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Covering Grady Hospital

Covering Grady Hospital

Picture of Philip Graitcer

It's a thankless task, running a public hospital. Squeezed by patients, governments, and community leaders, a public hospital can't - in the public's eye - seem to do anything right. Closing a clinic, laying off staff, increasing co-payments saves money, but at what human cost? For Grady Hospital, their public image reached crisis level when it decided to close its outpatient dialysis clinic, putting two dozen patients - mostly undocumented residents - out on the street with nowhere to get their life saving treatment. Local papers had a field day with stories accusing Grady of writing a death sentence for these patients. Then, two other outpatient clinics were closed, and there were complaints from the community. How to sort out what seems like bad moves and worse publicity from what's actually happening on the ground?

The trick to writing about a public hospital is follow the money. What part of their budget is covered by programs for the poor and uninsured? What about local and state government contributions? In Grady's case, Medicaid doesn't cover their costs. In Georgia, children can get coverage, but few women, and almost no men. What about the undocumented? Data provided by the American Hopsital Directory gave me a good baseline. Other data came from the state, however, their data came from the Georgia Hospital Association and was not in useable form. Fortunately, I was able to get help from a consumer advocate group as well as a local academic to interpret cost, revenue, and unreimbursed care data.

The state trust fund for indigent care - which was set up to cover the shortfall - is split among almost all the hospitals in Georgia to reimburse them - using a very complicated formula - for unreimbursed care. What's worse is that some local governments are getting a free ride - their uninsured and poor residents - get care at Grady, but the county governments contribute nothing to help cover the costs. Last year, for example, residents from 4 counties surrounding Grady ran up a 14 million dollar bill for health care costs for the poor, but the local govenerments contributed nothing.

Hospital management is left with few choices except reduce services or just close doors. And whatever they do, community advocates for the poor will protest, but perhaps their efforts might be better placed trying to get state and local governments to adequately fund the hospital.

Comments

Picture of Philip Graitcer

I'd like to add a footnote to my admonition to "follow the money" when trying to learn about a hospital. Hospitals are big financial institutions - Grady has a budget of nearly 2 billion dollars! To fully analyze a hospital's budget may be beyond many reporters' skill level. It certainly was mine. Fortunately in some states - notably California - much of a hospital's financial as well as patient data (in the aggregate) is available on line, or at a minimum from the state health department. This is NOT the case in Georgia, however. Hospital data - the kind that would be useful to reporters are kept by the Georgia Hospital Association (GHA) - a hospital trade association - and those data that are required by law, like amount of uncompensated care and charity care - are provided to the health department from the GHA. So information on patient distribution by ZIP code by type of payment (Medicaid, private insurance, etc) or uncompensated care or self pay, is not readily available in Georgia for any hospital. I was able to obtain some of these data from the American Hospital Directory - which provides on line data about hospitals that I presume is used primarily for marketing. The American Hospital Directory provides free of charge access to their data bases to qualified journalists by request. I used their summaries to give me an overview of Grady's cash flow. My other source of data was provided by GeorgiaWatch, a nonprofit consumer advocate group. They have used various state and GHA databases that are not readily accessible and are able to determine the geographic distribution of patients by payment type. In summary, hospital data - especially those data pertaining to money and payment - are often the key to seeing whether or not a hospital is meeting its mission, however those data are not always readily available. The first places to look should be the state health department and the state hospital trade association.

One other difficulty I had reporting this story was finding patients that I could interview. Although the hospital allowed me access to their clinics and the emergency department, prior to interviewing a patient, the hospital public information officer had to obtain signed consent from the patient to speak with me. This was confusing to some patients and they refused to sign. Others, including most patients in the emergency department, were considered by the hospital to be compromised by the their health emergency, and could not be asked to give permission in their altered state of health. One strategy to get patients for these stories was to stand on a corner outside the hospital and grab them as they entered or left.

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