Editor's note: Leaders at the University of North Carolina at Chapel Hill and UNC Health Care requested the opportunity to respond to our article "UNC Inc." published Jan. 17.
Dr. William L. Roper is the chief executive officer of UNC Health Care System. He was previously dean of the UNC School of Public Health and was director of the Centers for Disease Control and Prevention from 1990 to 1993.
The Jan. 17 issue of the Independent Weekly criticized UNC Health Care for its financial practices. The frustration with the cost of health care, who pays and how was evident:
"[T]oday, the major problems facing UNC Hospitals and many others are the declining revenue from Medicare, Medicaid and private insurance and the ever-increasing cost of operating large, geographically separated health systems, plus the growing number of patients without health insurance because of the collapse of manufacturing in North Carolina."
We at UNC Health Care share this frustration.
There is no doubt that the cost of health care has dramatically escalated. At the same time, payments to UNC Health Care from all sources—including the State of North Carolina—have radically decreased.
The advances of modern medicine, such as miracle drugs and amazing imaging devices, have enhanced the length and quality of life. But these advances are breathtakingly expensive.
North Carolina's population continues to grow by about 100,000 people a year. The demands on UNC Health Care's services have never been higher or more acute. Through this tumult, UNC's mission remains engraved on our edifice: "By and for the people of North Carolina." And there is an unwritten postscript: "Regardless of their ability to pay."
Last year UNC Health Care served nearly 400,000 patients from all 100 counties. Of the 2,400 people we care for each day, about 800 cannot afford to pay the full cost of their care.
Every single day, UNC Health Care provides about $500,000 in uncompensated care. In 2006, that added up to $185 million. Meanwhile, many bold medical advances have occurred—which North Carolinians deserve. But someone has to pay the bill.
These realities require a focused effort to ensure that UNC Health Care is financially stable. The causes of the widening gap between UNC's reimbursements and the cost of fulfilling our public mission have been out of our control. Nevertheless, UNC Health Care has had to find the solutions that will allow us to provide care to those who cannot pay for it.
To this end, we have made changes to ensure our institution is strong and can continue to meet the growing needs of North Carolinians. As a result, UNC Health Care is now on track financially. Our goal is simply to maintain a stable and responsible financial base—a responsibility that must be maintained if we are to fulfill our mission.
And yet as UNC Health Care brought about its own financial stability, we made mistakes. For example, we have not done a satisfactory job of letting some of our patients know that financial assistance is available. We also made some billing errors in which patients were served collection notices before they received bills. None of this was acceptable, and we have corrected these problems.
We successfully have resolved other issues, too. Under recent policy changes, we now:
- Automatically review catastrophic patient cases with medical bills in excess of $15,000, with the goal of minimizing the patient's obligation;
- Offer patients long-term, interest-free payment plans and up-front comprehensive financial counseling;
- No longer routinely forward cases of uncollected debt to the state attorney general's office for collection;
- Follow improved patient discharge policies to ensure proper care for frail and vulnerable patients after they leave our premises;
- Include community participation in our oversight, having invited an additional local citizen to join our board of directors and to serve on internal committees that address the needs of the most vulnerable residents. The Rev. Robert E. Seymour Jr., pastor emeritus of Chapel Hill's Binkley Baptist Church and founder of the Chapel Hill Senior Center, provides the community a voice that addresses the needs of the uninsured, the underserved and other vulnerable populations.
A detailed summary of our recent changes has been published in a community white paper that is available to all citizens at www.unchealthcare.org (click link called "Assuring Access").
We at UNC Health Care believe these and additional improvements will go a long way toward helping patients in financial need gain assistance and support. To be clear, we only want to make sure that people who can afford to pay do so. Otherwise, UNC will not be able to provide care to the growing number of people who can't.
I am pleased with the changes that have been made so far and am enthusiastic about additional improvements to come. After all, the goal is to serve our patients. As all of UNC Health Care's changes take hold, patients will experience a system of care that is easier to navigate and understand.
In the future, UNC Health Care will need to serve more people than it does today and will play an even greater role in finding cures for diseases that afflict patients. That is a challenging mission in this environment of escalating health care costs. But that is the mission that will continue to motivate us.