Children’s U Hospital Novenber 25,2018 ohn J. Dreyzehner, ND, MPH, FACEOM Commissioner Tennessee Department of Heath 710 James Robertson Parkway Nashulle, TN 37243 Dear Commissioner Dreyzehner: | am writing this ltr in suppor ofthe proposl submited by Ballad Health (Ballad) to consolidate the Ballad system NICU coverage atthe Niswonger Children's Hospi (Niswonger. The rationale provided by Balad in ther eter dated November 19, 018 is compeling and aligned withthe refeal pattems we have witnessed et Eas Teesse Chis Hospial (ETCH). Whi this realignment may cause some level ot temporary disruption whi to Kingsport community, | uly believe centaling cae at Nswengerf te right decison forthe region and, most important, forthe patent Mr Levine's eter discusses decining pediatic volumes fortis region. | have taken the poston since ariving at ETCH almost twelve years ago that acute pediatric cae forthe Tries regon should be centralized as much 2s possible win one cilren’s hospital. My bei was thal consolidation into a Single location provided the best opportunity to recruit the kindof subspecialty support necessary fo assure care local, Unfortunatly, with two system in the region tere was lie hope of achieving this outcome, With the creation of Balad comes the opportunity to improve regional coordination of care while providing a ‘more efcent solution for pation, families, fering physicians and physician specials CCurenty ETCH is waking with Niswonger to determine how we can improve coordination throughout he East Tennessee Grand Region. Unike the Middle and West Tennessee Grand Regions, East Tennessee is witnessing siow to negative growth nthe peiatrc population. Given that a significant jority of the ‘care provide at our respective institutions i paid trough the TeanCare program tony makes sense fo be as efcent as possible whi atlempting to minimize needless duplication or lng distance travel for families. Key o this evaluation is developing realistic expectations about haw and where care shoul be provided. Also key to this evaluation invoves how we can incorporate the needs of the East Tennessee State University Colege of Medicine Department of Pediat andthe traning program, An important {goal wl be to provide improved regional care coordination while strengtherng the ETSU Department of Pediatrics, and in partcuay, their pediatic residency traning program. We are commited to working with both Balad and ETSU to achieve this gol Balad has both opportunites and challenges associated wih Improving the heath status ofthe T-Cies ‘and Southwest Virginia. The decision to consoate NICU care makes sense ‘rom both agit and patentfamiy perspective. White this consoldation wl key result in fewer transfers to ETCH i wil enhance cae forthe region while keeping famies much closer to home anc Kross, vmwetch can 5 51 600November 26, 2018 Page? Ifyou have questions or would ike to discuss tis issue further | am avalable to do so, Thankyou in ‘advance for your postve consideration of this recommendation. Sincory, Keith O. Goadvin President & CEO cc: Alan Levine, Executive Chaiman, President and CEO, Ballad Heath Lisa Carter, CEO, NiswongerCrdren's Hospital Lamy Fitzgerald, Tennessee COPA Monitor Gary Miler, COPA Compliance Offcer, Balad Health