The leader of the national trade group representing public hospitals warns that Nashville will end up paying for indigent care, one way or another. Mayor Megan Barry has paused plans to close inpatient services at Nashville General but still wants a cost-reduction plan by the end of the year.
"I don't know that there's going to be a free lunch here," says Bruce Siegel, CEO of a Washington D.C.-based trade group called America's Essential Hospitals. "It's hard for me to see how Nashville is going to make sure tens of thousands of people get health care who don't have any coverage who don't have any money to pay for it."
For years, city officials have expected the safety-net facility to become less reliant on Davidson County taxpayers. But Siegel says the hospital's roughly $50 million annual subsidy is on the low side.
"This is a real problem," he says. "You have a hospital where 40 percent of the people can't pay for their own health care. And there's not going to be any simple answer that just makes that go away."
Of the 325 hospitals Siegel represents, the average subsidy from local governments was $71.4 million in 2015. However, there are some comparable cities that spend considerably less than Nashville, like Memphis. But there, the facility also has some specialized revenue-generating services that other hospitals in Nashville already have covered, like a Level 1 trauma center.
Siegel has been in Nashville to build support for General, and he says it's unlikely that the city could provide care to poor residents for much less than it is now.
"The question then becomes, is it cheaper for the city to do it at Nashville General? Or is it cheaper to do it by paying other hospitals?"
Mayor Barry has proposed a fund that would pay other hospitals to offset the cost of indigent patients if General Hospital closed. But Siegel argues that public hospitals can often provide care more cost effectively.