Nashville General board approves two-year professional services agreement with Meharry Medical College

NASHVILLE — The Hospital Authority board voted to approve a two‑year professional services agreement (PSA) formalizing the relationship between Nashville General Hospital and Meharry Medical College, after several board members sought clarification on physician appointments, billing and reimbursement responsibilities.

Board Chair (unnamed) brought the PSA to the table after a multi‑month drafting and legal review process. “The terms of that agreement were worked out, over the course of diligent meetings” said David Esquivel, who summarized the history and legal vetting of the contract before questions from the board. He told directors the agreement had been reviewed by counsel for Meharry, the hospital’s outside counsel (Spencer Fane) and a law firm retained by Metro government.

The agreement matters because, board members said, it replaces a multi‑year operating relationship that lacked a formal, current contract and addresses compliance and operational roles between the two institutions.

Board members pressed for clarity on two operational points: who selects chiefs of service, and who carries financial responsibility for billed services that go unpaid. Doctor Stanley Miller asked whether Nashville General or Meharry selects chiefs after noting potentially conflicting language in different sections of the draft. Doctor Elders, an interim hospital leader, said a joint hiring committee will make those selections collaboratively, and that the committee will be co‑chaired by hospital Chief Medical Officer Doctor Bullock and Meharry’s dean, Harris Haywood. "We are partnering to make those decisions collaboratively. So we will not be making those decisions in silo," Elders said.

Board members also asked about billing and reimbursement. The PSA preserves a historic reimbursement approach for uninsured patients: Meharry will bill patients and payers and Nashville General will reimburse Meharry for amounts Meharry cannot collect for self‑pay patients, according to hospital staff. Doctor Blackledge, who addressed compensation provisions, said, “That 125% is a historic number that was dated in the previous versions of the PSA, and we did not change that during this time.” The board discussed distinctions in the document between insured‑patient billing (where Meharry would be responsible) and arrangements for self‑pay patients that could result in reimbursement by the hospital in certain circumstances.

Board members asked how disputes about denied claims or collections would be handled. Hospital staff said the PSA and related processes rely on regular reconciliation between Meharry and hospital revenue teams and on escalation to a newly formed PSA finance committee for unresolved issues.

The PSA is limited to two years, a term hospital leaders said was selected so the contract coincides with the current building lease. Board members noted ongoing discussions about a potential lease extension and said a two‑year PSA allows both parties time to align longer‑term arrangements.

After the discussion the board chair called for a motion to approve the PSA; the motion passed with the board voting to approve the agreement.

Next steps: hospital staff said a public signing will be scheduled with the mayor’s office; board members were told invitations for a public PSA signing would be issued ahead of a planned September 3 event.

Ending: The board and hospital leadership characterized the PSA vote as an institutional milestone intended to stabilize clinical staffing and billing relationships with Meharry and to reduce compliance risk going forward.