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.
Tarwater 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
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)