Medicare health care in Tri cities area (Knoxville, Johnson City: health insurance, how much)

[Jude24]

We are a retired couple that will be moving to the area in a few months. We are both on Medicare and we're wanting recommendations. Thanks in advance for any advice.

[Serious Conversation]

Take this perspective for what you will. I'm a former employee of the regional hospital system. I worked there for many years, and left early this year. I implemented several computer systems that directly impacted patient care. I don't have any significant health issues, but my ex-girlfriend was in Bristol's hospital over twenty times, so I have a lot of experience from the patient side as well.

It's awful - the worst I've ever seen anywhere I've ever lived. Johnson City Medical Center, the area's "flagship hospital," has consistently declined in quality since the merger to form Ballad Health about five years ago. Today, that hospital is rated 1/5 stars by the Centers for Medicare and Medicaid.

There are two other tertiary hospitals - in Bristol and Johnson City. Both of those are now 2/5 star hospitals, but neither are level 1 trauma centers (Kingsport's was, but was downgraded from a 1 to 3), and certain specialties, like neurology, urology, gastroenterology, and even stroke (just found this out a couple months ago when my grandmother had a stroke) no longer have call coverage teams in Kingsport. I've heard orthopedic is next on the chopping block in Kingsport. The ICU is being closed in Elizabethton. There have been spats between Ballad and non-Ballad doctors for privileges in the operating room at Ballad hospitals, so you may not even have a choice with a Ballad vs. non-Ballad provider. There are other medical groups - like Houston Medical Group and State of Franklin Healthcare Associates - that do have general practitioners, specialists, etc., but all acute care is Ballad. They have, largely, a medical monopoly in this area.

The community hospitals, with some exceptions, are basically triage centers to send anything semi-serious to Johnson City Medical Center. What's that doing? That's causing an even greater crush of patients onto the already overloaded JCMC capacity. JCMC was understaffed and overtaxed and even before COVID, and that issue is much worse now.

From a personnel perspective, Ballad doesn't pay well enough to attract many new direct employees, or even retain the ones they have. I was in IT, but the team I was on at 1/1/23 doesn't even have half the staff it did then. Clinical teams can't attract talent due to Ballad's reputation and low pay. For now, they're augmenting with travel nurses and various other contractors, but they've lost somewhere around $20 million so far this fiscal year - this can't be sustained indefinitely.

My guess is that "Ballad as we know it" won't exist in five or ten years. The profitable parts, probably the three tertiary hospitals, and maybe the second community hospital in JC and one in Abingdon, VA, will be picked up by some outside entity, with many of the smaller and rural community hospitals and physician practices closing.

I switched all my healthcare to Asheville a couple of years back. For my personal travel pattern, and already working for an NC-based organization anyway, this made sense to me just from logistics, but if I were you, bad medical care would be a significant "no" decision point in locating here. At a minimum, you will need to go to Knoxville or Asheville for anything somewhat serious.

[rayzor58]

I totally agree with the last post. When I moved to Kingsport 30 years ago, health care was good until all the merging. It's all political, they seem to care more about money and power instead of health care, really sad. My wife had cancer surgery a couple years ago, they had to remove an organ, there was no room for her and she was put into a corner after the surgery. Her lines were not even inserted, they tried to give her the wrong meds, she was never checked on or given anything to drink, it was terrible. This was Holsten Valley, which was a great hospital till the merger. One more example, there was a wreck a few weeks ago, close too a hospital, they flew in a helicopter and flew the patient 20 miles or so to Johnson City. This stuff is happening all over the country, health care is failing us. Otherwise then that, the tri-cities is a fine place to live.

[Beretta]

I feel so strongly about the subpar healthcare in the Tri Cities right now I would encourage you to re-think your relocation.

[Ted Bear]

I am not quite as harsh about our local health care as others, but overall, it is not exactly world class.

We use the HMG System, which "seems" to be a cut above the Ballad/Johnson City Medical Ceneter farm style approach to medicine. They thrive on "volume", but not so much on quality care.

HMG seems to have better physicians, better facilities, and is not overrun with people seeking "free care" (many locals do not have health insurance, mostly due to their employment situation, so they flock to JC Med Ctr facilities to get "free care" for their sore throat and more. You get the picture).

Bottom line is that you will get decent care for basic needs. "Specialists" seem to merge functions, so you need to get used to that. For more serious health care you need to step outside the area. Neurosurgeons, pulmonary care, gastroenterology and other speciosities are weak. I suffer from a previously fractured spine and there is NO way i would let any of the local neuro's touch me. Yes they have "done that", but they did "One of those six months ago", whereas a specialist will have done several this week. You get the idea.

People go to Duke, Vanderbilt, Cleveland Clinic, Johns Hopkins, etc. for specialist care.

