Other Cities May Hold Clues for Indigent Care

Davidson County has subsidized the Hospital Authority an average of nearly 52-million dollars a year since it was created a decade ago.

The Hospital Authority governs Nashville General Hospital, as well as the Bordeaux long-term care facility and the Knowles assisted-living home.

With a tightening budget, the mayor’s office has said the city can’t continue funding at these levels. So it’s hired a consultant to find cheaper, more effective ways of providing health care services for the city’s poor. While every city funds indigent care differently, two have gotten out of the health care business altogether.

When Nashville’s Hospital Authority was created, it was supposed to function like a business and make money. But in reality, it functions more like a regular city department with Metro on the hook every time General Hospital overruns its budget.

Not every city has a public hospital but for those that do, many different arrangements exist to combat losing a steady stream of tax dollars. Austin, Texas, used to have a stand-alone facility like Nashville General. But in the 1990s, the city decided to get out of the health care business. Patricia Brown is the CEO of the Travis County Healthcare District. She says the city had too many rules about purchasing and hiring.

“The city wasn’t in the position to provide what it needed to be competitive in the market. So thus the idea that to try and join forces with one of the local health systems.”

The city leased its facility to the Seton Family of hospitals, part of the Catholic Ascension Health system. The city still pays about 4-million dollars to the hospital for charity care, but Seton is responsible for any losses.

Brown says Austin went a little further and created a “health care district,” which takes a portion of the property tax in that area. With the money, it runs a health insurance plan, pays for investments in the public hospital and supports a network of clinics.

But even with this arrangement, Brown says as the number of uninsured has risen, the issue of charity care hasn’t gone away.

“There is a continuing, I call it a dialogue, about how much charity care they should be subsidizing out of their profits. They of course want to minimize that and we of course want to maximize that. [laughter].”

Denver used to have a stand-alone hospital too, but the city went to an integrated system in 1997. Denver Health now runs the health department and a group of primary clinics. It also operates a poison help line and runs the city’s 911 ambulance service. But even with all these services, CFO Peg Burnette says it took about seven years to be included in the network of a major insurance carrier.

“And even still we battle the perception that we’re the public hospital for poor people but we’ve made a lot of progress in that area.”

Nashville’s consultants say local issues and the needs of Meharry Medical College—a historically black institution that uses General as its teaching hospital.

Ultimately, the amount city leaders decide to spend on charity care will affect what type of model Nashville selects. Recommendations are expected in September.

The Hospital Authority has its budget hearing before the Metro Council tonight.

**This story originally aired incorrectly stating the name of Denver Health’s CFO as Pat Burnette. Her name is Peg Burnette. We apologize for the error.