Erlanger Needs Study - And Response

Tuesday, April 02, 2013

Why is Erlanger so different from other safety net hospitals in Tennessee?  

Today, the Tennessean reports that the Metro Nashville Hospital Authority, which operates Nashville General Hospital, has presented Davidson County with it's annual request for $32.7 million for hospital operations. The Regional Medical Center in Memphis (the Med) normally receives $50 million annually from Shelby County, $2 million from the city of Memphis, and $5 million from Arkansas and Mississippi.  

Over a year ago, the Chattanooga-Hamilton County Medical Society along with the Erlanger Medical staff asked for a commission to be formed to study the Hospital Authority Act, compare Erlanger to similar institutions, and make recommendations for any changes. It has been difficult to watch the Hamilton County Commission and the Legislative delegation struggle to come to an agreement on legislation that reduces the Erlanger supplement from $1.5 million to $1 million, while Hamilton County receives $5 million a year in free care for its inmates. 

The new Erlanger CEO looks to be very capable, but without reasonable support, his opportunities for improvements at Erlanger will be limited. A study group of stakeholders, along with state and local leaders, and Mr. Speigel should be able to produce a consensus plan that would form the basis for new legislation to get Erlanger back on a sustainable track. Uncertainty over Medicaid expansion and the full rollout of the Affordable Care Act in 2014 makes quick action on this proposal a priority.

Working together, we can make this happen. Let's get busy. 

Chris Young, MD 

* * * 

I was at Erlanger in 1975 as a student and went on to graduate and work there until 1988. The day I walked onto the campus they were doing demolition on one of the old nursing dorms.  Not long after that they closed Wiehl street in front of the hospital.  The construction and renovations
never stopped. Never. Our department had two major renovations while I worked there. 

Erlanger has always wanted to be the county hospital, the best teaching hospital, and the 
best private hospital in a huge regional area, as well as the regional children's hospital, etc., etc.
Ambition and growth is not a bad idea, in fact it is required in order to attract physicians and patients which equals revenue, but how can all of that be financed and maintained indefinitely? 

Back in the day, Dalton Roberts hammered the board and the activities of the hospital. The news
was always filled with his challenges for the hospital to be more frugal and budget conscious.  I guess the question is this: How long can a hospital truly be all things to all people, never stop  huge construction projects, and maintain viability in the tightening health care crisis? 

One thing that I never really understood back then was that so many indigent patients came from a large region beyond Hamilton county.I saw service patients from Atlanta, Alabama, Georgia, as  well as many other counties in Tennessee. So how is that influx financed? Erlanger constantly complained [and still does] about not enough funds to support all their indigent patients. No, there are not enough dollars to pay for all of that coverage. Did the surrounding regions contribute to the costs?  Did the government [state or federal or both] contribute to support these patients? I could never get an answer from anyone on the subject. 

A close relative of mine worked in the clinics for a long time. They were puzzled by the addresses of many of the clinic  patients also, but no explanations were ever given.  

The only black ink I  vividly remember was when the hospital brought in a CEO that fired 14 or so vice presidents and then moved on to another healthcare facility. The hospital had a $16 [?] million surplus the next budget year. 

I hope that the new CEO can help Erlanger find solutions to the problems. Erlanger is a great hospital and I fear what would happen to our community and region without it. 

Ted Ladd
East Ridge



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