WakeMed continues to care for the vast majority – in excess of 80 percent – of the uninsured and medically underserved in Wake County.  WakeMed receives no state or county funding other than the limited payments for services received from government-funded Medicare and Medicaid programs. 

If UNC Health Care’s predatory actions continue, it may threaten WakeMed’s long-term strength and may impact our ability to uphold our mission of providing state-of-the-art care to this community. 

Many media articles have been posted about this request, including today’s News & Observer.

(L to R) Monica Oei, MD; Inam Rashid, MD; Michele Roberts Casey, MD; Leslie Robinson, MD

Located in the Physician Office Pavilion at WakeMed North Healthplex, Drs. Michele Roberts Casey, Monica Oei, Inam Rashid and Leslie Robinson are looking forward to accepting new patients.  Please call the office at (919) 848-9451 to schedule an appointment.

Other WakeMed owned or affiliated primary care practices opened or aligned with the system in the past year include Brier Creek Internal Medicine and Knightdale Family Medicine.

EMS — especially the field care, transportation, communication and workforce components — is an essential part of the U.S. health care system. However, EMS is often out of mind when the larger scope of the complex system is considered by health care planners.

Even though EMS-related components were only referenced four times in the health care reform legislation, we are well aware anything evoking major change to the overall system will ultimately have a far-reaching impact on EMS and emergency care patients.

The health care landscape is constantly evolving and changes have already been occurring. Relationships between hospitals and physicians have been strengthening. Hospitals have been consolidating. States like Massachusetts have taken greater steps to insure their population.

Major public and private investments in information technology and connectivity have been occurring. Insurance premiums have been rising rapidly, and there is a growing list of federal and advisory standards on quality, safety, education and community health.

And, hospitals have been creating solutions to ease capacity by opening urgent care centers and freestanding emergency departments. This recent legislation accelerates many of these changes and adds many significant new elements to the mix.

Ultimate goal
The legislation’s ultimate goal is to insure more Americans and to make health care more accessible, affordable and higher quality. Thirty-two million more Americans will have affordable access to health care insurance because of this legislation.

In EMS, we are well aware there are “haves and have-nots” when it comes to health care. This legislation should take us far in narrowing the number of “have-nots,” but EMS and emergency departments will continue to serve as a primary entrance to the health care system for the remaining uninsured.

Hopefully, the outcome of this legislation will be a smaller, more homogeneous uninsured population making it easier to provide appropriate and timely health care solutions. But even with a growing number of insured patients, the shortage of primary care providers will likewise continue to contribute to a growing use of EMS and EDs as a “front door” to health care in the United States.

The future of the health care payment system will be based on quality and effectiveness instead of quantity. This model will encourage further integration and coordination among health care providers to ensure the patient is receiving the right care at the right time. This coordination will have to happen at all care and service levels, from EMS to rehabilitation.

The legislation should also help distribute the cost of health care more evenly. In today’s system, cost shifting is a reality. We are paying for health care delivery in one way or another through our own medical bills, insurance premiums and taxes. This legislation should give us a clearer understanding of what we are paying for and what we are getting for our money.

Ideal system
The ideal health care system will include collaboration, coordination, cost effectiveness, efficiency, proven technology, quality and safety, a reduced rate of growth, scalability, sustainability and transparency.

While this legislation is a step in the right direction, there are elements that will not take effect for several years. And, many of the decisions about implementation will occur at the administrative level, so the final impact at the local, state and national levels is still ambiguous.

The history of the health care reform conversation began with President Teddy Roosevelt in 1912 and will extend well beyond the current administration. This, like most things in life, will evolve over time.

There are significant opportunities for EMS to fix the things that haven’t worked in the past, and there are opportunities to make health care better for everyone involved, starting with the patient. Doing the right things — for the right reasons — remains the appropriate focus in EMS and across the health care spectrum as we move forward.

Christine Craig is WakeMed’s director of government affairs.

Are you interested in what the federal Wake County delegation has to say about health care reform? Stay informed by checking their web sites.

