CMS mandate has Ballad between a rock and a hard place


By Dave Ongie

Ballad Health CEO Alan Levine

During a press conference on Jan. 27 addressing the latest surge in COVID-19 cases, Ballad Health CEO Alan Levine spent the bulk of his time looking beyond the current staffing crisis toward a crucial Feb. 11 deadline.
On Jan. 27, Ballad Health had a record number of patients – 436 – hospitalized due to the omicron variant of COVID-19. Meanwhile, 834 Ballad team members were at home after either testing positive for COVID-19 or awaiting test results.

But even as Levine announced emergency staffing measures being taken to ensure adequate patient care during the current surge, he talked about the very real possibility of permanently losing around 1,000 employees that were not yet vaccinated and had not yet applied for a medical or religious exemption ahead of a federally imposed COVID-19 vaccine mandate.

To put it bluntly, federal actions have put Ballad Health and countless other healthcare systems between a rock and a hard place. One choice is to fire employees that are still unvaccinated and have not requested a waiver by the time the deadline passes on Feb. 11, which Levine says will compromise patient care. The other choice is to keep those employees and risk being in violation of the United States Centers for Medicare and Medicaid Services (CMS), which would expose Ballad to the potential of steep fines and the possibility that patients on Medicaid and/or Medicare would not be able to seek care at Ballad facilities.

“We will do everything we can to work with CMS as we try to comply with the vaccine mandate,” Levine said on Jan. 27. “We’re not going to put our patients at risk. That’s our position.”

Levine has been a tireless advocate of the COVID-19 vaccines, touting their safety and efficacy at every turn. He is not, however, unsympathetic to the plight of his employees who have chosen not to receive the vaccine and has fought for their rights in the wake of vaccine mandates and legal challenges against those mandates.

“These people, just because they have chosen not to be vaccinated, that doesn’t make them bad people or less valuable team members,” Levine said.

In a letter to CMS administrator Chiquita Brooks-LaSure dated Jan. 3, Levine attempted to paint a picture of what enforcing the CMS vaccine mandate would look like for Ballad Health. He cited the chronic difficulties rural health systems face when it comes to recruiting and retaining healthcare workers, which predated COVID-19 but have been exacerbated by the pandemic.

While Levine estimated 95 percent of Ballad’s physicians had been vaccinated at the time the letter was written, he said about 60 percent of the non-physician team had been vaccinated, and losing employees in nursing, housekeeping, food service and other key positions would cripple Ballad’s ability to care for patients.

During the press conference on Jan. 27, Levine expressed his frustration that the current administration’s unwillingness to take cultural differences into account when issuing executive orders or crafting policies that create vaccine mandates. Levine said he pointed out during his testimony before Congress that 85 percent of the landmass of the United States was rural, and the cultural differences in rural communities cause many people to “recoil” when they are forced to inject something into their bodies by order of the federal government.

“If you’re looking for equity in healthcare, if you’re looking to create cultural inclusion in healthcare, then that means respecting cultural differences,” Levine said. “You can’t ignore that 85 percent of our country is rural and has a culture that’s different than the culture that exists in New York and Boston.”

Virginia Governor Glenn Youngkin echoed many of Levine’s concerns in a letter he co-signed with West Virginia Gov. Jim Justice on Jan. 31 asking for a “limited waiver” that would give Virginia hospitals flexibility when it came to vaccine requirements for staff members.

While efforts continue on many fronts to help alleviate the pressure vaccine mandates are putting on healthcare providers – particularly those in rural communities – Levine knows the clock is ticking and the options on the table are not likely to change by the Feb. 11 deadline. The 1,000 or so employees he referenced will either have to be vaccinated or apply for a medical or religious exemption.

With that in mind, Ballad is continuing its persistent effort to encourage immediate supervisors of the remaining employees to push for a solution that will allow Ballad to retain those employees.

The notion that every employee will have their individual situations resolved by Feb. 11 is virtually impossible, but Levine believes progress will be rewarded. “I don’t believe CMS will be unreasonable with enforcement, but I do believe if they don’t see us trying to comply, the penalties are going to be pretty severe,” he said.

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