Who runs Macon’s biggest hospital? The answer is complicated

Correction: An earlier version of this article incorrectly identified the lessee in the 1994 lease agreement. The Macon-Bibb County Hospital Authority’s 40-year lease is with The Medical Center of Central Georgia Inc., not with Central Georgia Health Systems Inc. The story has been updated.

Long before it became downtown’s sprawling Atrium Health Navicent The Medical Center, the public hospital on Pine Street was owned and operated by the city of Macon.

The Macon Hospital, which opened in 1895 and was taken over by the city council two decades later, remained under the city’s auspices until the Macon-Bibb County Hospital Authority board was created on Sept. 1, 1968.

The mayor at the time said the city’s tax base was not broad enough to support the growing hospital, which was already becoming a regional hub for health care. In order for hospitals to be eligible for state money, the Georgia Board of Health had ruled, counties were required to have hospital authorities.

Hospital authorities were Georgia’s way of developing a kind of public hospital system. 

In Macon, the city appointed three members and the county appointed four to the new joint governmental agency. Since the city and county consolidated in 2014, all appointments are made by the Macon-Bibb County Commission in conjunction with the Atrium Health Navicent nonprofit board.

For decades, the seven-member hospital authority board oversaw the business and operations of the hospital, according to its original bylaws.

Like many public hospital authorities in Georgia, Macon-Bibb’s board restructured its organizational chart in the 1990s amid nationwide challenges in the health care system. In short, the restructuring meant that the hospital authority set up a nonprofit corporation to run its hospital to avoid the restrictions of the Georgia Hospital Authorities Act. The 1940s-era law prohibited hospitals owned by hospital authorities from owning for-profit businesses and barred them from operating outside a 12-mile radius. The law also gives hospitals the power to exercise eminent domain. 

A spokesperson for the hospital requested The Melody send questions via email to the hospital authority’s lawyer, Michele Madison. The Melody sent questions on March 2 and afforded Madison five business days for a reply, but the hospital did not provide answers until April 8. 

“The Authority transitioned from an owner-operator model to a landlord role, leasing the hospital facilities to the newly formed The Medical Center of Central Georgia Inc. That entity assumed responsibility for hospital operations and continues to operate the facility today as Atrium Health Navicent The Medical Center,” Madison wrote.

The Medical Center of Central Georgia — as the Macon hospital was then known — created a not-for-profit, private holding company called Central Georgia Health Systems Inc., which would own multiple nonprofit and for-profit subsidiaries, divisions and affiliated companies.

The hospital’s organizational chart grew to include a private foundation that holds golf tournament fundraisers, outpatient services and joint ventures with physician groups, among other entities. 

The hospital authority maintained ownership of its land, building and physical assets and entered into a 40-year lease with The Medical Center of Central Georgia Inc., which took over the day-to-day operations at the hospital. The authority went on to open for-profit companies, clinics and other medical offices in surrounding counties. Profits from those subsidiaries flow back to Central Georgia Health Systems.

The 1994 restructuring made business at the hospital more opaque, as it was no longer a solely government body subject to Georgia laws requiring open records and public meetings. In 2017, the Georgia Supreme Court ruled that nonprofit hospitals operating on behalf of hospital authorities are subject to open records.

In 2014, The Medical Center rebranded with a new name: The Medical Center, Navicent Health. In 2018, Central Georgia Health Systems merged with Atrium Health, the nonprofit arm of the Charlotte-Mecklenberg Hospital Authority in North Carolina. In 2022, Atrium Health merged with Advocate Aurora Health in a move that made Macon’s hospital part of one of the largest healthcare conglomerates in the country.

It is difficult to tell where the hospital authority ends and Atrium Health Navicent The Medical Center begins.

It is also challenging to find details about Atrium Health Navicent’s finances and operations now that the information is lumped in sum reports that include other out-of-state hospitals and nonprofits, collectively referred to in board meetings as “the enterprise.”

The hospital also owns 100 properties which have a combined value of nearly half a billion dollars, according to an annual report on its website. Those properties are not taxable because they are owned by either the hospital authority or its nonprofits.

“This allows Atrium Health Navicent The Medical Center to use dollars saved to reinvest in the community. In 2024, Atrium Health Navicent reinvested nearly $222 million, providing additional services and supporting partners in efforts that improve community health,” according to Madison.

Across the Ocmulgee River from Atrium Health Navicent, Macon’s other hospital, Piedmont Macon, also owns land that’s off the tax rolls. Up until 2021, that hospital was called the Coliseum Medical Center and was owned by for-profit HCA Healthcare, which paid property taxes.

Piedmont Macon is part of Piedmont Healthcare, a nonprofit community health system that operates 16 hospitals across the state and leases some of them from hospital authorities in other counties.

A spokesperson for Piedmont declined to comment about its relationships with hospital authorities.

Fast facts

— Board members include Milton Appling, Monique Davis-Smith, Myrtle Habersham, Mark Grossnickle, Jacob Patton and Matt Astin.

– The Macon-Bibb County Hospital Authority Board meets quarterly and its next meetings are slated for June 4, Aug. 13 and Dec. 3. Meetings start at 12:30 p.m. and take place in the Weaver board room on the fourth floor at 877 Hemlock St.