Tens of millions of taxpayer dollars soon will be handed over to Grady Memorial Hospital with less control by elected officials over how it's being spent.
If the roughly $50 million Fulton County will pay Grady isn't spent as intended, then Fulton County taxpayers could find themselves in the unenviable position of asking the hospital to give money back. For the past three years Grady has had to first make a case for Fulton County's money, which helps cover the care of indigent Fulton residents.
At least one state lawmaker says he thinks the hospital will cut services to patients as a result of lesser oversight. Expect more clinic closures, said state Sen. Vincent Fort, D-Atlanta, co-chair of the Grady Coalition patient advocacy group, because now Grady's corporate board will have to answer less often to Fulton commissioners.
"The only leverage that the community has is the influence of the commission," Fort said.
As the state's largest trauma center, Grady has seen upwards of 100,000 patient visits to its emergency department this year with overall hospital visits surpassing 600,000. It spends more than $200 million each year on caring for the poor and uninsured.
Starting next month, the new contract between Fulton and the struggling safety net hospital gives Grady smoother access to Fulton's roughly $50 million -- funding Grady needs to keep operations afloat. Other lawmakers and commissioners agree with Fort, saying the new arrangement diminishes accountability, amounting to a blank check.
"It is returning to the practices of days of old where that's exactly what occurred," said state Rep. Lynne Riley, R-Johns Creek, formerly north Fulton's county commissioner. "That's, for me, personally disappointing, because it flies in the face of the 2009 [contract] that we worked so hard on."
Fulton and DeKalb taxpayers are among the hospital's biggest benefactors, contributing tens of millions of dollars per year needed to keep accounts in the black.
Facing its toughest fiscal challenges yet, Grady is grabbing for every dollar it can, and Fulton's pattern of withholding millions of dollars every year over its intensive audits isn't cutting it anymore. The hospital wants its money sooner rather than later, and thanks to a lobbying effort and contract changes about to go into effect that will happen.
Quarterly payments and audits will be replaced with monthly payments and an end-of-year reconciliation to find out whether Fulton's funds went to treat Fulton's neediest patients, as required.
If that can't be proven for all the money Grady receives, rather than asking for part of it back, it's more likely the commission would reduce the hospital's 2013 allocation for not living up to 2012 expectations, said Thomas Dortch, a corporate board member and chairman of the Fulton-DeKalb Hospital Authority board of trustees.
That's the last thing the hospital wants, so there will still be accountability, Dortch said. Currently, Grady treats far more Fulton patients than the county pays for, he said.
"It's not like the county is donating the money," Dortch said. "It's a partnership that's working."
Fulton's Grady allocation has been steadily declining in recent years, from $59 million in 2009 down to a tentative $51.7 million next year under a draft budget.
Such reductions have Grady facing a nearly $20 million shortfall this year. The hospital's bottom line has rapidly deteriorated following a roughly $20 million cut in local and federal dollars to care for the uninsured.
The hospital has eliminated 200-plus jobs, shuttered two neighborhood clinics and upped prescription drug co-pays, among other cost-saving measures.
The 2009 memorandum of understanding, put in place after the near financial collapse of the hospital and the subsequent transfer of control to the nonprofit Grady Memorial Hospital Corporation, requires proof that all Fulton tax dollars go to treating Fulton indigent and uninsured patients. Every year since, disputes over those stipulations caused money to be withheld -- $3.9 million this year, $9.9 million last year and more than $4 million in 2009.
The commission voted each time to pay the money anyway, but not without Grady officials taking severe tongue lashings on live television. In January, Commissioner William "Bill" Edwards charged that county taxpayers were being "bamboozled" by a hospital not holding up its end of a bargain, and former CEO Michael Young publicly apologized.
Those days came to an end Wednesday, when the county commission narrowly voted to pay out the $3.9 million after weeks of talks between Grady officials and key commissioners.
Grady has had difficulties in the past reporting of the number of patients it serves – most recently following the installation of a new electronic health records system late last year that caused data conversion problems, chief financial officer Sue McCarthy said.
According to documents submitted to the county by Grady, the hospital spent $65 million treating Fulton needy patients this year
"The reality is Fulton County patients that fit the criteria far exceed the amount of money that we budget for," said Fulton Commission Chairman John Eaves.
Grady officials need to cultivate better relationships with county commissioners, which have deteriorated and become more adversarial over the years, said Dorothy Leone-Glasser, president of the nonprofit Advocates for Responsible Care.
“There is nowhere for the underserved of Georgia to go if we don’t have Grady," she said.
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