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The devilsh details of health care reform


Charles T. Frock
Chief Executive Officer
FirstHealth of the Carolinas

Almost everyone agrees with the principles of full health care coverage, affordable cost and high quality, but the devil is inevitably in the details.

How do we extend coverage to all? How do we pay for it? How do we balance priorities with non-health obligations? The debate is playing out in Congress and will probably come to a head this fall. How it will turn out is anybody’s guess, but I am not overly concerned.

Let me explain.

Using three elements of health policy (access, cost and quality) is a useful format in assessing the efforts of FirstHealth of the Carolinas and its physicians in addressing these issues.

Access: FirstHealth already provides emergency care to all, regardless of ability to pay. Our charity care policy provides a sliding payment scale suited to individual financial capabilities. We support existing physician practices and clinics in recruiting additional physicians to the area. We have established Family Care Centers in less-populated areas and have transitioned several to free-standing status to provide better access.

Our non-profit health insurance subsidiary, FirstCarolinaCare, has focused on the small business community with significant incentives to cover the previously uninsured. Our Community Health Services division takes screening and other preventive services to schools, businesses, churches and community agencies. We work with other organizations, such as the Moore Free Clinic, to make primary care more accessible.

Costs: We strive to be as efficient and as cost-effective as possible. Our managers and staff have enabled us to remain a lowcost provider compared to other hospitals offering the same services. In fact, within our peer group of 10 similar hospitals across the Carolinas, we are consistently the first or second least expensive. We use industry techniques to reduce costs and eliminate errors. We encourage our physicians to find and use high-value drugs, implants and medical supplies without compromising quality. We have negotiated fair reimbursements from managed-care organizations to ensure our financial viability.

Our community generously supports our Foundation, allowing us to maintain cuttingedge technology, facilities and services. This is vital since more than two-thirds of our reimbursement is set by public programs (Medicare and Medicaid) that don’t cover the full cost of care

Quality: We and our physicians have been recognized for our results, and we remain committed to providing the best in medical care. We compare very favorably on a Consumer Reports Web site using Medicare data to compare hospital quality, tying with Duke for eighth out of 100 N.C. hospitals. So why am I optimistic about our future and whatever health reform brings?

  • FirstHealth and its physicians are committed to addressing the goals of health reform. We expect to keep our quality high, costs reasonable and care accessible.
  • Any major change out of Washington will likely be phased in or piloted, giving us time to plan accordingly.
  • Our experience is that the federal government will address unacceptable consequences from passed legislation with either technical adjustments or major revisions.

One caveat: There has been no discussion in Congress about tort reform or medical malpractice. Until there is meaningful reform in this area, and an end to the need for doctors to practice defensive medicine, we will never achieve the cost efficiencies our physicians and hospitals can provide.

The debate over health care reform rages.

Whatever happens (and I believe significant reform legislation will eventually be passed), rest assured that FirstHealth’s physicians and staff are committed to delivering what you expect from us: high-quality care at an affordable cost available to all.