Nashville General Plan Would Mean Loses Far Beyond Inpatient Care

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Bruce Siegel, MD, MPH

When we talk about members of America’s Essential Hospitals—and we’re proud to count Nashville General Hospital among that group—we often describe them as cornerstones of health, wellness, and economic activity that help communities thrive.

It’s a fitting description of Nashville General’s 127-year relationship with its namesake city. The hospital’s commitment to the community and, most important, to the city’s vulnerable residents underscores what Nashville stands to lose with plans to end inpatient care at the hospital.

Nashville isn’t the first city to put a proposal like this on the table; others have taken this same path, with mixed results. Nashville’s leaders would be wise to consider these cautionary tales before acting on a decision that could badly undermine access to care in disadvantaged neighborhoods.

Washington, D.C., offers one such case study. The city shuttered the inpatient side of its first and only public hospital, District of Columbia General Hospital, in 2001 with a plan to send indigent patients a half-hour away to a community hospital across the Anacostia River. The decision forced others to seek care at even more distant locations, in neighboring Maryland. But the hospitals that filled the void soon suffered the same cost pressures that beset D.C. General, with one nearly closing before the city was forced to step in—again.

I share this story only to suggest it’s not as straightforward (or economical) as you might believe to downsize or close an institution as central to a community’s well-being and sense of identity as Nashville General.

Essential hospitals, such as Nashville General, fill a safety-net role not easily replaced or farmed out to surrogates. Nashville General and our more than 300 other members combine to deliver about 17 percent of the nation’s uncompensated care. Nashville General alone provides about $70 million of uncompensated care annually, just above our member average. Its emergency department (ED) accounts for about half the hospital’s total 65,000 to 70,000 patient visits annually, and about 40 percent of its patients have little or no ability to pay for their care. Even with these challenges, Nashville General finds ways to keep its ED costs 45 percent lower than other Davison County facilities. Talk about doing more with less.

Also remember, Nashville General’s patients are more complex and costly to treat than those in other settings, and they often face severe socioeconomic hardships. An ambulatory clinic simply can’t substitute for the specialized care and knowledge found at an essential hospital, such as Nashville General.

Most important, Nashville General is a local partner in health for underserved North Nashville residents, providing them with a reliable source of emergent care and hospitalization close to home—and the irreplaceable sense of security and peace of mind that brings. Accessing health care is challenging enough for vulnerable patients without the added stress of traveling outside familiar surroundings for treatment by unfamiliar faces.

I urge city leaders to consider another, better approach to a sustainable future for Nashville General. Rather than reinvent the wheel and, possibly, jeopardize access to care for those in greatest need, recommit to keeping Nashville General’s rich experience caring for vulnerable patients where it belongs: with those patients, their families, and their community.

Siegel is president and CEO of America’s Essential Hospitals, in Washington, D.C.

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