NORTON COMMUNITY HOSPITAL
1021 W Oakland Ave, Johnson City, TN 37604 www.balladhealth.org

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Organizations Filed Purposes: Our mission is to honor those we serve by delivering the best possible care.

Our mission: Honor those we serve by delivering the best possible care.Our vision: To build a legacy of superior health by listening to and caring for those we serve.

Norton Community Hospital (NCH) is located in Norton, Virginia. Our 129-bed acute-care facility has served Southwest Virginia and Southeastern Kentucky since 1949. As the largest healthcare facility in the coalfield region, NCH provides a wide array of services through highly trained physicians and support staff. NCH is a Virginia nonprofit corporation. At the beginning of FY20, Mountain States Health Alliance (MSHA), was the 50.1% member of NCH, Inc., and Community Healthcare Foundation (CHCF), Inc. was the 49.9% member. During FY20, MSHA purchased CHCFs 49% membership resulting in MSHA now being the sole member.Also, NCH is the sole owner of Dickenson Community Hospital (DCH), a critical access hospital located in Clintwood, Virginia. NCH and DCH are part of the Ballad Health network, created when Mountain States Health Alliance and Wellmont Health System merged February 2018.NCH is recognized for its outstanding inpatient rehabilitation services, an osteopathic internal medicine residency program, black lung treatment services, high-quality imaging technology, and many other service lines. Improving the Communitys Health Status:NCHs black lung clinic offers the regions only program approved and federally certified by the U.S. Department of Labor for the Federal Black Lung program. We have eleven approved providers for our black lung program. Our black lung clinic offers disease screening/diagnostic testing and pulmonary rehabilitation services. Black lung disease, or coal workers pneumoconiosis, is a lung disease that results from breathing in dust from coal graphite, or man-made carbon over a long period of time. We provided just over 7,500 black lung procedures this year. NCH offers a free support group, The Better Breathers Club, for people with COPD, asthma, chronic bronchitis, lung cancer and other pulmonary diseases. The club meets monthly where members can receive valuable information and develop skills to help better manage breathing difficulties and improve their quality of life. Improving Access to Healthcare Services:Norton Community Hospital continues to subsidize a rural physician clinic to provide some relief of the physician shortage in our area. Our FY20 subsidy was just under $579,000. The primary care physician ratio in our county (number of residents to 1 primary care physician) is 38% higher than the overall state ratio. Recruiting physicians to a rural county such as ours is often challenging due to a myriad of factors, such as geography, economics, culture and education. Geographically, rural communities are often far removed from suburban and urban centers that provide access to educational, cultural and economic opportunities. These limitations influence the relocation decision of the physician candidate and his/her spouse/children to locate to a rural area. The Association of American Medical Colleges (AAMC) issued a press release dated April 11, 2018 stating that the United States could see a shortage of up to 120,000 physicians by 2030. The U.S. population is estimated to grow by nearly 11%, with those over age 65 increasing 50% by 2030. Much of the increased demand comes from a growing, aging population. The aging population will also affect physician supply since one-third of all currently active doctors will be older than 65 in the next decade and likely to retire. The AAMC points out that data conducted in 2017 indicated that an additional 31,600 physicians would have been needed if underserved populations utilized the same health care services as insured individuals. The data looked at people in non-metropolitan areas and people without insurance compared to people living in metropolitan areas. Furthermore, the study indicated nearly half of the shortage was in the South. NCH spent $49,540 during FY20 to recruit and retain physicians. NCH recruitment efforts are based on documented community need. NCH is located in a MUA (medically underserved area), as designated by the U.S. Health Resources & Services Administration (HRSA). MUA designation indicates an area as: having too few primary care providers, having a high infant mortality, a high poverty rate or a high elderly population.

