When Katherine Neuhausen enrolled in medical school, she expected to learn how to save patients—not hospitals.
But she wound up learning how to do both at Emory University School of Medicine, where she earned her medical degree and, at the same time, helped lead a successful advocacy campaign to rescue Grady Health System in Atlanta, one of the largest public safety-net hospitals in the nation.
In 2007, Grady was on the brink of economic collapse. But Neuhausen, MD, MPH, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar (2011-2013), and throngs of other student activists took time away from their studies that year to help keep its doors open to patients in need.
They succeeded, playing a pivotal role in saving Grady from the fate of several other public safety-net hospitals in major metropolitan areas that had been forced to shut their doors over the past decade. Neuhausen recounts her modern-day ‘David & Goliath’ tale of people over power in a riveting narrative essay published in June in Health Affairs, a leading health policy journal. “We couldn’t let Grady close without doing everything possible to try and keep it open,” she said.
Neuhausen developed a passion for Grady, the fifth largest public hospital in the country, and an interest in advocacy, early in her career. While a medical student at Emory, she worked with and got to know patients at Grady and came to better understand how social and political factors shape access to health care services and health outcomes. “I really started to make the connection between the personal and the political,” she said.
Neuhausen also began to understand her own power to influence policy—and ultimately, patient health—during that time. She joined Health Students Taking Action Together (HealthSTAT), a nonprofit statewide advocacy group run by health professional students in Georgia, and eventually joined its board of directors.
Using Power, Taking Action
In 2007, while a fourth-year medical student, she put that power into action. Together, she and her colleagues at HealthSTAT launched a campaign to raise awareness about the critical role that Grady played in the Atlanta region and about the urgent need to keep it open for the benefit of its underserved, underinsured patients. “When we show up in white coats at the Capitol, we have a powerful voice,” she said. “We humanize the impact and educate legislators when we tell stories about the real human cost of abstract political decisions.”
She and her colleagues attempted to inform legislators and funders about the need to support Grady through public relations tools such as phone calls, letters, postcards, patient stories, and buttons. They organized a panel discussion about the hospital, a public rally to save it, a march to the state Capitol, and a tour of the hospital, and they spent a lot of time trying to persuade state legislators to lend their support. We “became very familiar with the 10-minute walk from the hospital to the Georgia State Capitol,” she wrote.
The campaign worked. At an eleventh-hour hearing, county commissioners approved the hospital’s conversion from a public hospital to a non-profit organization, which triggered hundreds of millions of dollars in donations from charitable organizations, and attracted support from the local business community. It also eventually encouraged state lawmakers to approve increases in Medicaid reimbursement rates and authorize funds to support uncompensated care at state trauma centers—including Grady.
Now, five years later, Grady is thriving, Neuhausen said. It has a new trauma center and a new stroke neuroscience center. It has invested in other infrastructure improvements, including electronic health records. It has won awards for quality care and is now projecting a budget surplus, Neuhausen wrote.
“We managed to have a much greater impact than we ever imagined we could have,” Neuhausen said. She counts that work during her medical school years as one of her greatest accomplishments—and one that profoundly changed the course of her career.
When she graduated from medical school, Neuhausen became a resident at the University of California, San Francisco. After that, she earned her master’s degree in public health at the University of California, Los Angeles, where she also served as an RWJF Clinical Scholar.
During the program, which she completed in June, she researched the financial impact of the Affordable Care Act (ACA) on California’s safety-net hospitals. The ACA cuts billions of dollars from the Medicaid Disproportionate Share Hospital (DSH) payments that support safety-net hospitals providing a “disproportionate share” of care to Medicaid and uninsured patients. Neuhausen found that the ACA’s anticipated decrease in uncompensated care costs in California due to insurance expansion will not be sufficient to absorb the DSH reductions. Because California’s public hospitals’ DSH need is likely to remain close to current levels, California’s public hospitals will experience financial stress due to the deep DSH cuts.
In December, she will tackle the same subject—the impact of the ACA—but from another vantage point, as director of delivery system reform at the Office of Health Innovation at Virginia Commonwealth University, a large public safety-net health care system in Richmond, Va. “One of the reasons I am drawn to Virginia is to provide evidence demonstrating that Medicaid expansion will improve the health and financial security of the poorest and most vulnerable Virginians,” she said.
Neuhausen’s work in Virginia may put her back in touch with the organization that launched her career in health policy in the first place. HealthSTAT is now addressing Medicaid expansion, using tactics modeled after those used to save Grady. “They are really mobilized.”