Another 24 hours at Grady

A year ago, my mother had to go to Grady Hospital. We waited 24 hours in Grady’s dystopian, crazy-filled emergency room triage pen. I blogged through the last 16 hours of it.

Well, I’m doing it again. Journalism as performance art.

Right now, I’m sitting in Grady Hospital’s emergency triage ward. For 24 hours straight, I’m going to walk the halls of Grady, documenting everything I see as a live blog on Peach Pundit.

Grady is facing a $100 million budget cut of county, state and federal funds. If they lose that money, Grady is going to cut its mental health services and it’s going to be like killing the power on the containment field at Ghostbusters Headquarters.

I am aware of HIPAA and I’m not going to break the law. But unless people really understand what Grady has to do to get through a day, those cuts aren’t going to be viewed as insane as they should be.

Let’s see what a day here is like.




  1. John Konop says:

    I fell for you and I am sorry to hear about the problem…..

    We could implement a few solutions to help:

    1) We could create a 800 call in number for non emergency care which would save money and give better service.

    2) We could shift dollars savings away from incarceration of mental health issues and instead use it for treatment….Safer society, saves money and it is the right thing……

    3) We could once again decriminalize social behavior and shift some of the dollars toward treatment over incarceration

    4) We could increase available dollars for Medicare/Medicaid by implementing a proper transaction fraud system with hold backs similar to what we do in banking, credit card….. transactions.

    5) We could use VA pricing on drugs for Medicare/Medicaid patients saving tax payers about 50 to 60 percent of the cost which part could be invested into people in need.

    I realize nothing I posted will help your issues today…..and it is terrible what people most deal with…….

  2. Not completely related to Grady, but we could also do what Maryland does with hospitals. The state has set the rates that they are allowed to bill since the 70’s. Instead of billing $4,000 for a procedure that they hope to only collect $1,000 from an insurance company, in Maryland they bill the actual amount they want insurers to pay. And anyone who walks in who is uninsured gets billed the actual amount as well.

    In some states, hospitals bill about 350% of what they collect, yet typically only write off about 2% of their billings as actual bad debt (in other words, if they bill $4k and insurance pays them $1k, that’s not bad debt). In Maryland, hospitals bill about 125% of what they collect, and as a whole turned a profit of about 7% in recent years.

    How would something like this help Grady? Real rates that have a real chance of being collected from uninsured or self insured individuals. In many cases, uncompensated care is something like $20,000 bill that insurance would only pay $2,000 for and the hospital would gladly accept. But if you’re uninsured, you see that $20,000 and they won’t bargain with you down to $2k, and so you just never pay anything. If Grady saves your life, and you were given the opportunity to pay what the same amount that would have been paid if an insurance company was paying instead, you’d be much more likely to pay it instead of filing for bankruptcy.

    Expanding Medicaid is important to Grady, but reforming how hospitals bill everyone is important to everyone, including Grady.

    • Jackster says:

      I think what you’re referring to is the inflation of services to account for lower reimbursement and a single fee schedule.

      Ideally, there should be one price – a cash price. Your insurance could pay it, cover the services, or what not. Either way, it’s on you (and whatever you’ve arranged for coverage).

      If you went a single low cost fee schedule, would you then back into a single payer system, since at that point you’ve pretty well commoditized the service?

      Seems to me that most conservatives would want this sort of approach.

    • John Konop says:

      Chris in all due respect you are avoiding the cost side,… just paying less without dealing with cost you will only leave more people behind……

      • Raleigh says:

        When a hospital patient is charged 15.50 for a blood pressure pill that cost 3 cents and charged $67 for sterile water that cost $1.67 it goes way beyond “Cost” If the grocer used the same model for a 99 cent loaf of bread would cost you $506.88. That type of hospital markup would inflate the cost of a 20 dollar steak to $10,240. That would make a nice steak dinner out of the question. You cannot justify those type of markups as cost recuperation. No other business I know of can charge like that.

        Also hospitals make it very difficult to get an itemized bill. What and why are they hiding it? I wouldn’t have anything to do with Medicare charges would it? You cannot justify those types of markups as cost recuperation. Again what are they hiding?

        • John Konop says:

          The reason this happens is because they are passing the cost of uninsured or underinsured back to tax payers and or people with good insurance. At the end it is just a shifting game rather than dealing with the fact that the cost of healthcare for years has been rising we faster than real wages.

          In any business you have 2 things to balance revenue in verse payments out. If cost of goods rise faster than what your customers can afford you got a real issue. In healthcare we have been playing a shell game for years…that is why I warned years ago you can only play the game so long….

          The real solution is we need to lower cost and have more pay in……and we have to be realistic on what we can afford……

          • Raleigh says:

            John if the overhead cost to do “business” causes a hospital bed to be $20,000 a night then so be it. Call it want you want but don’t just hide those cost in inflating consumables to over 1000%. When you do that you are hiding something. I also keep hearing it’s the “uninsured and underinsured” causing the issue however where is any in-depth report that backs up that statement? I haven’t seen one. I would venture to say one problem is the agreements hospitals make to insurance companies and Medicare on what reasonable charges are allowed. As Chris pointed out if hospitals allow insurance companies to pay $1000 dollars on a procedure they book at 10 times that amount then they should not be allowed to charge a cash customer more that what they accepted from insurance companies, or Medicare or anyone else. I think what we need is a truth in medical billing act.

