Privatized Grady Proposes Cuts to Low-Income Care

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(APN) ATLANTA — About 40 activists representing numerous local, state, and national organizations gathered Thursday, December 18, 2008, at Grady Memorial Hospital to express opposition to a proposal they said could leave thousands of uninsured citizens without a safety net.

Atlanta Progressive News broke the news Monday at our blog, that Grady was considering the cuts.

“We have heard of Draconian cuts at Grady,” State Sen. Vincent Fort (D-District 39) said Thursday, adding that the proposal amounts to “an outrage before God.”

Grady officials declined comment through spokesperson Denise Simpson.

“Admin [sic] says they won’t discuss any proposed changes in the Grady Card eligibility guidelines until a final proposal has been developed and presented to the board,” Simpson told APN in an e-mail. “The board is scheduled to hear and discuss any potenetail [sic] changes on Jan 5 at its regular meeting.”

Grady CFO Michael Ayres made a presentation to five members of the Grady Coalition, a group that advocates for Grady patients and workers, on December 12, 2008, that Ayres plans to take to the Grady Memorial Hospital Corporation (GMHC) on January 05, 2009, for a possible vote.

The proposal, which Ayres called “a series of recommendations by management,” calls for the Grady Health System to require Fulton and DeKalb County patients who earn between 126 and 200 percent of the federal poverty guidelines to pay for 40 percent of their care, up to 25% of their annual income.

Those outside of Fulton and Dekalb in this income bracket would pay for 70% of their care, up to 25% of their annual income; presumably this reflects the fact that other counties do not financially support Grady.

An individual earning $13,000 per year or less (125 percent or less of the federal poverty guidelines) would still receive free care if they are from Dekalb or Fulton.

Under current rules, all Fulton and Dekalb patients earning less than 250 percent of the federal poverty guidelines, or $26,000 per year, receive free care at Grady. Those from outside these counties currently pay 30%.

Overall, the changes would effect working families without health insurance who make more than near-poverty wages.

“We will not stand silent while low income people are pushed to the curb… because they are not poor enough,” State Sen. Nan Orrock (D-District 36) said. “There’s a better way.”

“This is awful — to balance Grady’s budget on the backs of people who are least able to pay,” Larry Soublet, Vice President of fundraising for Atlantans Building Leadership for Empowerment (ABLE), said.

Soublet called on the Georgia General Assembly to pass legislation that would require other Metro Atlanta counties to pay money to Grady and require Georgia to kick in annual dollars to the system.

There are currently about 250,000 patients receiving some kind of discount at Grady, Ayres told the Grady Coalition, according to members who attended the meeting.

The system delivers more than 40 percent of indigent care in Georgia through the Indigent Care Trust Fund. However, Grady receives only about 30 percent of the $400 million paid by the State every year because of a 30 percent “cap” rule.

The proposal appears to be out of line with the stated mission outlined in the lease and transfer agreement between the Fulton-DeKalb Hospital Authority (FDHA) and the GMHC, according to APN’s analysis of the documents.

“Lessee [GMHC] will (i) irrevocably, absolutely, and unconditionally provide indigent care and charity care in accordance with the provisions of the Operating Agreements and (ii) operate the Hospital as a Safety Net Hospital,” the lease states.

“Where’s the compassion?” State Representative-elect Ralph Long III (D-District 61), asked. “It’s disheartening.”

“This community was made promises…that Grady was going to uphold its historic mission to serve as a safety net hospital,” Orrock said.

When the FDHA was considering the GMHC lease in December 2007, FDHA Vice Chair Christopher Edwards said, “The historic mission of the hospital — changing that is a deal breaker. That is not an option. We envision those services will continue to be provided,” APN reported.

But both GMHC chairman Pete Correll and Grady CEO Michael Young both indicated over the last year that a change like this could happen.

Long before Correll took the GMHC helm, he gave a November 2007 interview to The Los Angeles Times during which he said while any Board “would be hesitant to cut services in order to survive,” it had to confront the question “How do we decide what is a reasonable level of health?”

As reported previously by APN, Young said in September 2008 that other large, Metro Atlanta hospitals like Piedmont and Northside need to help Grady carry the indigent care burden.

“We’re going to need some help from the rest of the medical community in the 14 county area – which isn’t to say we’re not going to do more than our fair share – but we can’t be the sole answer for every county in western Georgia… in the current financial model that’s not survivable for us,” he said on September 05, 2008.

Fort said Thursday “the honeymoon with Mr. Young is over.”

Joe Beasley, the Southeast Regional Director of the Rainbow/PUSH Coalition, called Young and Correll “liars.”

“[Young] has shown where his heart is and it’s not with the people,” Beasley said.

“We know those folks on the [GMHC] are not committed to poor folk,” John Evans, former president of the DeKalb County National Association for the Advancement of Colored People and current president of Operation LEAD, said.

Their unwillingness to speak on the matter leaves several blanks. For example, how many people are going to be affected by the change? Is it dozens, hundreds, or thousands?

The Grady Coalition believes thousands will be affected. “People being denied access to health care will ultimately, here in Fulton, result in people dying,” Fort said.

Why is management calling for these changes and who is making the call for the changes? Is it Fulton and DeKalb commissioners, the business community, or some other party?

Ayres told the Grady Coalition on December 12 that Fulton and DeKalb wanted to know if certain patients are receiving “inappropriate” free care.

As part of the proposal, Ayres told the Grady Coalition that the system wants to also develop a program that would require patients to prove their eligibility before they receive a Grady Card.

This includes providing proof a patient applied and was denied Medicaid, proof of a patient’s “financial eligibility score,” and proof of financial assets, all of which are not currently required.

Overall, Ayres told the Grady Coalition that urgent and emergency services will be covered. But “non-emergency” services will be provided “at the hospital’s discretion.”

Ayres did not define “non-emergency” and did not elaborate about whom would be in charge of defining that term, the Grady Coalition said.

Did officials ever consider holding a public meeting on the issue to at least inform citizens of the changes before January 5?

The Grady Coalition indicated Thursday they might hold their own town hall meeting before January 5.

What about the FDHA? Are those members going to be consulted before a vote?

“The Lessee shall not cease providing indigent care…and emergency services…without the consent of the Authority,” the lease between FDHA and GMHC states. The lease does not specify what “consent” means.

The lease agreement between FDHA and GMHC was modified before it was approved, where it had previously given thee FDHA veto power. This is no longer specified.

Will management simply send out an email to each member or will officials have to make a meaningful presentation to the FDHA for debate and discussion?

Simpson told APN that the FDHA will not have to approve the changes and that she did not know what consultation would consist of, adding that the GMHC contains several FDHA Board Members.

Grady officials issued a statement Thursday after the rally, calling the Grady Coalition’s statements about the proposal “inaccurate.”

“Grady does not and will not deny care to low-income patients in need, and we will continue to assess each patient’s financial contribution for that care on a case-by-case basis,” a statement obtained by APN said. “We do, however, believe that individuals who have some ability to pay should pay something for the services they receive.”

“We are disappointed the coalition has decided not to work with us,” the statement added. “But Grady Health System remains committed to finding solutions that are not only consistent with our mission, but also are focused on our long term stability.”

In an interview with APN, Simpson said the “inaccurate” statement made by the Grady Coalition referred to is that Fulton and Dekalb patients in the 125-200% bracket would have to pay 40% of their income, when in fact it is 40% of the bill up to 25% of their income.

About the author:

Jonathan Springston is a Senior Staff Writer for The Atlanta Progressive News, and is reachable is jonathan@atlantaprogressivenews.com.

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