Monday, February 16, 2015

How the Mayoral candidates would address Metro General Hospital. None of them impress me.

Last week, six of the eight candidates for Mayor attended a candidates forum called “pancakes and politics,” at Meharry Medical College, sponsored by The Tennessee Tribune, Nashville’s Black newspaper, and The Nashville Association of Black Journalists.

The only Black candidate for Mayor, current Criminal Court Clerk and former Vice Mayor Howard Gentry, who got in the race late was not present, stating he had a previous engagement already scheduled by the time he learned of the forum. No mention was made of candidate Kenneth Eaton and why he was not present. In fact the article incorrectly stated that “six of the seven candidates for mayor…” participated in the forum, when in fact there are eight candidates running for Mayor.

Being that this forum was held at Meharry and that the status of Metro’s General Hospital at Meharry is a concern to the Black community, every candidate should have been prepared to answer a question about his policy toward General Hospital and the very first question of the candidates was about General Hospital. Candidates were asked, “if General Hospital, located at Meharry, would continue to serve the safety net needs of patients who have the highest needs, would Meharry and Metro General be supported in the Mayor’s budget and to what extend”?

Jeremy Kane replied, “yes” and said the hospital also needs a pharmacy. Bill Freeman said he “would explore that issue and give every bit of support I could, providing funding and direction.” Megan Barry said health care is a “fundamental right” and that “dictates how the next Mayor will engage Metro General Hospital.” Charles Bone said, “the answer is yes,” and that Meharry needs more patients and different pay structure. David Fox said the University of Tennessee plans to move its medical school to Nashville, and said Meharry and General are a financial issue that he’s trying to solve. Linda Eskind Rebrovick said the mayor must support General and Meharry and that her experience as a consultant will help increase the efficiency of the hospital and as mayor she would get her physical there.

I was not at the forum and the above it taken from a report in The Tennessee Tribune. Maybe the candidates gave elaborated answers and left some wiggle room, but from the above, all of the candidates lost a point except for Megan Barry who lost two points, and David Fox who did not lose or gain a point.

In my view, Metro Nashville needs to get out of the hospital business just as we got out of the nursing home business last year when we privatized Bordeaux Long-term Care and Knowles Home Assisted Living and Adult Day Services, saving the city $10.5 million a year. Maybe none of the candidates agree with me or none have the guts to tell the truth to a Black audience that we need to stop funding General.

Many years ago there was a need for local governments to provide charity hospitals and many cities did. As healthcare changed and low income people no longer had to go to the charity hospitals but could go to the hospital of their choice, the justification for such safety net hospitals went away, but with government slow to change, many cities continued their funding of charity hospitals as did Nashville. Overtime other changes occurred which made General even less viable, such as more people being treated as outpatients rather than being admitted into hospitals and length of stay in hospitals being shortened.

Metro General Hospital opened as the City Hospital on April 23, 1890 as Nashville’s first full-service hospital. In 1891 the hospital started a school of nursing and in 1913 it opened a pediatric ward. The hospital grew and flourished until after World War II when admissions began declining. As more hospitals opened in Nashville customers had more choice. St. Thomas opened in 1898 and then Baptist Hospital, first known as the Protestant Hospital, opened in 1917. Park View which was the first in what was to became a chain of hospitals known as HCA opened in the mid 1960’s. Vanderbilt Hospital opened in the 1970’s and there have been numerous expansion and additions of other hospitals since then.

Not only did more choice mean less demand for General, but when Medicare and Medicaid were signed into law in 1965 that meant that low income people could go to any hospital and not depend on city charity. By the 1990’s General was facing a crisis. Not only did low income people have choice, but General, dependent on Metro’s level of funding, did not have the resources to acquire the latest in technology and equipment. Also the building, by this time a hundred years old, was in need of rebuilding or major rehabilitation.

Maharry Medical College was also facing a financial crisis in the late 1980’s and early 1990’s. In an effort to help both institutions, in October 1991 Nashville approved of a plan to merge the Meharry Hospital with Metro General. The merger phased out services at the Metro General Hospital site on the bluffs of the Cumberland, now known as “Rolling Mill Hill,” and relocated services to Meharry-Hubbard hospital. General Hospital became the teaching hospital for Meharry Medical School and metro heavily subsidized the 116-bed facility.

General has had a difficult time competing with the many other hospitals in the area despite Metro’s generous subsidy, although the subsidy is not as generous as it was when the merger first occurred. Last year Metro’s subsidy was $33.5 million. I have not researched how much Metro has subsidized Meharry-General year to year, but I know a few years earlier the subsidy was almost twice that amount. Despite Metro’s continued subsidy of the hospital, the hospital struggles to attract patients. All Metro prisoners are treated at Mehary-General and Metro employees are given an advantageous deal if they will use Meharry, and yet still the hospital struggles.

In 2012 the city commissioned a study of Meharry-General conducted by the firm of Alvarez and Marsal. The study found that as currently operating Meharry General was not sustainable. One thing plaguing meharry is that it cannot fill its beds. They only have an occupancy rate to about 42%, but even if they operated at full capacity they would have a per patient loss per day of $1,602. The per patient loss is higher with fewer patients, but the overall loss would be greater with more patients.

The consultants offered a range of options for addressing the situation, ranging  from “maintaining the status quo to re-purposing the hospital as an ambulatory care facility with reduced inpatient services to a full scale re-design of the business model focused entirely on outpatient and clinical service.”

Last year Metro spun off its nursing homes and saved the city $10.5 million a year. A city owned nursing home is as about as archaic as a city poor farm, yet ending metro’s ownership and operation of a nursing home was not without its opponents and yet the city did it. Even Megan Barry voted to privatize Boudreaux and Knowles.

If there was a candidate who was not at the forum or any candidate who was but who would like to give a more detailed answer to the question about the future funding of Meharry General, I would be glad to post your position paper or statement.

None of the candidates at this forum impressed me with their answer to this questions.

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1 comment:

  1. The following email was received from mayoral candidate Kenneth Eaton:
    RE: "Pancakes and Politics" Forum

    I was not at the "Pancakes and Politics Forum" Because of a non-Invite,
    I take it they would have known my answer, and did not want to hear the answer
    Seems the other candidates answer questions as to who is in attendance,
    My answers will be one that will be a Business Decision and what is best for the people of Davidson County,
    Your remark about Metro's General Hospital Is dead on,
    General Hospital in History served, The needs of Davidson County Residents.
    But in today's market the City of Nashville NO LONGER NEEDS to be in the Healthcare Business
    This loss of revenue should be put to use in other places, such as paying down the city's 5 billion dollar debt, or
    paying its unfunded retirement funds.


    Kenneth Eaton