Brass Talks Nuts and Bolts at Hospital Listening Session

“If you give good service patients will come back,” said Aram Khoshnaw.

By Peter White

NASHVILLE, TN — A poorly attended meeting of the General Hospital Safety Net Consortium met last Saturday at the Salahadeen Center in South Nashville. Since only a handful of community members showed up, the Meharry stakeholder work team talked amongst themselves for two hours.

The Chief Financial Officer of Nashville General Hospital said the bottom fell out of General’s patient volume after Mayor Megan Barry floated a plan last November to close the hospital.

“The revenue that we produce on our own dropped $600,000 -$700,000 a month overnight,” said CFO Bruce Naremore. He said patient volume dropped 40 percent immediately after Barry’s announcement. Naremore said that was the reason General had to ask for $19 million in emergency funding last month. They got $17 million.

“My challenge is that I don’t know what it’s going to be July 1,” he said.

Although emergency room visits have returned to normal, paying patient volume is still down. Naremore said he doesn’t know when it will pick up again.

“Are things going to turn around? Is it marketing? Is it an announcement from the Mayor’s office ‘yes, press the reset button and I see a good future for Nashville General Hospital’? That would mean a lot,” he said.

“I am committed to the city having a public hospital, period,” said Mayor David Briley at his first news conference last Tuesday.

Last December, Dr. James E. K. Hildreth, President of Meharry Medical College, convened the stakeholder work team following Barry’s announcement to close down the city’s safety net hospital.

The work team is supposed to recommend a new model of indigent care to the Mayor and the Metro City Council.


Dr. Rev. Judy Cummings, a registered nurse and Senior Pastor at New Covenant Christian Church moderated a discussion at Salahadeen Center Saturday.

Saturday’s session was the fourth such gathering and was in sharp contrast with an earlier listening session at First Baptist Church, Capitol Hill, when hundreds of residents showed up in support of Nashville General and to blast Barry’s plan to close the hospital.

“It comes down to money and just really not wanting to fund it,” said Judy Cummings, who moderated the listening session.

The work team talked mostly about how to improve service, funding, marketing, and operations at General. There was no talk of what to do if it closed and now it appears that it won’t. There is a parallel city council committee taking up the same issues of funding and operations at General Hospital. City department budget hearings will take place this month and that includes Nashville General.

Our ER volume is back but the rest of the patient load is not back yet,” said Bruce Naremore, Chief Financial Officer of Nashville General Hospital.

Metro Finance Director Talia Lomax-O’dneal said almost half Metro’s budget goes to schools. “Healthcare service is probably less than 5% of Metro’s total budget,” she said. Metro schools get $879 million. Police, courts, and jails get $809 million. Health and hospitals get $79.4 million.

Those priorities haven’t changed much going back two decades. “All the departments are competing for funds,” said Dr. William S. Paul, Public Health Director.

“If Metro General gets $50 million they are going to be looking at my budget in the health department to squeeze that to find $50 million to pay Metro General. So my business is health. Their business is health so that’s kind of the conundrum in the Mayor’s office trying to make a limited amount of tax dollars meet all the needs of the city,” he said.

Aram Khoshnaw manages a statewide program called Health Assist. He helps people who are underinsured or uninsured find resources to get the care they need.

“Ask the mayor what they can do to have more patients with health insurance,” he suggested. Almost half of the patients treated at Nashville General don’t have insurance. Other hospitals treat the uninsured, too, but they account for around 5 percent of their total patient volume.

l-r; CFO Bruce Naremore and Dr. William S. Paul, Director of Metro Public Health Department, compete for the city’s health care dollars.

“We’ve never seen Meharry or General come forward and say ‘these are our services’,“ said Khalat Hama. She noted that in health care everything has been about marketing for the last four or five years.

Metro General spends no money on advertising. It all goes to treat patients. Its oncology department is the best in the MidSouth.

“Our survival rate outstrips anybody else in Tennessee, Kentucky, Georgia, any state in the Southeast,” said Vernon Rose, Executive Director of the Nashville General Hospital Foundation. General just received a silver accreditation, getting five excellent scores out of a possible seven.

Rose predicted General Hospital will earn a gold standard rating in two years. She said there are only ten gold standard oncology programs in the country and none of them are in Tennessee.

“If I got cancer tomorrow I would be at Nashville General. No thought about it because I know it’s the best care I’m going to get in the city,” she said. Cancer patients without insurance can get chemotherapy at Nashville General but at no other local hospital.

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