By Tribune staff
NASHVILLE, TN — The ongoing situation facing General Hospital, as well as the relationship between General and Meharry, has been a source of much controversy since last May. That was when Mayor Megan Barry’s budget, which subsequently was approved by the City Council, only gave General Hospital $35 of the $55 million they maintained was needed.
Initial attempts to increase the subsidy failed. Then there was a meeting between Hospital Authority chair Dr. Jan Brandes and Meharry CEO James E. K. Hildreth to discuss proposed cutbacks at General. In the aftermath of that meeting, questions were raised regarding exactly what was said, and more importantly, what resulted from the meeting. Some allegations and statements were published in stories that need to be corrected. So the Tribune is setting the record straight regarding exactly what is happening at General.
Contrary to any previously published reports, Brandes did NOT and has NOT said Meharry was going to shut down its OB-GYN Department and stop delivering babies. Nor is it true Southern Hills is going to be Meharry’s new training partner, or that Meharry is planning to leave General Hospital to move in with Southern Hills Medical Center. In addition, Meharry Senior V-P Patrick Johnson strongly denies a statement attributed to him saying Meharry’s efforts to deal with the situation since Mayor Barry’s announcement have been universally met with suspicion and distrust.
The Tribune covered a Jan. 11 meeting about the General/Meharry situation organized by Tennessee State University Professor Isaac Adae that attracted an overflow crowd to the Historic First Baptist Church, Capitol Hill. During that meeting Johnson and others addressed some issues and made some statements.
“Everyone is challenging our motives,” Johnson said. He defended the privacy of Meharry’s training agreement with Southern Hills and the decision to exclude the public from the hospital stakeholders’ meetings. “Only because you don’t trust us to be competent and intelligent enough to work for our own people,” he said.
Councilwoman Tanaka Vercher, Chair of the Budget and Finance Committee, replied that Meharry should be forthcoming and transparent or the council will be outflanked and the hospital’s natural allies will be played against each other. “If you put everything on the table, the community doesn’t doubt, the council doesn’t doubt,” Vercher told Johnson.
Five panelists spoke. Dr. Joseph Webb, CEO of General Hospital, presented a slideshow about General. The main points were:
• Safety net hospital since 1890
• 40% of patients are self pay or uninsured
• General provides $57 million in free medical care annually
• 150 licensed beds
• Patient demographics: 31% white, 53% African American, 9% Latino
• Staff demographics: 46% white, 47% African American, 3% Latino
Webb noted Nashville ranked 42 out of 50 U.S. cities in worst health outcomes last year. A tertiary hospital like General treats acutely ill patients in its emergency room. Then its staff stabilizes them in hospital beds where they are “transitioned” into a regime to manage their chronic illnesses better. This integrated medical delivery system works.
Webb said 67 percent of General’s high-risk diabetic patients are controlling their blood sugar. Fifty-three percent of its hypertension patients are controlling their blood pressure. Those patients are no longer being rushed into the emergency room by ambulances.
Webb compared General’s current model of medical care to an ambulatory care center (ACC) that Mayor Megan Barry has proposed for General. The differences are like day and night.
General’s patients are a “medically complex” population. ACC patents are “stable”.
Patient outcomes can be measured over time at General. Clinic patients may get treated at more than one place and their health outcomes will be more fragmented.
Access to care at General is 24/7. It is limited in an ambulatory center.
Metro supports General with a subsidy If there were multiple providers drawing from an Indigent Fund, per patient cost would be harder to manage and administrative costs would be higher.
The Mayor’s main reason for wanting to make changes at General to save money. State Representative Brenda Gilmore criticized this motivation, calling Barry’s idea pennywise and pound-foolish because only one-third of General’s $98 million operating budget is covered by Metro. Gilmore said $20 million in federal funds support General’s operations now.
“These payments would cease if Metro inpatient services would cease because no other public hospital is eligible for the payments, “ Gilmore said. Those dollars would be redistributed to other safety net hospitals in Tennessee.
Gilmore also said the state would lose $36 million more in certified public expenditures if Nashville General stopped inpatient medical care. If the Barry administration refuses to increase its subsidy to General by $20 million, the city will lose somewhere between $20-$56 million it now gets from the federal government.
With Barry’s blessing, Meharry formed an 11-member stakeholders group that has met twice to discuss what impact her proposal would have on the patients General now serves and to craft the city’s plan for indigent healthcare.
“We wanted to have control over the healthcare in our community,” Johnson said and Barry agreed. She announced January 11 the city would fund General until the end of this year.
The stakeholders group includes officials from Meharry and General, SEIU Political Director Freda Player, District 58 Representative Harold Love, Councilwoman Vercher, and Talia Lomax-O’dneal, Metro’s Director of Finance.
Most importantly, Meharry is NOT abandoning General, General’s OB-GYN facilities are not closing, and Meharry has not yet officially chosen a new training partner.