The State of NC Healthcare

More Changes in NC Healthcare

Posted in NC Healthpress by writemyline on 30 June 2009

The Charlotte Business Journal reported back in April that Carolinas Healthcare System (CHS) will “manage” Haywood Regional Medical Center and WestCare Health System. Mission Health System Hospital in Asheville was also considered by the BODs of both western NC hospitals.

Carolinas Healthcare System has gained a considerable hand in four community-based hospitals in this year alone. In the early spring, CHS announced management contracts with Stanly Regional Medical Center in Albemarle and Scotland Memorial Hospital in Laurinburg. With the addition of Haywood and WestCare, CHS owns, leases, or manages 25 hospitals in the Carolinas. The expansion of CHS continues outward despite its $551 million loss in 2008 earnings.

Haywood proposal is “secret for now.”

Posted in NC Healthpress by writemyline on 13 February 2009

Becky Johnson of The Smoky Mountain News has a lengthy article discussing Haywood Regional Medical Center and WestCare’s direction towards a partnership with either Carolinas HealthCare or Mission Hospitals. Read it here.

On Stanly Regional Medical Center and Scotland Memorial Hospital

Posted in Grassroots, NC Healthpress, Reform-in-progress by writemyline on 12 February 2009

John Lowder’s recent article In the Stanly News and Press (1 Feb. 2009) discusses Stanly Regional Medical Center’s (SRMC) management service agreement with Carolinas HealthCare System (CHS). It is a well-written statement with significant points of discussion that speaks directly to Stanly County citizens. It identifies the issues and circumstances leading to the SRMC Board of Directors’ decision to deepen the hospital’s relationship with CHS. Articles similar to Lowder’s Making change work for the community appeared about the same time in The Exchange and The Fayetteville Observer; however, these articles announce a management contract between CHS and Scotland Memorial Hospital in Laurinburg.

It is not surprising that CHS is the largest healthcare organization in the Carolinas. It is a very aggressive one in terms of acquisitions, mergers, leases, and management contracts. The Charlotte-based business has ties to 25 facilities from North Wilkesboro NC to Charleston SC; two additional hospitals in western NC are currently considering affiliate proposals. Russ Guerin, CHS executive vice president of business development and planning comments in the Charlotte Business Journal that Carolinas HealthCare management relationships, such as those with Stanly Regional and Scotland Memorial, can lead to mergers and leases.  

Integrating CHS’s large academic healthcare model into Stanly and Scotland’s smaller healthcare culture will be challenging. Technically speaking, the contract provides that the autonomy of the small hospitals remain; however, the management association with Carolinas HealthCare will be very visible in the public eye as well as the professional one. This could tax the confidence of some folks. Stanly and Scotland have histories that are entirely built on their local communities. Shifting their identity towards a corporate giant is unsettling; and, to some people, equates to a departure from certain long-held values of the community.

Indeed, management is a necessary component of any healthcare delivery system; but the public and professional perception of management weighs heavily on patients and their families. Perhaps the decision of Scotland and Stanly boards to deepen their relationships with Carolinas HealthCare System will prove financially fruitful and beneficial to the health of the community; but if and how much community citizens and local healthcare professionals will benefit financially is questionable, especially given the current chaotic state of the US economy. And the greater community, including physicians and healthcare professionals, could wait months, or perhaps even years, before the trickle-down effects of change deliver a substantial and beneficial outcome.

Smaller geographic areas, particularly rural ones and those with increased over-65 and disabled populations, are bound to the services closest to home. For some, there is no element of choice when it comes to health services; and when this is the case, public trust is absolutely critical. The role of organizational healthcare leadership in small boroughs and rural areas has a primary obligation to its service area population because there is no local competition providing other options.  Regardless of the business, service, or industry, public trust is critical for security and progress. And fostering and maintaining trust requires forthrightness, especially when it comes to healthcare issues.