“This is the best chance we have to reduce sky-rocketing health care cost for North Carolina families.”  Congressman Bob Etheridge

“Health insurance reform is essential to ensuring coverage and controlling health care costs, now and in the future.” Congressman Brad Miller

“We must pass health care reform that invests in our nation’s future by providing families with high-quality care, giving businesses access to affordable plans for their employees, and reining in government spending.” Congressman David Price

“Currently, health care expenditures account for 16% of our nation’s GDP.  This is unsustainable, and one goal of reforming health care must be to enact sound policies that drive health care costs down so that all Americans can access quality and affordable health care.” Senator Richard Burr

“Here is why we need reform: ten years ago, North Carolinians paid $6,000 in annual family premiums. Today they pay $12,000. By 2016, it is projected that families will pay $24,000. North Carolina’s families deserve better than this.” Senator Kay Hagan

Becky Andrews, WakeMed’s vice president of finance, spoke to the News & Observer about the legislation’s new reporting requirements for non-profit hospitals.

Dr. Susan Weaver, Senior Vice President for WakeMed Physician Practices and a primary care physician, spoke to NBC-17 about providing health care for the uninsured and the shortage of primary care doctors.

Dr. Bill Atkinson, president and CEO of WakeMed, told News 14 Carolina that health care reform could provide a major economic boost for North Carolina with the legislation’s emphasis on information technology. See the video above for Dr. Atkinson’s interview on WRAL about the implications of the legislation for Americans and our nation’s hospitals.

Yesterday was a historic day for health care as the House voted to pass the health care reform bill that was approved by the Senate in December. We would like to acknowledge and commend the leadership of North Carolina’s congressional representatives, particularly Brad Miller, David Price and Bob Etheridge, for voting in support of this historic legislation.  We have worked closely with our representatives and their staffs from the beginning of the health care reform conversation up to the final vote yesterday. We are grateful that our delegation made every effort to understand how this legislation will affect our state’s hospitals and patients.

This legislation is a historic step that will ensure the majority of Americans have health insurance. When fully implemented, 95 percent of American citizens will be covered.

But this legislation is not perfect, and there are still challenges ahead. We wish that significant cost control measures such as medical liability reform had been included in the bill. And, the Congressional Budget Office estimates that there will be 23 million people living in America, many of whom are not U.S. citizens, who will remain uninsured.  These people will still need health care services, making programs like Disproportionate Share very important for hospitals like WakeMed that care for a majority of the uninsured in their communities (disproportionate share is a federal program that provides slightly higher reimbursement rates for hospitals that care for the largest percentage of uninsured patients.  We have blogged on the importance of preserving this program in the past.) We recognize that all health care providers will face challenges in implementing these new changes – like a shift in the payment system that focuses on volumes to one that focuses on quality outcomes.

WakeMed is ready to embrace these challenges, and we applaud Congress for taking such major steps to reform America’s very complex health system.

At a recent Raleigh Chamber meeting, WRAL’s new General Manager Steve Hammel asked Dr. Atkinson to help him understand the charges he incurred after having surgery at another local hospital.  Dr. Atkinson explained how health care charges are calculated. Steve was impressed by the answer and thought the community would like to hear about it as well.   Dr. Atkinson agreed to an interview and was promptly contacted by reporter Bruce Mildwurf.

WakeMed prides itself on being transparent and always welcomes the opportunity to answer questions health care consumers have.  But, we also know that this is a very complex issue that likely cannot be fully explained in less than two minutes, so we thought we would share some additional thoughts on this blog in advance of the story airing. 

The easiest way to explain what goes into the charge for a medication or medical device is to walk you through what it takes for something as simple as getting an aspirin prescribed and delivered to the patient.  This likely requires more resources than you may think.

The doctor has to order an aspirin, the nurse inputs the order, the pharmacy tech fills it, the pharmacist checks it and then the nurse delivers it to the patient.  The charge for all of these individual staff and the technology it takes to fill the order are rolled into the $1 WakeMed charges for an aspirin.  It would be very easy to sensationalize the fact that an aspirin costs $1 in the hospital and only $.07 or less at Costco, but this would not be a fair comparison. 

