With Nashville’s safety-net hospital in dire financial straits and facing a tough few years ahead, its board is about to choose who will guide the ship.
The Metro Nashville Hospital Authority Board is expected to vote on a new CEO this week. That person will lead Nashville General Hospital, a city-owned facility that is a major source of indigent care in North Nashville, an economically marginalized, historically Black neighborhood. It’s also a learning lab for Meharry Medical College, one of the country’s only medical schools housed in an HBCU.
It’s down to two candidates. One is the current interim CEO, who took over last year in the midst of several public crises for the hospital. The other is an outsider. He would be coming from a similar hospital, which also relies on academic faculty for care, serves low-income patients and has to navigate severe financial strain.
The job won’t be easy.
Nashville General’s challenges
The hospital has always struggled; caring for very sick people who often can’t pay is inherently difficult. But Nashville General has a host of unique challenges. Its severely outdated building has caused expensive, systemic problems. The lease on that building ends soon, and it’s unclear whether the plan is to stay or go. In a recent meeting, hospital staff said updating the building would likely cost at least $400 million. And leadership said last year that a new facility would cost at least $500 million, according to the Nashville Banner.
The hospital gets a major subsidy from Metro’s budget. This year, it’s getting nearly $70 million. That figure has been on the rise in recent years, as the hospital requests more each year due to its financial struggles. Back in 2021, it was getting about $43 million. The subsidy is a critical lifeline for the hospital, but also a liability. That’s because in tough times, city leaders can start eyeing the chopping block. For example, former Mayor Megan Barry pitched closing the facility.
As of May, the hospital was running at a loss of $4.6 million for the year, according to materials provided to the board for this month’s meeting. That’s largely because admissions are down, and revenue from those admissions has come in $15 million short of expected so far this year.
A city board oversees the hospital. A committee has been meeting regularly for over a year to look for a new CEO. On Wednesday morning, its members will vote on which of the two finalists to recommend for the job. The next day, the full board will make the official call.
Finalists
The short list includes the woman now serving as interim CEO, Dr. Veronica Elders. Before taking this role, she was the hospital’s chief nursing officer, and has worked at Nashville General in several capacities for about a decade.
The hospital’s most recent CEO, Dr. Joseph Webb, had a contentious relationship with both Metro’s Hospital Authority Board and Meharry Medical College — which houses the hospital on its campus and supplies faculty and student workers. Elders has appeared to have a closer working relationship with both institutions. The biography provided to the committee notes city leadership asked Elders to take the position. She also oversaw the signing of a new professional services agreement between Nashville General and Meharry — a process that had languished for years, creating possible legal problems for the hospital.
Dr. Keith B. Churchwell was most recently the president of Yale New Haven Hospital and an executive vice president over the five-hospital health system. That job included managing the relationship with the Yale School of Medicine. He also has Nashville ties. He was the executive director and chief medical officer at Vanderbilt Heart & Vascular Institute.
Pay discussion
Late last month, the Hospital Authority Board laid out a plan for final interviews and a voting schedule. Members said the candidates had been given a range on salary and other kinds of compensation, like bonuses, but that the final number would be negotiated.
A new member, Dr. Shane B. Scott, tried to get some clarity around how much money the candidates were being offered.
“I’m not sure that I have heard any ranges around compensation,” he said. “So is it not expected that the board is engaged on that level? … How is it going to play out in terms of board governance?”
The team considered past CEOs’ salaries. They also worked with the staffing consultant on the search, AMN Healthcare, to figure out what CEOs at comparable hospitals would be offered. And they referenced a study the hospital commissioned on appropriate pay for the hospital’s employees.
Ultimately, a range wasn’t disclosed during the meeting. The board’s vice chair, David Esquivel, noted that the board has to sign off on any contracts that total more than $100,000, and he said the total pay would cross that threshold.
Webb’s departure
The former CEO, Dr. Joseph Webb, resigned amid controversy last year.
The board was holding meetings to discuss firing him, and less than a week before, Metro’s internal audit office released an investigation into the hospital’s management. The document, obtained by the Nashville Banner, substantiated claims that hospital executives signed off on more than $4.5 million in contracts without board approval, and that they falsified documents provided to news media through open records requests.
The board also said members had received anonymous complaints about a retaliatory work culture. And Webb had been in hot water as well for the hospital’s tense relationship with Meharry. Among other things, the medical school’s leaders said they were upset Nashville General was hiring its own doctors and medical staff, instead of following tradition and relying on Meharry faculty and students.
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