Michael Tarwater, CEO of Carolinas healthcare system, said the future of health care depended on "keeping people well instead of fixing them when they're broken,"
Hospitals and doctors would continue to treat patients who were sick or injured though now the emphasis would be "caring for them and keeping them well," he said.
AdvertisementTarwater felt that after the Affordable Care Act was passed in 2010 and the health care industry was finding it difficult to sustain rising costs, he felt fundamental changes were needed.
Among the changes "fee-for-service" reimbursement would be a major change, as under this clause doctors and hospitals got paid by the insurance company for each patient appointment and procedure. Tarwater wants to make this a value based system where health care providers will be paid to keep people healthy. The payment could be one time irrespective of the number of appointments or procedures needed.
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. Recently, Medicare, the federal health program for seniors, had stopped paying hospitals when patients with certain conditions, such as heart attack and pneumonia, were readmitted within 30 days.
Now, both Carolinas HealthCare and Novant Health, Charlotte's other major hospital system, have started programs that have nurses, social workers and pharmacists taking care to make sure that 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 re-admissions are preventable, but some re-admissions are not," Tarwater said. "The transition is not easy....It's not going to happen overnight."
CEO of Ortho Carolina - Dr. Daniel Murrey says - that this orthopedics practice has 143 physicians in 33 locations. This group has been accepting "bundled payments" 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."
Karen Garloch, August 2014
Hannah Punitha (IRDA Licence Number: 2710062)