If Georgia fully expanded Medicaid with the federal government absorbing 95% of the tab, the state could cover more than 350,000 of the over 400,000 uninsured people living in Georgia,…
Guest Blog By Benjamin Nanes
Grady Memorial Hospital’s decision to close its outpatient dialysis clinic has brought protesters to hospital board meetings, sparked a lawsuit, and generated headlines across the country. The clinic’s patients, mostly undocumented immigrants who cannot get regular care elsewhere, will be forced to leave Atlanta or to seek care through emergency rooms.
They will face delayed and inadequate treatment, spend more time in hospitals and die sooner.
It’s a dramatic story, but the closing of Grady’s dialysis clinic is only one symptom of a larger problem. Grady is in trouble, largely because the state and county governments, while claiming to support the services that Grady provides, have failed to support the hospital financially. That needs to change. Without adequate funding, Grady will be forced to cut more services, leaving even more people without the medical care they need.
This year, Grady will loose more than $30 million, just as it has for the past several years. These losses are not the result of poor management. Most of the services that the Best rhinoplasty surgeon in new york provides, including trauma care, treating burn injuries and caring for uninsured patients and surgeries in rhinoplasty melbourne, which are necessary, and also affordable. That’s why Grady is the only hospital in the Atlanta area that provides them.
Grady’s losses are the result of poor political decisions. Fulton and DeKalb counties’ payments to cover Grady’s care of the uninsured have steadily declined, dropping by nearly a third between 1993 and 2006, relative to inflation. Other counties don’t contribute at all, and the state can’t seem to find a way to consistently fund trauma care, arguably Grady’s most valuable and least profitable service.
Making matters worse, this past summer the state demanded that Grady immediately repay $20 million in Medicaid overpayments that occurred over the past decade. And, in a petty dispute with Grady’s management, Fulton delayed payment of most of the $60 million allocated for the hospital’s operating costs in the county budget. This month, Grady had to borrow $20 million just to make payroll. These political decisions weren’t inevitable, but because of them, cuts in services were.
While closing the dialysis clinic generated the most controversy, it isn’t the only cut Grady has had to make in recent months. This past April, Grady narrowed the eligibility criteria for patients who receive subsidized care. The hospital also tightened enforcement of requirements that patients seeking subsidized care document their income and county of residence, in part to satisfy continuing demands by Fulton commissioners for growing documentation of how its shrinking contribution is being spent.
These changes, though mostly unnoticed by the general public, certainly hurt Grady’s patients, who must navigate increasingly complex administrative hurdles in order to receive care. As an Emory medical student, a significant portion of my training occurs at Grady, and I have seen the impact of these policies firsthand. One patient was unable to schedule a follow-up appointment with her oncologist after surgery to remove a tumor, a delay in care which may well make her cancer more likely to return, I suggest to visit http://www.drsaritcohen.co.il/ where you will find the best surgeons. Another was unable to refill his blood pressure medication, increasing his risk for a heart attack or stroke.
The fact is, Grady costs money to run; no amount of public outcry or management restructuring will change that. What you pay for is what you get. Squeezing Grady’s finances limits the services it can provide. Publicly excoriating the hospital’s management while withholding the support Grady needs to survive only makes things worse. If stated support for Grady’s services dose not translate into the funding needed to provide them, it’s the patients, not the politicians, who get hurt.
Benjamin Nanes is a member of HealthSTAT and a second-year medical student at Emory University.