            • John Konop says:

              I agree….I have done a lot of turnarounds in business….that is one of the first signs of trouble is poor allocation of cost verse price sold…..When you lie to yourself…….

  3. Jon Lester says:

    It’s very big of you to do this. I had to deal with pharmacies today, something I only rarely have to do, and even that was all the waiting I could stand.

  4. drjay says:

    i have never set foot in grady, how is their er set up? do they have a fast track, a separate peds er, is there a dedicated observation unit? it almost sounds unreal, like a parody that i am readin…

  5. bgsmallz says:

    Quick correction…Atlanta Medical Center received Trauma-1 designation in 2011…while there isn’t a Level 1 in Gainesville to my knowledge. AMC, Grady, Macon, Savannah, and GMC in Augusta are the 5 Level 1 Trauma centers in Georgia.

    One thing that is probably relevant in this discussion as it comes to paying for things that we need…

    Trauma Centers have gone from around 15 in 2009 to ~24 today…part of that has to do with the incredibly successful Super Speeder Law. The actual revenues from Super Speeder tickets in 2013 was over $18.5 Million.

    I don’t think it’s worth wading in on whether Deal should have expanded Medicaid…but that decision can’t be made in a vacuum. Doing nothing provides leverage against Obamacare, but how many lives are literally going to be lost if the state doesn’t cover the gap in funding to Grady?

      • Toxic Avenger says:

        I’ve always been told Grady is the only one in Atlanta Metro, but according to Wikipedia, AMC is as well. Interesting.

        Good blog, George.

        • bgsmallz says:

          One more critique (hopefully constructive)…claiming that hospitals seem to go on diversion in order to keep away non-paying patients isn’t really fair or accurate.

          “The scandal is that hospital administrators are quite aware that people coming through their emergency rooms are statistically much more likely to lack insurance and result in indigent care than their standard patient load.”

          That’s not really true for many hospitals. While I’m all for making sure that Grady is funded, I don’t think it is necessary to imply that other hospitals are somehow complicit in Grady’s problems by diverting non-paying customers there.

  6. saltycracker says:

    AMC is a trauma 1 hospital. Grady is the traditional go to center for indigents. A part of the costs and hospital frustrations are the non-compliant that will not follow instructions and are repetitive. Medicaid has ratcheted up the issue by rejecting claims for the same problem within 30 days, like diabetics that will not take their meds and have problems. Medicare responds that the hospitals must do a better training job. Care is mandated so Grady will be taking some big hits.

  7. Dave Bearse says:

    I read the first few entries from the top down but was off-put by the length of the post over an hour ago. I soon returned a short while ago to read first rate journalism from the bottom up.

  8. Dave Bearse says:

    Governor Deal’s got another feather in his cap!

    We’re No.3! Third behind only TX and FL in the net loss of nearly $3B in federal funds we’ll lose by not expanding Medicaid.

    Said Deal (facetiously), “We’ll lose money on most uninsured treated in Grady’s ER, but we’ll make it up in volume.”

    The numbers are on p. 9:

  9. drjay says:

    “But if you have a cold? Regular people aren’t coming here.”

    in all honesty, if you have a cold you shouldn’t be going there anyway…this is also part of why i was asking about the set up, i used to think that i once worked in a very busy, level 1 trauma center er, we often had 4 or 5 hour waits, we took all comers and were prohibited by admin from sending folks away (even if the pcp on their medicaid card said “send them over, we can see them right now” when we called for a authorization number) but good grief it was never anything like you are describing here–when we had stretchers in the hall it was a crazy day, not a tuesday…but we also had a dedicated peds er, separate entrance and everything, we had “fast track” (which was a pa that would see sore throats and sprained ankles so that they didn’t clog up the system) and observation unit that would keep folks for 12 to 23 hours that didn’t necessarily need admitting, but we were not quite ready to send home either…

    we also used to have a saying along the lines of “if you can sit and wait for 6 hours in the er waiting room, you probably don’t need to be in the er to begin with…”

    • saltycracker says:

      The truly needy are overwhelmed by moochers in the disability office, food line, health care, child care, charity outlet, immigration process, unemployment line….it is so easy as we avoid being judgmental or enforcing beyond all we can handle.

  10. analogkid says:

    This is quite possibly the best post ever on PP.

    Bold (?) Prediction: Six months into Gov. Deal’s second term, he agrees to expand Medicaid, citing some “new information” or a “new development” that (supposedly) changed his mind.

    The governor is a smart man and an astute politician. I probably won’t vote for him in the general election, but I’d be shocked if my prediction turns out to be false.

  11. drjay says:

    what is the rest of the hospital like??? i was at emory yesterday for a procedure and couldn’t help thinking about how not like the experience described here it was…

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