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Nashville General updates board on FY26 budget, says it can meet Metro’s modified $60.7 million subsidy
Summary
Hospital presenters told the board they were approved for a modified Metro subsidy of $60.7 million (down from an initial $66 million request) and outlined cost‑containment steps, the KPMG engagement, recent financials showing a monthly net loss and details on payer mix and cash position.
Nashville General Hospital leadership told the Hospital Authority board that Metro Council approved a modified funding request of $60.7 million for fiscal year 2026, down from the hospital's initial $66 million submission. Hospital presenters said the leadership team intends to execute cost containment and revenue initiatives to align with the approved amount.
Doctor Blackledge (presenting the budget update) summarized the Metro Council hearing and the hospital's request: "Our initial request was for $66,000,000. We were approved modified approved for 60,700,000.0. We made no request for additional funding during our budget hearing." She outlined seven topics covered at the hearing, including leadership changes, program descriptions, recent performance, cost‑containment strategies, engagement with KPMG for workforce optimization and a slide titled "new beginnings" focused on transparency, financial pivots and workforce investment.
When asked whether the hospital could meet the $60.7 million figure, a senior presenter said, "Yes. That's definitely our intent. We believe that we can get to 60.7. It is not easy. It is not an easy task... There are hard decisions. There are tough calls." Presenters stressed the need for a culture shift to execute reductions and process changes.
Controller Keith Moran presented April financial statements. Key figures in the presentation included a monthly net loss of about $1,100,000 and a year‑to‑date shortfall of approximately $19,900,000 compared with budget. Patient volumes showed small month‑to‑month movements (inpatient admissions declined from 232 in March to 221 in April) and a case‑mix index decline from 1.28 to 1.21. Moran said total revenues for the reporting period were about $25.3 million, roughly 10% below budget, and detailed expense drivers including higher contract labor and unbudgeted leases for medical and IT equipment.
Moran said the hospital's cash position at the time of the statement was approximately $5.5 million in the bank and that the hospital expected to receive an additional $9 million in Metro supplemental funding in May, which staff said would change year‑to‑date results. He also described prior Medicare cost‑report settlements the hospital had to repay (a $683,000 adjustment for the 2022 cost report and an anticipated ~$850,000 for 2023), which staff attributed to omitted items in prior filings and said they had implemented processes to prevent recurrence.
Staff also reviewed payer mix slides showing a multi‑year trend of rising insured proportions among both inpatient and outpatient populations and that uninsured patients and Davidson County inmates compose a meaningful share of the hospital's patient mix (transcript noted uninsured ~28.8% and Davidson County inmates ~4.05%). Presenters tied the payer mix and the Metro subsidy together to explain how the hospital's revenue and mission intersect.
Board members and hospital leadership agreed to hold a fuller revenue discussion and the KPMG update at a subsequent board meeting to avoid running past scheduled time. The board then adjourned.