In regards to SRMC, there are statements in need of clarification for the benefit of Stanly County citizens:

John Lowder writes: “Control over Stanly Regional will remain within the community. The Board of Directors will continue to govern the medical center and will retain ownership of all assets. The Board will make decisions in the best interests of the community and our same management team, led by Al Taylor, will run the medical center.”

Scott White, spokesperson for Carolinas HealthCare, says something different about the contract with SRMC in the Hickory Record: “We’ll hire the executive officers and manage the hospital on behalf of the board.”  (Hickory Record, 28 January 2009)

White’s and Lowder’s conflicting statements are very troublesome for the public. Merging the two statements suggests that CHS will hire the existing SRMC executive staff, including CEO Al Taylor. If that is, indeed, the case, then “control over Stanly Regional” will not actually remain in the community because its executive staff will not be appropriately vested by SRMC and its board of directors. Clarification and a more detailed disclosure of CHS’s management contract would be a positive step towards preserving public trust.

Another thing lacking is substantion of SRMC’s claim of a long-standing relationship with Carolinas HealthCare by physicians and healthcare professionals close to home. Public confidence is better built on relationships with the first line of care–primary care physicians, family doctors, specialists, and other healthcare providers, not management.  Moreover, how involved were Stanly physicians in the board’s decision? 

 Healthcare reform is an undeniable paradigm shift occurring at all levels of American society, from grassroots to corporate giants. It is a phenomenon that will ultimately redesign systems of healthcare delivery, finance, and management. It is a phenomenon in which organizations like Stanly Regional Medical Center and Scotland Memorial Hospital along with hundreds of other independent non-profit hospitals in the US will lead and represent the healthcare culture of small communities. On the other hand, Carolinas HealthCare System and other corporate giants will aggressively protect their own interests and profitability; small community-led healthcare will not be a top priority in reformation from their perspective.

 Indeed, change can be positive and work for small communities when citizens are directly involved in the process. Patients and families in Stanly and Scotland counties have that opportunity now by expecting their leaders to listen and respond with diligence and honesty.

The headlines: Carolinas HealthCare, Scotland, Stanly

Posted in NC Healthpress by writemyline on 31 January 2009
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Carolinas HealthCare System to “manage” Stanly and Scotland

Posted in Grassroots, NC Healthpress, Reform-in-progress by writemyline on 30 January 2009

The Charlotte Business Journal featured an article by Jennifer Thomas this week that announces a management service agreement (MSA) between Carolinas HealthCare (CHS) and two independent NC hospitals: Scotland Memorial Hospital (SMH) and Stanly Regional Medical Center (SRMC). The article, CHS to manage two more hospitals, appeared on January 28.

Thomas writes that CHS’s 10-yr. contract with Stanly begins March 1 and with Scotland on April 1. The article does not disclose the financial terms of the two contracts; however, the article suggests that the 10-yr. contract could mean a merger later on down the road. Russ Guerin, executive vice president of business development and planning at CHS,  is quoted: “managing independent local hospitals is a business line of (CHS).”  He also comments that such agreements have the potential for mergers.

Interestingly, CHS and Stanly’s recent request for a certificate of need for a 40-bed rehab facility was denied by N.C. Division of Health Service Regulation (NCDHSR) because the two organizations failed to demonstrate need and cost-effectiveness. The facility would have been built in Cabarrus County. CHS and Stanly are appealing the State’s decision. 

Both Stanly and Scotland serve local communities and are significant providers of care “close to home.”  People age 65 and over constitute 14.6% of Stanly County’s population. In addition, 20% of the county’s total population consists of disabled citizens over the age of 5. In Scotland County, 11.6% are 65 and up and 22% disabled.  Stanly’s older population exceeds the state/county average of 12.2%; and both, Stanly and Scotland, exceed the state/county average of 17% disabled. (Census Bureau)

“Close to home” care is a big concern for many of the folks affected by big hospitals swallowing up smaller ones. CHS is the 3rd largest public system in the country and the largest in NC. It owns, leases, or manages 25 hospitals from North Wilkesboro NC to Charleston SC, including SRMC and SMH.