Locally everyone takes Medicare because they need to participate in every "plan" in order to maximize their revenue and cover the cost of the multitudes who can't/don't pay. Welcome to Appalachia.

Look, the area is wonderful. The climate is great. The environment phenomenal. The people are fantastic and very welcoming. Cost of living is decent, and the tax situation is good. Every area has its plusses and minuses. Northeast Tennessee is no different. But there has to be a reason why people are flocking here, in spite of shortcomings in the healthcare system.

BTW, the local rumor is that Ballad is being pursued by an out of area health care system. Duke Medical tried to buy them when they merged local outfits, so it might be them, or ??? Time will tell if the rumors are true, and whether a deal with an outside system will provide better health care.

Come join us. Don't let healthcare get in your way. Overall, it's just not that big of an issue unless you require substantial high-end care.

Addendum: Many doctors are moving to the VA System in Johnson City. Not sure of the motivation, but the VA Hospital is a large regional facility as part of a major campus of VA Services. Perhaps you qualify to use the facility...???

[Beretta]

HMG doctors are better than other options but even they are dismayed by the situation in the area. Let's face it the HMG's of the world can only do so much.

As far as Ballad selling off parts; those discussions have been going on for years and years with various contenders. Ever wonder why a deal never gets off the ground? hmmmm.

Quality metrics tell the tale. Check out the Medicare statistics for yourself. If you want a shortcut there is a person named Dani Cook that posts on her public Facebook page about the situation in the region.

As a native of the area I have seen it all. And as a longtime Moderator here I am here to say: eyes wide open. Don't blame us if you move here and find it isn't all that you thought it would be. Don't come bellyache here that you can't find a Medicare provider. Don't bellyache when you have to travel hours to find a good, quality specialist. Apologies for the bluntness but as an insider I want you to know the truth. Many of that that are extremely well connected in this region know the truth and see the coverups.

[Jude24]

Originally Posted by Beretta

HMG doctors are better than other options but even they are dismayed by the situation in the area. Let's face it the HMG's of the world can only do so much.

As far as Ballad selling off parts; those discussions have been going on for years and years with various contenders. Ever wonder why a deal never gets off the ground? hmmmm.

Quality metrics tell the tale. Check out the Medicare statistics for yourself. If you want a shortcut there is a person named Dani Cook that posts on her public Facebook page about the situation in the region.

As a native of the area I have seen it all. And as a longtime Moderator here I am here to say: eyes wide open. Don't blame us if you move here and find it isn't all that you thought it would be. Don't come bellyache here that you can't find a Medicare provider. Don't bellyache when you have to travel hours to find a good, quality specialist. Apologies for the bluntness but as an insider I want you to know the truth. Many of that that are extremely well connected in this region know the truth and see the coverups.

I appreciate the honesty, I'm on here to try to get a true picture, warts and all.

[Serious Conversation]

The problem with the traveling is that it doesn't look like an issue until it is.

Ex needed a hip replacement due to complications from the treatments for her autoimmune disorders. Ballad had no interest in dealing with a hip replacement on a 25 year old with complicated autoimmune problems. She had to go to Vanderbilt. She was taken down there and brought back in medical transport.

That's 4.5 hours each way. Even a trip down there and back for an appointment is an all day ordeal - tiring for a healthy person. Now pile being unwell on top of the long trips. If you need assistance from someone else, then they have to be able to make the trip too.

My mother also has a hip issue and autoimmune problems. She's going to Knoxville. She has trouble getting around, so I've had to take off work a couple times to take her to the appointments.

I have sleep apnea. I'm being treated for that through a local non-Ballad provider. I need an ENT consult, but getting into a non-Ballad ENT is going to take awhile. I asked for a referral to an Asheville-based ENT, but the provider seemed confused that I was requesting an out-of-area referral, and wouldn't do it. That's the only local healthcare I have now, and I guess that'll need to be moved.

Also, there's the issue with medflights. For instance, some traumas and codes that used to be able to be handled in Kingsport have to go to Johnson City now. If you're too far out for an ambulance, you're out the $50k or so for the medflight. Those are generally not covered by regular insurance. If you live in a rural area, you might want to pick up insurance for that.

Yes, some of these problems are general healthcare issues - staffing is a problem basically everywhere, but a good bit of it are truly local issues caused by mismanagement.

[Lin19687]

Originally Posted by Serious Conversation

$50k or so for the medflight. Those are generally not covered by regular insurance. If you live in a rural area, you might want to pick up insurance for that.

.

Where do you get insurance for that and how much does That cost ?

[Beretta]

Originally Posted by Lin19687

Where do you get insurance for that and how much does That cost ?

That is off topic for this thread but I have medical transport insurance, too. Just google so you can find coverage in your specific area because it isn't one size fits all. We have a lifetime plan.