable care organization, AnewCare Collaborative, was named by the U.S. Centers for Medicare and Medicaid Services (CMS) as one of only 18 in the nation to have achieved savings in each of the 6 years of the federal program, while at the same time achieving quality scores in excess of 90 percent.
• The health system improved screening rates for cancer, diabetes and hypertension.
• Ballad Health expanded the infusion center at Russell County Hospital.
• 3D mammography is now available for the region served by Smyth County Community Hospital in Virginia.
• Ballad Health’s Cancer Center at Greeneville Community Hospital was reaccredited by the Commission on Cancer of the American College of Surgeons.
• Norton Community Hospital’s inpatient rehabilitation program has been recognized among the top 10 percent in the nation for the 13th year in a row.
• Holston Valley Medical Center’s orthopedic residency program received accreditation by ACGME.

“While Ballad Health is reporting exceptional financial results, it continues to perform at the highest levels for quality of care,” said Dr. Clay Runnels, Ballad Health’s chief physician executive. “Our physicians and clinical teams are focused on delivering the level of quality they would expect for their own families.”

Capital and provider investment

During the quarter, Ballad Health continued to make investment in infrastructure and expansion of the number of providers for the region. Ballad Health invested $27 million into a variety of capital projects ranging from health information technology to replacement of patient beds.

Examples of investments included:

• Transition to Epic electronic health records system
• Laboratory and microbiology equipment
• Replacement of patient beds
• Neurosurgical navigation systems
• 3D mammography
• Neuro-spine equipment
• Endoscopy equipment upgrade
• Ultrasound equipment
• Surgery center renovations
• Transesophogeal echocardiography

Additionally, during the quarter, Ballad Health invested in 65 new providers starting work in the region during the first quarter, including 31 physicians and 34 advanced practice providers. These providers span various specialties, including neurosurgery, cardiovascular surgery, cardiology, primary care, pediatrics, psychiatry and a variety of other needed specialties in the various communities served by Ballad Health. Since the closing of the merger that created Ballad Health, 182 new providers have begun work in the region – 88 physicians and 94 advanced practice providers.

Financial and operating results

Ballad Health continues to collaborate with physicians and payers to reduce the total cost of care by working to reduce low-acuity admissions and to provide services in a lower cost, mostly outpatient, setting. This work has led to reduced overall volumes but improved operating performance.

For the quarter ended September 31, 2019:

• Acute discharges declined by 2.6 percent. Total surgeries decreased by 1.1 percent to 18,106 cases. Ambulatory surgery cases reported decreased by 24 percent, due to a restructuring of two joint venture surgery centers which increased physician participation. This ownership restructuring results in Ballad Health no longer consolidating the volumes for reporting purporses.
• Operating cash flow (operating EBITDA) improved to $51.9 million from $48.5 million in the same quarter prior year, a 7.2 percent increase.
• Total cash flow (EBITDA) improved to $58.7 million versus $52.6 million in the same quarter prior year, an 11.7 percent increase.
• Revenue for the quarter increased by 4.5 percent, while expenses increased by 3.7 percent, leading to an improvement in the operating margin over prior year.
• Ballad Health continued to focus on expense management, improvements in productivity and supply cost management. Ballad Health invested $261.7 million into the region’s labor force.
• Operating margin improved to 0.8 percent compared to a slight loss of 0.04 percent for the same quarter last year. EBITDA margin improved to 10.9 percent in the quarter from 10.2 percent in the prior year quarter.