Safety Net Hospitals in Georgia Under Threat; Atlanta Medical Center is just the latest example

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Recently, outside the Atlanta Medical Center, Cynthia Pratt was waiting for an elevator, 20 miles from College Park.

“I’ve been coming to the hospital for about 10 years,” Pratt said. “You know, the people are friendly, they’re family oriented. They treat you good. You know, they treat you like you’re somebody.”

Pratt has a leg injury that she has the hospital checked out once a week. She gets most of her treatment covered by Medicare. Atlanta Medical Center is where she sees a cardiologist and receives primary care.

A stone’s throw from Grady Memorial Hospital and Emory University Hospital Midtown, Atlanta Medical Center is a safety-net hospital, meaning more than 10 percent of its patients cannot afford to pay for care. More than 20% of its patients depend on federal health insurance.

But after more than 100 years of serving the community, the hospital closes Nov. 1, and Pratt isn’t sure where to go next.

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“You know, a lot of patients have to travel too, not just doctors,” Pratt says. “Everyone will be replaced.”

In its initial announcement, Wellstar blamed the closure on “declining revenue and rising costs,” saying the Atlanta Medical Center’s operating losses reached $107 million year-over-year.

This is the second Wellstar facility to face closures in Atlanta this year.

Hundreds of patients left behind by the Atlanta Medical Center closure, many uninsured or underinsured, will have to go elsewhere for treatment. And nearby health care facilities are not ready for them.

“We now have patients who have been admitted who have to spend several hours in the emergency room before being assigned to an inpatient bed,” Grady Health Systems CEO John Haupert said in an interview with GPB in late August. .

Grady Memorial Hospital is expected to see an additional 200 patients a day once the Atlanta Medical Center closes its emergency room on Oct. 14. This is only a fraction of AMC’s total patient load.

But Grady, just 1 mile south of AMC, already regularly diverts patients to other hospitals.

So even with Grady’s help, patients could still be left seeking care, perhaps even 100 miles from Macon. Dennis Ashley, director of trauma care at Macon Medical Center, warns his hospital may not be able to pick up the slack.

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“If you look at this mid-state strip, on Interstate 75, we have our hands full with all the patients we can handle,” Ashley said.

Health facilities in South and North Georgia often send patients to Atlanta for more intensive care, according to Liz Atkins of the Georgia Trauma Commission,

“So cutting that number by nearly half … is going to create a backlog of patients who need to access that care,” Atkins said, referring to the loss of the Atlanta Medical Center.

But whether these surrounding hospitals are ready or not, they have agreed to take over the healthcare system.

Atlanta Medical Center, Grady Memorial, and Atrium Health Navicent are nonprofit hospitals, which means they must accept patients regardless of their ability to pay. This is in exchange for fat tax breaks.

More than half of all hospitals in Georgia are nonprofit. Since 2008, four of the 10 hospitals that have closed have been non-profit and three have been government-owned.

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Monty Veazy leads the Georgia Alliance of Community Hospitals, which represents such hospitals.

“We are walking a tightrope today because of the diversity of payers,” Veazy said, meaning hospitals say unpaid and underpaid care costs put them at risk of closure.

Other factors, such as the exorbitant costs of contract nurses amid growing healthcare worker shortages, put nonprofit hospitals at great risk of closure, Veazy said.

“All profits generated must go back to the hospital or the community,” Veazy said. “And when you don’t have a good combination of cases, and that’s the case with Wellstar, you can’t make a bottom line.”

Possible solutions are now campaign issues.

Democratic gubernatorial candidate Stacey Abrams spoke at Macon Medical Center during a September 22 campaign stop.

“You’re going to be expected to accept these patients who always come here without insurance,” Abrams told the crowd.

Abrams has made comprehensive Medicaid expansion the centerpiece of his campaign. The federal government has encouraged states to adopt this program since the Affordable Care Act was passed, with the idea of ​​providing financial stability to safety net hospitals that often depend on fluctuating government support.

Full expansion of Medicaid in Georgia would insure an additional 500,000 people who otherwise could not afford their health care.

“Expanding Medicaid isn’t just about giving someone an insurance card,” Abrams said. “It’s about making sure the rest of Georgia doesn’t foot the bill.”

But even with the federal government stepping in at 90% of the cost, expanding Medicaid would still require additional state money, something Georgia’s Republican-led legislature has consistently opposed.

Gov. Brian Kemp’s partial Medicaid expansion offers a more conservative approach, covering 50,000 people with work requirements at nearly three times less than what the full expansion would cost the state.

Hospitals in expanding states have seen more care paid for by Medicaid, according to studies by the Journal of the American Medical Association and the Health Affairs Journal. Nonprofit hospitals in these states also close less often.

Kemp’s solution is to give Grady Health Systems $130 million in U.S. federal bailout funds to build about 200 additional inpatient beds — beds that Grady already needed before he was expecting patients from the University Medical Center. ‘Atlanta.

“These are not band-aid solutions,” Kemp said at a Sept. 15 press conference at the Georgia Capitol. “These are meaningful, carefully thought out and implemented steps designed to ensure that this cornerstone of Atlanta’s healthcare system rests on a solid foundation for many years to come.”

Although Grady Memorial Hospital needs more beds, Veazy said he expects more hospital closures unless something changes statewide.

“We’ve been discussing this for over a year,” Veazy said of the Atlanta Medical Center closing. “I think the timing was an issue, but I don’t think it’s a big surprise that their future wasn’t going to last too long.”

Adding more beds to Grady could take at least a year. Meanwhile, Atlanta Medical Center has already stopped accepting ambulance traffic to its emergency department.

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