Of all American healthcare organizations, safety-net hospitals are facing one of the largest curveballs, as nearly 30 million Americans stand to gain coverage under the Patient Protection and Affordable Care Act beginning in 2014. Nationwide, only 2 percent of acute-care hospitals are safety-net facilities, but they currently provide about 20 percent of all uncompensated care to provided to the uninsured.

Despite this statistic, a decline in America's uninsured is unlikely to relinquish the need for safety-net hospitals, according to experts. Public hospitals for the poor will still have a place in the American landscape, especially since most safety-nets are responsible for training physicians and take on significant patient volumes would otherwise incapacitate markets. Instead, it's the traditional role and public perception of safety-nets that's poised for the biggest transformation.

"These hospitals don't always set out wanting to be the safety-nets, but it's a position they get forced into," says Igor Belokrinitsky, a strategy consultant with Booz & Company in Chicago. "They become a hospital of last resort, but they really want to be a hospital of choice. Do you want to stay a safety-net hospital or find something else that will set you apart?"

One safey-net's approach
Newspaper editor Henry W. Grady founded Atlanta-based Grady Health more than 120 years ago, concerned about a lack of quality healthcare for Atlanta's poor. Today, Grady's payer mix is roughly 34 percent uninsured, 32 percent Medicaid and 17 percent Medicare, with the rest covered by commercial insurance and workers' compensation. Grady provided roughly $200 million in uncompensated care to 100,000 uninsured patients in fiscal year 2011, and the system also trains roughly one-quarter of Georgia's physicians.

Like many safety-nets, Grady is facing questions about patients'