See press releases on the Carolinas Medical Center website:

Stanly Regional Medical Center Partners With CHS

Scotland Regional Health Care System Partners with CHS

Carolinas HealthCare Salaries

Posted in NC Healthpress by writemyline on 15 January 2009

Well, well, well…We finally get the bottom line on Carolinas HealthCare System executive salaries. Yesterday’s Charlotte Observer headline reads: Carolinas HealthCare discloses its top pay packages. For the first time in nearly a decade, Carolinas Healthcare System reveals executives’ pay.

CEO Michael Tarwater  recieved a total compensation of $3.5 million in 2008.  One has to wonder how many financially-struggling sick or injured people made that 7-figure salary possible. How many had to max out their credit cards or empty their kid’s college fund to pay for healthcare? AND – how much of that $3.5 came from Medicare and Medicaid?

What could possibly justify such a large salary package, especially when our economy is suffering like it is?

What could $3.5 million pay for?  How about 5 heart transplants or 11 bone marrow transplants or treatment for 175,000 cases of early-stage cervical cancer.  $3.5 million would cover about 120,000 hours of nursing care or annual salaries for about 56 experienced RNs.  It would also cover annual medical costs for 300,000 diabetics.

This debate needs to be a public one. It’s not just about healthcare executive salaries; it’s about insurance premiums and co-pays, Medicare, Medicaid, and private funds — all of which contribute to compensation packages.

Are there reasonable compensation limits for healthcare executives? Absolutely.

Jim Buie’s comments on healthcare reform

Posted in Reform-in-progress by writemyline on 12 January 2009

Jim Buie (The Buie Knife) posted the following comment on writemyline in response to an earlier post that first appeared on this blog and entitled “Bits and pieces” of healthcare reform . I think Jim is right on target and that his thoughts deserve consideration, especially his idea of healthcare being similar to a public utility.

Jim Buie: 
It will be very important for those of us concerned about health care reform to put the heat on the new administration. Sens. Kennedy and Baucus will take a leading role in proposals, I’m reading. What passes will largely be determined by COST, given the huge bailout package. The argument that will be most persuasive is that health care reform, in the long run, SAVES money. We in the U.S. need to face the fact that other countries manage to INSURE EVERYONE and provide, overall, better care for far less cost than we do. We need to learn from studies of comparative health care internationally and implement recommendations.

– by insuring the uninsured, we move them away from the most expensive care, in emergency rooms, and eliminate cost-shifting.

– by allowing the gov’t to purchase generic phamaceuticals in bulk, we reduce price gouging by pharmaceutical companies.

– we should reduce the “for profit” nature of private health care, with exorbitant salaries for executives. Cap their salaries and eliminate bonuses. Start thinking of health care as a public utility.

– reduce the number and wasteful purchase of expensive machines, such as CT scans (utilization in the u.s. is far greater than in other countries).

– merge small insurance groups into much larger pools to reduce adverse selection, ban cherry-picking of healthy (and most profitable) patients, and reduce the overall risk of health care plans — that should reduce monthly premiums because risk is shared more widely.

– maybe open up Medicare to younger people, and the federal health insurance programs to people who aren’t federal employees. If people could get into these plans, they’d pay far less than they do for private health care plans.

(I currently pay $300+ a month as a self-employed person for health care for myself, my wife, and son, but there’s a $10,000 a year deductible. This is not really health insurance, it’s simply insurance against the loss of our home in the event of major illness.)

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Recent NC health headlines

Posted in NC Healthpress by writemyline on 26 November 2008

Republican Sen. Richard Burr (N.C.) is in a position to have a significant influence on health reform… Read this article from The Hill.

Novant opposes CMC-NorthEast tower. Read about this at the Charlotte Business Journal.

The N.C. Institute for Constitutional Law has filed a lawsuit challenging the constitutionality of the state law that determines the awarding of health-care facilities and equipment. Winston-Salem Journal

CIGNA HealthCare has been recognized as the top-ranked health plan in North Carolina for the second year. Read at Market Watch.

