By Peter White
NASHVLLE, TN – General Hospital is stuck between a rock and a hard place. The Hospital Authority, whose 11 board members are appointed by Mayor Barry, submitted a $55.7 million budget and only got $35 million to run the city’s public safety net hospital this year.
“They have never been given the amount of money they need to adequately run that hospital,” says At-Large Councilwoman Sharon Hurt.
In addition to its perennial shortage of funds, General’s CEO, Dr. Joseph Webb, could be leaving at the end of the year. His current contract ends in December. He doesn’t know if an extension will be offered or whether he will stay if it is.
Reverend Enoch Fuzz, who chaired the NAACP Health Committee for ten years, has known all four previous presidents. He says Webb is the best of the lot.
“Dr. Webb is the best thing to happen to the hospital since sliced bread,” he said. But Webb’s leadership has not gone unchallenged. Last year, then Hospital Authority President Mary Bufwac, presented to the board a number of letters accusing Webb of mismanagement, misappropriation of hospital funds, and racism.
“Those were anonymous letters, “ Fuzz said. “I stood up and told Mary Bufwac she needed to resign. I was shocked that she did,” he said. Mayor Barry picked a new board president and added four new board members.
According to Fuzz, before Webb arrived in 2015, hospital employees would come to him “crying about how they were being discriminated against and sexually harassed, and how people were hiring their friends,” said Fuzz. “Dr. Webb came in and he cleaned all that up. That is where all these repercussions are coming from,” he added.
The Hospital Authority met last week without Webb. According to three members who attended the strategy session, the discussion was about how to make up the $20 million shortfall in Metro General’s budget.
Webb said the board might offer him a contract extension, or maybe not, but the more important business that must be decided later this month is what services General Hospital will no longer offer and what cutbacks will have to be made.
Forty percent of General’s patients receive free medical care because they are poor and have no medical insurance.
One of General Hospital’s six revenue streams comes from 60 per cent of its patients who do have health insurance. That amounted to $42 million or about 44% of total revenues last year. The hospital collected $3.4 million in nonpatient dollars from grants, cafeteria, pharmacy, and outpatient services. Then things get wonky.
General Hospital got $1 million in Disproportionate Share Hospital payments (DHS). Those are federal dollars the hospital gets for serving the poor and uninsured; it got $11 million from a supplemental pool of state and federal funds for being one of eighteen safety net hospitals in Tennessee (PHSP). The hospital also got $2.2 million in Essential Access Dollars (EAH) for providing services to TennCare patients.
And it got a $35 million subsidy from the city.
And all that is not enough. General’s yearly operating costs are about $95 million. The main problem is that health and hospital costs keep rising and General’s funding keeps falling. Every year there is some question about whether the hospital will stay open or perhaps be sold off. Chronic financial instability creates a climate of uncertainty for staff who don’t want to stay and for patients who don’t want to come there for treatment.
“If there is instability and uncertainty it makes people want to leave. If there is uncertainty in the organization’s ability to obtain resources it makes people question whether they should seek service there,“ Webb says. Like a slow-growing cancer, chronic underfunding is killing peoples’ confidence in the hospital and the quality of the service it provides.
Hospital-born infections kill about 100,000 people a year. In 2016 Nashville General cut the standard infection ratio in its ICU units from 3.3 to .5 The lower number means fewer infections. In 2015 seven people got sick from germs they picked up in the hospital. In 2016, only one patient did.
On Webb’s watch, Metro General has earned a gold star accreditation. That’s the same rank as Vanderbilt, St Thomas, and TriStar Centennial. The gold standard is given to hospitals when they can show over time they create a safe environment for their patients.
“Metro General delivers quality care. We need to move away from this notion that the care you’re going to get is subpar. It’s simply not true,” said Richard Manson, a member of the Hospital Authority.
“If General cannot do what it is supposed to do, everybody will be affected by it,” says Manson. Its ridiculous, he says, when Metro employees don’t use a facility that the city owns where they would not have to pay a deductible if they used it.
Webb worries about what’s happening in Washington. What will it mean if Congress puts a per capita cap on Medicaid funding? Webb says it would be devastating if Congress cut $800 billion in Medicaid funds.
“Then we are talking about serious hardship for safety-net hospitals and particularly rural hospitals and the underserved populations they serve,” he said
In general, it would be worse for people in states like Tennessee. In poorer states where Medicaid covers a higher percent of the population, 30 percent cuts “across the board” will hurt the most vulnerable. Some states split Medicaid costs with the federal government 50-50. But in places like Tennessee, where the split is more like 70-30 percent, the math is painful.
“Thirty percent of seventy percent is going to be greater than thirty percent of fifty percent,” says Webb. So the least generous states will become downright flinty.
“I don’t think the problem is the leadership. I think the adequacy of the funding is where the problem lies,” says Sharon Hurt. She was talking about Nashville General Hospital but she could have been talking about Medicare for all, an idea that is percolating into communities around the country.
“We spend a lot of money to make sure tourists have a wonderful experience here, and we need to spend as much taking care of those people who took care of Nashville before it became the ‘it’ city,” Hurt said.
Metro budget figures show Metro will spend $23 million in hotel taxes this year on hotel occupancy tourist promotion and another $11.6 million on other tourist-related expenses. Nashville General Hospital’s budget shortfall is $20.7 million.