METROPOLITAN GOVERNMENT OF NASHVILLE AND DAVIDSON COUNTY OFFICE OF THE MAYOR [MEGAN BARRY - “ MerRoroLsTan courTHoUsE ‘MAYOR 7 NASHVILLE, TENNESSEE Svat PHONE: 5) 520 EMAIL mayortnasnl.gor November 17,2017 Dr: Jan Brandes and Members ofthe Hospital Authority Nashville General Hospital at Menarry 1818 Albion Street Nashville Tennessee 37208 Dear Dr, Brandes and Hospital Authority Members, | wantto start offby thanking each and every one of you for your service tothe city of Nashville on ‘the Hospital Authority. You serve on one ofthe most challenging of the Boards and Commissions in Davidson County, with complex ssues that are not easy to navigate in an uncertain health care environment | would also like to apologize forthe way in which news about the future of Nashville General Hospital \was released on Thursday, November 9. The timing ofthe message was driven by the exciting announcement by Meharry and IICA regarding their new partnership forthe training of Meharry students going forward, The natural frst question after such an announcement is “What does this ‘mean for Nashville General?" which is why I decided to address the matter at the same ime as the Meharry-HICA announcement. Due to some confidentiality agreements while Meharry and HCA were finalizing thelr agreement, we ‘were unable to have the open front-end discussions with the Hospital Authority and Council Members that I would like to have had. Its my understanding that Kevin Crumbo relayed our inability to ‘comment tothe board on a couple of occasions. Hut 'm not offering excuses forthe messaging, In hindsight, we should have done < better job. But | believe we all can agree thatthe current operating ‘model for Nashville General Hospital has not been working and isnot sustainable without significant changes. ‘Meharry has an opportunity witt HCA that Nashville General was not able to provide, whichis the ability to have all of their students train herein Nashville. Nashville General operates in a building ‘owned by Meharry, on its campus, and with significant changes to the 25-year partnership model bing announced, we must rethink how to best provide services at this facility | know you begin every board meeting remembering your mission - To improve the health and wellness of Nashville by providing equitable access to coordinated patient-centered care, ‘supporting tomorrow's caregivers and translating sefence into clinical practice. I, too believe inthe mission ~ so now the question we need to answer is how can we adjust the operating model in away that will improve healthcare outcomes forthe community, ensure quality indigent care, and provide assurance tothe taxpayers of Davidson County that their tax dollars allocated to healthcare are being spentin the most efficient and effective manner possible?Dr, Jan Brandes and Members ofthe Hospital Authority November 17,2017 Page Two Nashville General isan institution that has, and will continue to have, an important role in the health care needs of our community. [believe transition to an ambulatory outpatient facility model is the best approach. Funding hospital at a required in-patient staffing level that far exceeds the number of ‘occupied beds is not the responsible thing todo. ‘But transitioning toa new model won't be easy and there are very difficult and complex questions that ‘must be answered in order fortis to be the positive development forthe community that I believe it can be. In order to do that, [am going to need help and input from the Hospital Authority, Meharry, Nashville General Hospital employees, Metro Council members, and community leaders. ‘The first order of business, and he number one priority right now, Is to get an accurate supplemental funding dollar amount from the Hospital Authority that will preserve the status quo at Nashville General Hospital for the remainder ofthe fiscal yea: ‘The proposed operational reductions that you have identified in an effort to come closer to operating on the $35 million subsidy are wellthought out and reasonable. Unfortunately, a number of these reductions directly impact Mehcrry’s ability to train its students forthe remainder ofthe school year. 1am respectfully asking that you delay implementing these reductions for the time being so that I can propose a supplemental funding request tothe Metro Council inthe coming weeks. [further ask thatthe ‘board devote its attention to the supplemental funding request over the next couple of weeks so that lean submit a funding request to the Metro Counel that is based upon solid financial data Stabilizing operations atleast through the end of the fiscal year will provide us the ability to work with all ofthe stakeholders to ensure that employees are protected, while working together to come up with the best solution for the transitin to an out-patient model and forthe creation of an indigent care fund. | don't haveall the answers right now. It ill take a community effort to provide them all. But Lam committed to seeing that Nashv lle General remains an important part of our healthcare community in the years to come. I believe if we keep the mission asthe focus Ta improve the health and wellness of Nashville by providing equitable access to coordinated patient-centered care, supporting tomorrow's caregivers and translating science into clinical practice," we will ind the answers together. ‘Thankyou for your service to our city and tothe health care needs of our community