The Charlotte Observer is to be commended for advancing public discussion of the variables affecting health care costs. We are, however, disappointed with the lack of balance and perspective we know was shared by many health care experts throughout the development of this series.
During the past week, North Carolinians have been provided with an unprecedented opportunity to learn about this aspect of health care. Few things today have greater impact on peoples’ lives and pocketbooks in a more personal or universal way.
The current trajectory of health care costs is indeed unsustainable. Carolinas HealthCare System (CHS) is aware of this and is fully committed to participating in finding effective solutions. Having been part of CHS for more than 30 years, I am proud of who we are and all we have done to guarantee high quality health care for everyone who needs it.
With roots dating back to the late 19th century, Carolinas Medical Center (first known as St. Peter’s Hospital) has matured alongside this growing region, expanding services continuously to meet the demands of an ever-expanding population.
During the past 30 years, in fact, CMC, along with other CHS hospitals, has taken on special significance as a key safety net hospital and also as the region’s Level I Trauma Center. One achievement of special note during this period is our network of community clinics, which the Observer singled out in its series.
These have been remarkably successful in providing an affordable medical home for patients who would have otherwise lacked access to primary care. In addition to our community clinics, CHS provides numerous other programs that address patient and community needs throughout the region – programs from which we receive little or no revenue.
In total, CHS provided more than $1 billion in community benefit, including funding for a wide variety of critically important public health programs. These include the Carolinas Poison Control Center (a statewide network); Teen Health Connection (which addresses eating disorders); the Faith Community Health Ministry (which serves area religious organizations); the Children’s Advocacy Center (which addresses child abuse); and the Adaptive Sports and Adventure Program (which serves rehabilitation patients).
CMC may be the best known hospital in our system, but it is only one in a comprehensive network of care locations and treatment centers that make up our integrated delivery system, which today comprises more than 30 hospitals, 650 care locations and 48,000 employees across the two Carolinas.
As we look to the future, those of us responsible for health care delivery face a world of “unknowns.” We are navigating a complex business in a sea of change. The imperative to reduce costs is long overdue. However, one unavoidable reality is that the public’s demand for quality, access and convenience has not changed.
These issues can and must be tackled on multiple levels. First and most importantly, we must all work to elevate the importance of personal responsibility. We must enable and empower every individual to improve his or her health and take control of related behaviors and lifestyles. Wellness must become a basic part of our culture.
We also need to achieve a new consensus on how best to continue to guarantee quality care for everyone. Our mission at CHS is to ensure that everyone receives the health care they need. However, in today’s payment models, those CHS hospitals located in greater Charlotte receive only about 80 cents in compensation for every dollar we spend caring for Medicare and Medicaid patients. This group of patients represents more than 50 percent of the total patient population in this area.
For many of the other hospitals that we have been entrusted to manage – many serving as the sole safety net provider in their communities – that percentage is considerably higher. This circumstance does not address the thousands of other patients who need care but do not qualify for subsidized reimbursement. In such cases, we and many other providers receive little or no reimbursement at all.
In short, our community needs and deserves a new model of care that is less vulnerable to the impact of still more government cutbacks or insurance benefit reductions, not to mention the skyrocketing costs of pharmaceuticals, medical equipment and new technologies.
The traditional reimbursement model – whereby a higher volume of patients equals a higher revenue stream – is increasingly obsolete. It must inevitably be replaced by a model that links payments to outcomes, and rewards those who successfully reduce demand for more expensive facilities and services.
In such a system, inpatient beds will be reserved for only the most seriously ill patients. Primary and preventative care will be priorities, and new facilities and the services they provide will be far more specialized in their design and use.
We do not know what the future will bring, and it is certain that a sustainable new model of care will not be achieved overnight. Nonetheless, CHS can and will work hard to define the future of health care in a way that fulfills our mission and meets the health care needs of the communities we serve. We are committed to working with our health care colleagues across the Carolinas and beyond to provide innovative solutions that meet patient needs today and tomorrow.