Dive Brief:
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Nashville healthcare and political leaders have created a plan called BetterHealth Nashville in hopes of reducing the $150 million annual uncompensated care spent in the city's hospitals.
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Meharry Medical College would run the program and track indigent patients. The proposal would help facilities like city-funded Nashville General Hospital, which takes on most of the city's uncompensated care. More than half of Nashville General's payer mix is self-funded.
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The proposal brings together officials and health leaders, but one important piece not resolved is how to fund the project. One option is a new tax. Another is spreading the cost of uncompensated care across more city facilities.
Dive Insight:
Despite the Affordable Care Act expanding Medicaid and providing millions of Americans with health insurance, safety net hospitals continue to struggle. That is especially true for a non-expansion state like Tennessee, which have seen more uncompensated care.
About 15% of Nashville's residents are uninsured or underinsured. That puts pressure on facilities and providers to collect from patients, who might not be able to afford care. Chasing down payments causes more costs for the health system and still often results in writing off care.
Dr. James Hildreth says only @MeharryMedical has the standing to convene all the health care leaders in town to create an indigent care system in Nashville. pic.twitter.com/kIzuv42gRd
— Blake Farmer (@flakebarmer) March 5, 2019
The Nashville plan comes two years after then-Mayor Megan Barry proposed closing Nashville General as an inpatient facility. At that point, Nashville had spent more than $500 million over 12 years to help the hospital. Berry said there was a better way to spend that money and help low-income residents. At the time, she included a request to create an indigent care fund to help pay for the care of uninsured people in safety net hospitals.
BetterHealth Nashville would oversee care for uninsured and low-income patients. Eligible patients would enroll in the program and work with program care coordinators. BetterHealth would pay for care.
The plan calls for splitting up hospitals so they can have their own focus. For instance, Nashville General would receive more low-acuity patients. Patients in the program with complex needs would be sent to another facility, such as Vanderbilt University Medical Center. This combination would keep a steady flow of lower need patients going to Nashville General while allowing other facilities to focus on their strengths.
There are still vital pieces of the proposal to work out, namely how to pay for the project. Plus, the plan needs more buy-in. Nashville General released a statement saying it will "formally review" the proposal.
— NashvilleGeneral (@NashGenHospital) March 5, 2019
