Nashville General outlines FY2026 priorities, cost cuts and Meharry partnership to council committee

Nashville General Hospital interim leaders presented to the Metro Council Budget & Finance Committee Thursday, detailing recent operational changes, a planned professional services agreement with Meharry Medical College and steps to contain costs as the hospital prepares its FY2026 budget.

The presentation, led by Dr. Veronica Elders, interim CEO and chief nursing officer, and Dr. Blackledge, interim chief financial officer, said the hospital has responded to findings from a recent Metro internal audit, implemented new procurement controls and started to reduce contract labor and outside services to lower costs.

The changes followed a timeline Elders described as “the last 60 days,” during which the hospital tightened procurement authority, introduced DocuSign for contract workflows and terminated or renegotiated several outside contracts. Dr. Blackledge said three audit compliance items remain open: a legal recoupment action involving City Ballet, leadership training on the new contract-management system due in June, and two contracts to be brought into compliance and presented to the hospital board on May 29.

Why it matters: Nashville General is a safety-net provider for Davidson County, a licensed 150-bed hospital and the primary teaching hospital for Meharry Medical College. The hospital reported roughly 57,000 clinic visits, about 300,000 procedures and tests, and just under 27,000 annual emergency department visits for 2024 activity, figures Elders presented to the committee.

The hospital said it has 867 employees and that leadership ranks have been reduced; at one point the organization had 16 executive positions and now lists seven. Elders said workforce optimization work with an external consultant (APMG) aims to standardize hiring and onboarding and to evaluate service-line utilization.

On the Meharry relationship, Elders said the two organizations have negotiated charters and a revised professional services agreement (PSA), with signatures expected in June. She described two governance committees tied to the PSA: a joint hiring committee and a finance committee intended to align funding streams such as graduate medical education and reduce future grievances. “We are committed to joint hiring, moving forward,” Elders said.

Budget and revenue: Elders told the committee the hospital submitted a $66 million request in February; that request was adjusted by Metro Finance to a lower figure in the hospital’s modified budget. The hospital presented a revenue mix showing patient collections as the largest source, state funding and other revenues; Elders presented a total operating income figure of about $158.8 million in the slide deck shown to the committee. Dr. Blackledge said Medicaid comprises roughly 18% of the hospital’s patient mix.

The committee and hospital leaders discussed a recent Metro resolution that provided supplemental support: Elders and Blackledge said Resolution RS202511O9 granted the hospital a $10,000,000 subsidy for FY2025, and that they did not request additional funds at the hearing in light of that recent allocation.

Cost containment and staffing: Hospital leaders said the most significant short-term savings came from reducing contract labor (travel nurses and other temporary staff) and cutting or renegotiating contract services. Elders emphasized the goal of maintaining quality and reviewing service lines before making staffing decisions; she said salary expense is a major driver of costs and that the hospital’s FY2026 budget includes a 5% employee pay increase.

Access and community programs: Elders described 23 primary care and specialty practices across the county, two pharmacy locations, the state’s first “food pharmacy” program and long-standing programs that serve people experiencing homelessness and victims of child and sexual abuse. The hospital’s cancer program noted more than 80 years of accreditation by the American College of Surgeons, and the organization highlighted an A rating from Leapfrog.

Council questions and next steps: Councilmembers sought more detail on clinic locations and utilization; Elders identified clinics at 1919 Charlotte Avenue (Midtown), Metro Center, French Landing and Bordeaux (off Clarksville Highway). Councilmember Johnston requested a district-level breakdown of patient origin; Elders said the hospital has presented ZIP-code heat maps to the council and would return with further analysis as part of clinic operations reviews promised to the hospital authority board.

Councilmembers also asked about possible use of the hospital’s unused bed capacity for mental health care and about contingency planning for potential federal Medicaid changes; Dr. Blackledge called such federal shifts a “headwind,” said the hospital meets regularly with Metro Finance and pledged to develop plans quickly if changes materialize.

The committee exchange concluded with councilmembers offering assistance on southern-county access and potential partnerships for psychiatric capacity; Elders said discussions about a needs assessment and partnership with the mayor’s office would inform future facility decisions.

Ending: Hospital leaders closed by thanking staff in the audience and said they would return with clinic reviews and further budget updates; the committee then moved on to the next scheduled department hearing.