Benefits of an Integrated Health System:Since 2010, more than 130 rural hospitals have closed in the United States, according to the North Carolina Rural Health Research Program. Studies have shown rural communities that lose their hospitals struggle with reductions in access to physicians, healthcare services and in overall health status. Through Ballad Health, the scale and ability for larger and more financially solvent hospitals to subsidize losses in smaller rural communities is a clear and convincing foundational public benefit. It is clear the steps Ballad Health has taken to reduce overhead cost, realign services, invest capital and prioritize high quality have led to the sustainability of services - expanding, rather than reducing access, as has been seen in rural regions throughout the nation. Ballad Health invested more than $200 million to adopt a common information technology platform for all their merged hospitals and care sites. With Epic as the single technology platform for Ballad Health, patient data will be controlled by patients and their providers, and it will be more secure than ever before. New services will be available to patients, including real-time scheduling, digital access to health information, transparency in pricing and, most importantly, better coordination between healthcare providers, regardless of where the providers are or what data systems they use. Mountain States Health Alliance (Mountain States) is one of only 29 organizations in the country participating in the Centers for Medicare & Medicaid Services (CMS) new initiative, Accountable Health Communities Model (referred to as AHC Program), aimed at improving the health of eligible Medicare and Medicaid beneficiaries. The Southwest Virginia Accountable Health Communities Program (AHC) is a collaboration between community groups and Ballad Health that seeks to improve the overall health of Medicare and Medicaid beneficiaries by helping address patients health-related social needs. As part of the program, Medicare and Medicaid patients in Southwest Virginia are screened for health-related social needs when they visit a Ballad Health facility. Once those needs are identified, Ballad Health tries to link those patients with resources and programs within their communities to resolve those needs.On March 10, 2020, Ballad Health executed its disaster plan in response to the coronavirus disease 2019 (COVID-19) global pandemic. This included the activation of its Corporate Emergency Operations Center to coordinate efforts across the system, including NCH, to rapidly plan for, and execute, ongoing response to the issues resulting from the pandemic. In May 2020, Ballad Health partnered with Premier, Inc. on a new program to ensure our team members and patients are always protected through the availability of personal protective equipment, such as gloves, gowns and masks. This program focused on investing in domestic manufacturers to enhance supply chains for essential medical products and PPE. This program led to Ballad Health acquiring a minority stake in Prestige Ameritech, the largest domestic manufacturer of face masks, including N95 respirators and surgical masks. PPE products critical for the daily operations of health systems are overwhelmingly sourced overseas. The risks associated with this overreliance on overseas providers came into focus twice in 2020, as the supply chain was disrupted when an overseas provider failed to meet FDA requirements for sterile gowns, and again as the COVID-19 pandemic swept across the globe. Prestige Ameritech operates primarily in the United States, where it obtains its raw materials. Ballad Health, provides numerous services to improve the health of our communities. The following services are provided by the Ballad Health entity but funded by the various hospitals and other divisions within our health system. The funding levels by NCH for these services are reflected below:The Ballad Health parish nurse program is designed to provide holistic ministry and special promotion services within the faith community. The parish nurse program assists individuals in gaining optimal mental, physical and spiritual health by complementing the ministry provided by pastors and other lay ministers. Some of the services and programs provided include screenings for blood pressure, cholesterol, diabetes, glaucoma and overall fitness, classes for all age groups offered on health related issues (nutrition, exercise, parenting, care for elderly parents, stress management, CPR), hospital, nursing home and home visits for assessment of health care needs, referrals to appropriate community resources and the creation of health tips in congregational newsletters, bulletin boards and other forms of communication. Currently, there are dozens of churches in Northeast Tennessee and Southwest Virginia that are serviced by the Ballad Health parish nurse program. NCH funded $2,648 for this program in FY20. Ballad Healths Nurse Connect is a toll-free line that connects community members with experienced nurses around the clock. The nurses provide expert medical advice anytime, day or night, make referrals to a new primary care provider with a location and hours convenient to the community member and referrals to a physician specialist when they need advanced local medical care. They also provide health information and resources, including health screenings and immunizations, and make referrals to urgent care clinics to see a doctor near the community member the same day. NCH funded $14,568 toward this popular service during FY20.Ballad Health contracts with Med-Trans, locally known as Wings Air Rescue, to operate full-time bases in Elizabethton, TN, Greeneville, TN, Jenkins, KY and Marion, VA plus a base at Bristol Motor Speedway, which is active during race events. Med-Trans provides air ambulance transport of critically ill and injured patients to one of the closest tertiary hospitals in the region. Ballad Health also provide staffing, physicians, and medical supplies to the Commonwealth of Virginia for the Virginia State Polices Med Flight air ambulance service. VSP Med Flight maintains its base in Abingdon, VA. NCHs contribution this year for the air ambulance services that are especially critical in rural areas was $18,759.Ballad Health is focused on investing in various initiatives to improve population health-the overall health and well-being of the residents living in the Appalachian Highlands. In FY19 Ballad Health established a new department, Population Health, to focus on these initiatives. NCH invested $32,603 in FY20 toward this initiative that supplements the many other forms of community benefit provided by our health systems hospitals.

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