By Peter White
NASHVILLE, TN — There is plenty of blame to go around. Mayor Megan Barry’s budget and the city council that approved it, only gave General Hospital $35 million of the $55 million it needed. That was last May.
Since then, the marriage between Meharry and Nashville General Hospital went South. The medical school’s residents have trained at General for twenty-three years and the hospital has provided the patients to treat them.
Shortly after attempts to increase General’s subsidy failed, Dr. Jan Brandes, Hospital Authority chair, met with Meharry’s CEO, James E.K. Hildreth, to discuss the imminent cutbacks at General. The meeting didn’t go well.
According to Meharry Senior V-P Patrick Johnson, Brandes told Hildreth: to save money General needed to shut down its OB-GYN department and stop delivering babies at General.
In a packed sanctuary at Historic First Baptist Church, Capitol Hill last week, Johnson said it was not mediation between partners but more of an ultimatum Brandes delivered as a fait accompli.
“I’m not asking you if this is ok, I’m telling you l’m going to do this and you will be okay. That was a terrible day at Meharry,” Johnson said. If General stopped Ob-Gyn and maternity services, he said it would threaten Meharry’s accreditation as a medical school.
Brandes told the Tribune that’s not what happened and that she would never do that to Meharry’s medical students. The rift between Meharry and General festered for months.
Then in November, the Mayor announced her plan to stop inpatient services at General Hospital. At the same time, Meharry announced its new training partner, Southern Hills Medical Center.
“We did what we had to do,” said Johnson.
He assured the crowd at First Baptist that Meharry isn’t going away and it will still be General’s partner no matter what happens. Meharry owns the hospital and the city is its tenant. But if General can no longer meet Meharry’s needs their longtime relationship will end.
Meharry is planning to move in with HCA’s Southern Hills Medical Center by summer and General will have to live with the new arrangement. So will its patients.
“We don’t play politics. We are a private institution that has a public charge. Our job is to take care of those who are underserved and to train those who are willing to do so, “Johnson said. “Since 1876, we have always risen to that challenge,” he added.
It is hard to see how Meharry could fulfill that mission if General shuts its doors to hospital-based medical care.
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 Tanaka Vercher, who chairs the Budget and Finance Committee, and Talia Lomax-O’dneal, Metro’s Director of Finance.
Meharry’s effort to fill the vacuum in the wake of Barry’s bombshell announcement has been met with suspicion and distrust Johnson said.
“Everyone is challenging our motives,” he said. Johnson 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.
Vercher 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.
The exchange took place during a discussion about the future of General Hospital organized by TSU Professor Isaac Adae.
Five panelists spoke. Dr. Joseph Webb, CEO of General Hospital, presented a slideshow about General. Here are the main points:
• 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 wants to make changes at General to save money. State Representative Brenda Gilmore says Barry’s idea is 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 also lose $36 million 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.