A statement itemizing charges is also not a good representation of what a hospital actually is paid for performing a procedure.  Additionally, Medicare ruled long ago that you could not have a separate line item for nursing care or other required support like kitchen staff, housekeepers, laundry staff, janitorial staff, medical records, IT, doctors, lab personnel, human resources, reception, clerical staff, transcription, billing and coding staff, insurance verification, switchboard operators and the administrators required to ensure that everything runs as smoothly as possible. Not to mention the costs of state-of-the-art medical technology, food, telephone, TV, electricity, linens, pillows, mattresses, beds, cleaning supplies, etc.  All of these costs get rolled into the medication, supplies, and procedures listed on a charge statement.

The system is not perfect. In fact it has many flaws that need to be addressed, but for a hospital to survive and meet its mission of caring for all, it must learn to work within the system.  Hopefully, in the near future, we will all see some substantive changes in the way lives are covered and how the medical miracles of today are funded.

Update March 3 9:55 am: Missed the story last night, catch it here.  In a short period of time, Bruce did a nice job explaining many of the issues.

The study was based on Medicare/Medicaid reimbursement rates that do not cover our cost of providing care. Additionally, prisoners are more expensive to care for because of their higher acuity levels.  (In other words, they tend to be much sicker and tend not have had consistent access to health care or preventative medicine.) Caring for prisoners also requires significantly increased numbers of clinical staff and additional security.

WakeMed is a highly efficient hospital, and we are proud to provide high quality health care to everyone.  But the reality is that as a private not-for-profit, we receive no funds from the state, county or city and provide the majority of the charity care in Wake County.  We also incur the additional costs of caring for a large number of prisoners – who are very expensive to care for.

Over the past 18 months, WakeMed and the North Carolina Hospital Association have been working on a solution that would distribute the prisoner population evenly to hospitals throughout the state.  This solution would also ensure reasonable reimbursement for caring for this unique population of patients. Additionally, we have  been working with the Department of Correction to help them provide more care within the prison system hospitals, so that prisoner health care costs can be even further reduced.

First Lady Michelle Obama introduced Let's Move, a nationwide campaign to tackle the challenge of childhood obesity

As health care reform progresses, wellness and prevention must be a priority.  It is, and has been, one of WakeMed’s top health reform priorities, particularly as the obesity epidemic is a very real issue in Wake County.  According to local research:

• 70% of adults living in Wake County are overweight/obese
• 52% of children 12-18 years of age are overweight/obese
• 24% of Wake county’s youngest children are overweight/obese

Locally, WakeMed has been working with children for years to curb obesity and prevent type 2 diabetes.  Dr. Piehl, director of WakeMed’s Children’s Hospital, created the Energize! program which is focused on altering lifestyles of children who are at risk of developing type 2 diabetes.  Our medical team is having great success in preventing the on-set of this disease with the program’s participants through a continued focus on exercise and healthy eating.  So much success, that the General Assembly appropriated funds a few years ago to North Carolina’s Division of Public Health to expand Energize! throughout the state.  Energize! has been implemented in nearly a dozen counties in North Carolina, from the coast to the mountains, and the Division of Public Health considers Energize! a “best practice” in the fight against type 2 diabetes.

Caring for individuals who suffer from type 2 diabetes, which stems from obesity, is a tremendous cost in our health care system. Preventative programs like Engergize! are a much more efficient way to save money and provide better care for patients – and these programs need to be the focus of future efforts to curb obesity in America.

In Wake County, Advocates for Health in Action (AHA), working in partnership Wake County Health & Human Services, recently applied for stimulus dollars through a proposal that outlines a $10 million comprehensive community initiative to put prevention strategies to work in Wake County. The proposed strategies will increase physical activity levels, improve nutrition and address obesity in our population. 

On the federal level, we are pleased that United States Senator Kay Hagan included a provision in the Senate’s final amendment to the health care reform bill to fight the diabetes epidemic in America.  The provision comes from Senator Hagan’s Senate Bill 1473 – The Catalyst to Better Diabetes Care Act of 2009.  More information can be found on her website.

We are also very excited that the fight against childhood obesity is gaining momentum in the white house. First Lady Michelle Obama has designated childhood obesity as one of her top priorities, and President Obama issued a memorandum yesterday announcing that his Administration will redouble efforts to solve the obesity epidemic within this generation.