Nashville General Says Community Care Depends On Remaining A Full-Service Hospital

Mayor Megan Barry has now given until the end of the year for some kind of restructuring at Nashville General Hospital to begin, but the only idea on the table at the moment is hers: Close the inpatient hospital to save money and focus instead on outpatient chronic disease care.

Hospital officials say they’re already headed that direction, but they will still need to keep the hospital doors open.

A year ago, the safety-net facility started experimenting with chronic disease management under a larger effort known as a
patient-centered medical home. Sometimes it looks less like health care and more like a health class.

“Ramen noodles is the bane of my existence. That stuff is evil,” registered nurse Lisa Quiambao tells a few hypertension patients attending a two-hour session. They’re gathered around a table littered with the packages of ramen and surprisingly high-sodium foods, like canned green beans and orange drink.

“The doctors tell them, ‘take your medicines, watch your salt.’ But they don’t understand what that means,” Quiambao says.

One of her new patients, Phyllis Daniels, says her blood pressure spikes so high after eating salty foods that she came to the General Hospital emergency room 10 times last year with chest pain and headaches.

“We are hard-headed and we don’t want to do what the doctors say,” Daniels says, adding that she’s committed to improve her eating habits and exercise as much as she can given her recent stroke.

Her frequent visits to the ER funneled her into this program where a nurse like Quiambao is going to get to the root of the repeat health scares. In Quiambao’s diabetes class, she says one man has improved enough through diet and exercise to get off of medication entirely.

This kind of care is precisely what public health officials consider the ideal. And in business terms, it doesn’t make much money, but it should yield savings by keeping sick people without insurance from needing expensive inpatient care.

So the question some city officials are asking is this: Do you need a full-service hospital to make this happen?
Why pay for inpatient care when the focus is on preventing that?

Quiambao says it’s not that simple. Some indigent patients only show up because they know ERs have to help them — especially at General. If it were just a clinic, she says they might go to another hospital that doesn’t take so much time with patients who can’t pay.

“The whole point is to keep people out of inpatient,” she acknowledges. “But we get a lot of referrals because of inpatients that are poorly controlled.”

Unsurprisingly, Nashville General’s management has argued to keep the hospital open and find other efficiencies. CEO Joseph Webb
told a community group late last week that closing would undermine recent gains in managing chronic diseases.

“I don’t see how that could be a solution,” he said.

But in three years at the helm, Webb hasn’t come up with a solution that satisfies the mayor and relies less on Davidson County taxpayers. Now he has until the end of the year.