Nashville General CEO: Change needed, but nixing in-patient care imperils hospital's goals

The CEO of Nashville General Hospital at Meharry thinks closing in-patient services would be detrimental to its mission but said that change, given the mayor's push, is necessary.

A proposal by Mayor Megan Barry to transition the city-owned hospital into an ambulatory surgery center and outpatient clinic — a vision that preceded her tenure as mayor — could derail Joseph Webb's plan of strengthening the coordination of care to improve people's long-term health. 

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Now, he's managing a staff that is "looking over their shoulder and wondering whether they’ll have a job in a few months" amid navigating an uncharted course for the hospital on a public, contentious stage. Nashville General gets $35 million from the city but often needs additional funds during the year.

"I think we all agree that based on what the mayor said there has to be a change in the way the model is designed," Webb said in an interview ahead of a council meeting.
"We’re on board with that. We just have to figure out what that change is going to look like.” 

Yet, closing in-patient services would be detrimental to what he and his team are trying to do, which is change the health of a population that faces critical barriers to receiving care or the everyday things that influence health, such as healthy food, he said.

Nashville General has been on a path — similar to other hospitals — of seeing more people in outpatient clinics, which are less expensive and help them manage or prevent some of the diseases that land them in hospital beds in crisis. 

Webb said the number of unnecessary and avoidable emergency room visits is down 9 percent and that better management of chronic disease, such as diabetes, have helped reduce re-admissions.

In order to maintain and sustain the progress, Webb wants to continue along the integrated line of care that includes in-patient services.

“It's difficult to recapture them in your model once they go out and seek care all over the city," Webb said. "When they are in crisis, if we are doing that all over the city we’re losing the continuity. It becomes fragmented rather than integrated care delivery."

The health systems in Nashville do not share electronic medical records. The onus would be on the patient, as it is in most corners of health care, to connect providers to each other.

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Nashville General isn't facing problems that aren't to some degree impacting hospitals around the state and country. 

It is going to be reimagining its future with the input from a variety of stakeholders — from other health systems and patient advocates to council members, the mayor and Meharry Medical College. 

Not all of them understand the intricacies of running a hospital.

It's time for all those involved with or impacted by potential changes of Nashville General to get on the same page about finding a way forward for the facility, Webb said. 

Hospitals get different levels of reimbursement from different payers and rely on the judgment and skill of highly trained staff to administer the right care at the right time. Hospitals around the state are having to look for other ways to bring in revenue because patient care doesn't always keep them in the black.

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Webb said he thinks the council called the meeting to better understand the operations. 

"I think they, along with everyone else, want to know what’s going to be the best solution but you’re noting to know until you investigate,” Webb said.

"It’s not always seen on the surface, what we’re doing here and healthcare delivery is very complex as it is. Many of the council people have all different types of jobs and expertise. Not many have health care expertise.”

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Webb is proud of the staff and the work they've put into improving the hospital's care and coordination of services. 

Nursing staff is being recruited in light of Barry's proposal. Employees expressed frustration at a board meeting on Nov. 17 about the security of their jobs. 

Most learned of the mayor's plan from media coverage. 

Webb said the ambulatory surgery option has long been favored since former mayor Karl Dean commissioned an independent assessment.  

When asked when he knew about the mayor's plans, Webb declined to give a date. 

"That’s kind of a tricky issue because, honestly, this whole notion of an ambulatory system has been under discussion for several years. That’s no surprise to anyone. When we were going to implement or close wasn’t clear to all of the stakeholders,” he said.

He's optimistic that everyone will be able to come to the table to talk about what's best for the hospital and its patients. 

The staff, he thinks, "is open to change" as long as "the idea is what's going to be best for the patient population."