Imagine a preventative health and hospital system in the heart of downtown Atlanta designed to coordinate a full range of services, from wellness checkups to acute hospital care, for residents who are poor and lack insurance.
Think as well about getting to the tens of thousands of patients who suffer from uncontrolled diabetes, hypertension, lung disease and other chronic conditions before they get so sick they end up in the always-overcrowded Grady Memorial Hospital emergency department. Maybe such a system could include a place for the homeless with severe mental issues to go until they are stabilized, instead of taking them to the county jail.
Mayor Andre Dickens’ decision to temporarily pump the brakes on any commercial rezoning and redevelopment of the soon-to-be-abandoned Atlanta Medical Center site provides us a real opportunity to deal with Atlanta’s perennial crisis of health care services for the poor and underserved. The linchpin for all this would be expanding the publicly owned Grady Health System.
Grady, with more than 900 licensed beds, was founded in 1892 as a charity hospital. AMC, with about 450 beds, was founded as Georgia Baptist Hospital about a decade later to provide similar charitable care. They are only blocks apart, separated by the Downtown Connector. Both have traditionally served a similar patient base of uninsured patients and only the poorest of the poor and disabled adults who qualify for Georgia’s notoriously stingy Medicaid program. Wellstar Health System, which now owns AMC, has decided to give up on that mission in downtown Atlanta.
A new, Grady-run Atlanta Medical Center could retain its trauma service but could also convert some of its intensive care beds to general, acute-care beds for those patients who now have to wait in the Grady ER for these sometimes-scarce beds to open up.
Other services now housed at Grady, such as its psychiatric unit, or the beds dedicated for incarcerated patients and homeless patients, could be switched to AMC. This would free up more beds for some of Grady’s highest-level services, such as its recently renovated neurology/stroke unit, neonatal intensive care, and women’s cancer pavilion, a move that might even attract more privately insured patients to the system and make it less reliant on public funding.
These decisions would have to be made by the nonprofit community corporation that runs Grady, which is more stable now and less prone to political cronyism than when it nearly closed 15 years ago. To be sure it will be complicated because of the way Grady operates — using Atlanta’s two medical schools, Emory and the Morehouse School of Medicine, as it’s in-house staff.
But it will never get off the ground unless Georgia is willing to expand its Medicaid program to take in more low-income adults who go without insurance now. The whole state need not go to full expansion, although that would make the most sense. Georgia could seek a waiver from the federal government to expand eligibility for a targeted group of low-income adults living in Fulton and DeKalb counties.
Indeed, Grady proposed such an expansion in 2015 to create a coordinated primary- and acute-care plan for about 50,000 uninsured adults who now rely on the hospital emergency room for their health care. It wanted to enroll these new Medicaid patients into regular checkups and routine care at the hospital’s community clinics. Others would get care at federally funded primary care clinics and nonprofit providers, like Mercy Care. The goal was to reduce visits to the ER and prevent unnecessary hospitalizations. It would have the added benefit of helping control Medicaid expansion costs for the state.
Cleveland, Ohio has enrolled more than 30,000 new Medicaid patients under a similar plan, through its flagship public hospital’s MetroHealth System. Experts have studied how it works and determined that health outcomes for those enrolled improved significantly and costs were much better controlled than in the years prior to expansion. Even better, the federal government picked up 100 percent of the cost of the expansion in its first few years. The MetroHealth system now has four hospitals, 20 health care centers and over 40 ancillary sites operating in Cuyahoga County, all coordinating care for 300,000 patients, two-thirds of whom are either uninsured or covered by Medicare or Medicaid.
An even more ambitious plan is working in Chicago, where Cook County Hospital operates a Medicaid HMO with more than 100 clinics and more than a dozen cooperating hospitals, effectively spreading the burden of caring for low-income patients countywide.
Georgia officials have complained often and loudly about how costly the Medicaid program is, and how it isn’t tailored to Georgia’s specific needs. They want to implement a very-scaled-back expansion for some low-income adults that is tied to the recipient’s efforts to find a job, get training or do some form of charity work in order to qualify. It is woefully inadequate and attempts to transform Medicaid from a medical assistance plan to welfare, which it was never designed to be.
Instead, we should dust off Grady’s waiver proposal from 2015 that creates a coordinated, cost-effective approach to a range of health care services for the poor and uninsured in Fulton and DeKalb counties and test it to see if it can be tailored for other areas of the state. Expanding Grady to include the Atlanta Medical Center is a preferable approach for accomplishing both of the state’s goals.
Mike King is a retired Atlanta journalist who worked on the editorial board of The Atlanta Journal-Constitution. He is author of the award-winning book, “A Spirit of Charity: Restoring the Bond between America and Its Public Hospitals.”
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