The future of health care depends on “keeping people well instead of fixing them when they’re broken,” Carolinas HealthCare System CEO Michael Tarwater told Charlotte leaders Friday.
While doctors and hospitals will continue to treat patients when they’re ill or injured, the new emphasis will be on “caring for them and keeping them well,” he said.
Tarwater, who is also this year’s chairman of the Charlotte Chamber, was opening speaker at the chamber’s annual Health Care Summit, which drew about 450 business and health care leaders to the Westin hotel.
As he has many times, Tarwater said the health care industry’s “traditional way of doing things is unsustainable.” And Congress’ passage of the Affordable Care Act in 2010 was a “strong reminder that fundamental changes need to be made.”
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Among those changes will be a move from “fee-for-service” reimbursement, under which doctors and hospitals get paid by insurance companies for each patient encounter and procedure, to a “value-based” system, under which health care providers “will get paid to keep people well.” The reimbursement could be a single “bundled payment” for each patient diagnosis no matter how many visits or procedures are required.
Under fee-for-service, if a patient is treated and then returns to the hospital, “everybody who sees that patient again would get paid again,” Tarwater said. But in recent years, Medicare, the federal health program for seniors, has stopped paying hospitals when patients with certain conditions, such as heart attack and pneumonia, are readmitted within 30 days.
In response, both Carolinas HealthCare and Novant Health, Charlotte’s other major hospital system, have started programs that have nurses, social workers and pharmacists following up to make sure patients who leave the hospital get their medicines, keep their doctor’s appointments and manage chronic illnesses so they don’t get out of control.
“Some readmissions are preventable, but some readmissions are not,” Tarwater said. “The transition is not easy. … It’s not going to happen overnight.”
Dr. Daniel Murrey, CEO of OrthoCarolina, an orthopedics practice with 143 physicians in 33 locations, said his group has been accepting “bundled payments” as part of a pilot project with Blue Cross and Blue Shield of North Carolina for employees of Duke Energy who undergo knee replacements.
“We’ve been doing this since October,” he said. “We get paid one price for the work we do. … Private practice physicians should not be standing on the sidelines waiting for health care to be reformed.”