Covering Grady Hospital
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.