Following an automobile accident in which he is severely injured, a young man is transferred by ambulance to Erlanger hospital. Surgeries, a prolonged stay in intensive care and further in-patient care lead to his discharge home. More than $50,000 of his hospital expenses are not covered by his TennCare insurance.
A very premature baby requires a prolonged stay in the neonatal intensive care unit of Children's Hospital at Erlanger before she can go home. More than $100,000 of her hospital expenses must be written off.
A young man with multiple gunshot wounds is admitted through the emergency room for a long and complicated stay. He has no health insurance and no financial resources. His total hospital bill is classified as charity care.
In the last fiscal year, Erlanger provided $82 million in uncompensated medical care, the majority of which was delivered to residents of Hamilton County. This sum represents indigent care, the gap between TennCare payments and actual cost of care, and bad debt.
Unlike most municipal hospitals, Erlanger has over the years been able to cover such losses with revenues from patients with non-Medicaid insurance or those who paid cash for services. The recession that began in 2008 led to reductions in elective procedures, which had been an important revenue stream. Increasing numbers of patients who have lost jobs and insurance in the recession rely upon the hospital as their medical safety net.
Beginning in 1976 with the establishment of the Chattanooga-Hamilton County Hospital Authority, Hamilton County contributed $3 million to Erlanger for improvement of facilities and other projects. Last year, this supplement was slashed in half. By contrast, Davidson County provides $33 million to Metro General Hospital; Shelby County provides $51 million toward the operation of The Med, that city's municipal hospital.
Faced with burgeoning debts, a typical business would eliminate money-losing services. In the case of Erlanger, that would involve shutting down the trauma center, Children's Hospital and the educational program.
Erlanger is the only Level 1 trauma center for a region that extends for a radius of 150 miles from Chattanooga. At times when other trauma centers are on "divert" status, the hospital will accept trauma patients from further afield. Level 1 certification requires continuous availability of all specialties and diagnostic and treatment services.
Children's Hospital within the Erlanger complex offers to the county and to the region unique services that are never profitable. Absent the center, children with complex illnesses would require transfer to Atlanta or Nashville. Children's Hospital offers state-of-the art care for children ranging from infancy through adolescence.
Through its academic affiliations, Erlanger provides training for medical students and for residents in a variety of pediatric, medical and surgical specialties. The hospital is one of two in Tennessee to offer a residency in emergency medicine. Upon completion of training, many of these physicians establish practices within the region, elevating the level of care. More importantly, an academic medical environment stimulates research and medical advances within its boundaries. The stroke intervention program is a dramatic example (more about this in a future column).
Media have focused almost exclusively upon the hospital's financial deficits. The origin of the losses is seldom mentioned: Medical and surgical therapy for vulnerable populations depend upon Erlanger for their health and their lives.
The Hamilton County Commission owes Erlanger hospital more realistic, financial support to cover some of the uncompensated care of county residents. While not as glitzy as other aspects of our rapidly evolving urban area, Erlanger provides an irreplaceable array of services without which we cannot function as a modern and caring society.
Contact Clif Cleaveland at email@example.com.
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