Dispelling myths about the hospital serving the needs of the community
NASHVILLE, TN — There is a lot of misinformation about Nashville General Hospital circulating in the aftermath of Mayor Megan Barry’s surprise announcement about the potential elimination of inpatient services at the facility. Below is information about why Nashville General Hospital matters and offers truth about its operations.
Nashville General runs at about one-third of its licensed capacity with only about 40 of its 120 beds being used on an average day. This is false. NGH is licensed for 150 beds – this is not the physical number of beds in hospital; rather the MOST number of beds we are licensed to have in the hospital (pending any future expansion). Inpatient average daily census (ADC) is 49, a 59% occupancy rate just slightly below the 61%national average.
The hospital is staffed to serve 120 beds at all times, which has contributed to its financial challenges. This is not true. Like most hospitals, Nashville General staffs based on the number of patients – not to available beds. There are 114 available (semi-private) beds, however, standard of care is private so when rooms were converted from semi-private rooms to private, it lowered available beds to 86.
Since 2005, taxpayers have provided more than half a billion dollars to support the operations of Nashville General – far outweighing the benefit the hospital has provided the community. Untrue. In support of its mission, Nashville General has provided nearly $1 billion in uncompensated care since 2005 – twice the subsidy it received during the same time period.
The number of patients being served at Nashville General is declining rapidly. Year-to-date visits have decreased by just 3% since 2014, and some of this decrease was intentional on the hospital’s part.
In 2015, Nashville General strategically implemented a chronic disease management model of care to keep people healthier at home and ensure they are getting the right care in the right place. For example, the hospital reduced emergency room visits by 3,000 in the last year as part of an initiative to shift unnecessary emergency room visits (at the highest cost of care) to the coordinated patient clinic (at the lowest cost of care) resulting in better access and improved outcomes. Most recently, as a result of this model, patients are controlling their blood sugar (diabetes) and blood pressure (hypertension).
Nashville General has poor quality care and outcomes that are far inferior to other area hospitals. This is patently false. The hospital offers high quality care from dedicated providers. Nashville General Hospital is Joint Commission Accredited and its Cancer Center just received Accreditation with Commendation (Silver Level) by the American College of Surgeon’s Commission on Cancer.
There are plenty of open beds at other regional hospitals, and the beds at Nashville General are unneeded. It is unclear if this statement is true or realistic in the long term given the boom in our population regionally.
A new model is needed for care at Nashville General, and an outpatient ambulatory care model is the right one.
An outpatient ambulatory center is not the right direction. There are many problems relying on outpatient services to care for a vulnerable population– a lack of access to care, problems with effective care coordination, potential to jeopardize patients’ health, and cost among them.
Closure of Nashville General’s emergency department will send 32,000 patient visits to private hospitals. It is unclear if other local hospitals can accommodate this influx of patients. Given that estimated cost of emergency care is, on average, 45% lower at Nashville General than at other Davidson County facilities, emergency indigent care is likely to cost our city much more at these facilities.
The tested provision of healthcare for underserved populations is already proven to be the chronic disease model in place at Nashville General Hospital. The model is perfectly designed to get the results we are obtaining which are statistically significant outcomes in two of the top three health disparity categories in Nashville and across the nation: Hemoglobin A1C (diabetes) and Hypertension. So, when asked – why don’t we look at other cities – the answer is – we are already doing what other cities are doing. So, what is missing? Adequate funding. Nashville General takes care of patients without the ability to pay, and at the end of the day adequate funding is needed to accomplish their mission. The staff and community leaders have been working together to enact positive changes. There has been a great deal of success on many fronts, but the facility is not yet where it needs to be. The staff and supporters are hopeful that an open, honest and productive dialogue with the community, the Mayor’s office and Metro Council about how to best position Nashville General for the future. But it is vital that this conversation happen with all of the constituencies (not a select few with varying agendas) who rely on the hospital, considering the merits and drawbacks from the point of view of many and reviewing lessons learned from other regions. This community – which has counted on Nashville General for more than a century – deserves no less, and the constant spouting of untrue and misleading statements serves no one.
Nashville General Hospital has a model in place to provide the best care and quality outcomes, and ending inpatient services will derail.