Dominion Healthcare in Durham has agreed to reimburse the NC Deptartment of Health and Human Services more than $1.6 million. Read the article in Winston-Salem Journal.

Rex Healthcare has been named in Top 200 Hospitals in Coding Study. Read on Carolina Newswire

VA Hospital in Salisbury may end surgical and ER services. Read the full article.

UNC selected by U.S. Agency for Healthcare Research and Quality for important cancer treatment study. Read here.

VOCA Corporation and Residential Healthcare Affiliates of North Carolina MR  bids for an intermediate care facility for the mentally retarded in Guilford County. Read at News-Record.

Carolinas Healthcare System holds hearing in Kannapolis. Read in the Salisbury Post.  Also read the follow-up article, “Proposed diagnostic imaging center draws ire of physicians, citizens.”

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Stern writes on high-risk health insurance pool

Posted in NC health insurance by writemyline on 16 November 2008

In following up on NC new health insurance risk pool, I came across an interesting article by Henry Stern. Good discussion. Read Stern’s “Better late…” post here.

“Bits and pieces” of healthcare reform?

Posted in Reform-in-progress by writemyline on 16 November 2008

From Can Obama Truly Deliver?   “On October 31, Obama told CNN that he would set five immediate priorities: “stabilize” the financial system, move toward energy independence, enact some form of healthcare reform, grant middle-class tax cuts, and strengthen the education system. But he made clear that the nation has entered an era of limits because the economy is in such bad shape.”

But will Election Day exit polls further influence President-elect Obama’s “todo” list? 

According to Kenneth T. Walsh of US News and World Report(USN&WR), “about 62 percent of voters said the economy was their biggest concern–far and away the most important issue. About 19 percent listed Iraq or terrorism, and 9 percent said healthcare.”  USN&WR did not report the numbers for voters mostly concerned with energy independence, education, and other issues. If exit polls determine Obama’s response to American voters and the order in which he addresses the country’s most significant concerns, then healthcare reform is not so high on the list. With the overwhelming majority of voters depending on deliverance from the current global financial crisis, Obama’s promise of healthcare reform is likely to fade in the background.

USN&WR says that Obama’s aides “expect him to compromise in his own particular way.” They say that the President-elect will likely “scale back each of his priorities.” An unidentified, but “prominent Democrat who knows him well” says Obama will do “bits and pieces” rather than abandoning or down-sizing the issues he promised to work on. 

As far as Obama’s healthcare reform plan, it is probably safe to assume that it won’t be as aggressive as promised throughout his campaign and could settle on “insuring everyone under 18 years old so no child would be without health insurance”–not exactly the universal care that appealed to voters most concerned about healthcare. While insuring those 18 and under is, indeed, a worthy accomplishment, whether it can boost the movement toward overall reform is questionable. 

One wonders if some or a little change is better than no change at all, particularly when the larger issues continue to burden the whole system of healthcare providers and institutions as well as the entire profile of the population they must serve. Can a government-initiated healthcare reform project set out on the path of least resistance and get anywhere, especially when politically motivated? Is it likely to make a lasting impact?

It will be necessary for President-elect Obama to continuously re-evaluate his priorities; still, the American people depend on progress or at least the hope of it. In regards to healthcare reform, it is critical that leadership fuel the momentum with the knowledge that lasting and positive change is a long-term goal, that results are often slow to come into focus, and that the final page will most likely be written by future leaders and subsequent administrations. With that said, perhaps President-elect Obama will be the one who truly initiates change–not necessarily the one who signs final legislation.

President-elect Obama has a difficult task ahead because not all voters are going to be satisfied with just “bits and pieces” of the expectations they cast along in the ballot box. As one of those voters, I am more hopeful that our President will initiate and engage in an effective healthcare reform process in which there is no turning back–one that, perhaps, may not come to an end under his tenure, but surely would not have started without vision and leadership.