The American health care system is going through a once in a lifetime transformation. Many of these changes are for the better. In the state of North Carolina, these changes are playing out in ways that are quite evident but not always predictable. As part of this transformation, revenues provided to deliver health care continue to decrease, but the demand for these services does not. While hospitals and health care providers across the country are adjusting to the newly-imposed regulations, we are all searching for the best long-term solutions. Today’s health care delivery will look quite different from the way it will in the future. Rural health care is particularly challenging because the solutions must be sustainable, or they are not solutions.

The Affordable Care Act (ACA) made deep cuts to Medicare and Medicaid payment rates for hospitals and other providers of care, making it more difficult to operate small, rural facilities. While half of the states in the U.S. have adopted the more flexible Medicaid eligibility rules allowed under the ACA, many states, including North Carolina, have not. Hospitals that rely on Medicare and Medicaid to pay most of the bills are left to find ways to provide the same level of care with reduced payments.   This is neither possible nor sustainable using the current models of care that have been in place for more than 50 years that do not deliver needed levels of health, regardless of their cost.

Vidant Health is working to change the health care model in our region to better provide health and sustainable health care. Today, we serve a geography of more than 1.4 million people in eastern North Carolina and are the largest private employer in the region. Hospitals serving rural communities have faced multiple pressures that have led a number of facilities in the Southeast to close. Alan Morgan, CEO of the National Rural Health Association, blamed the closures on a number of factors, including reimbursement cuts, state decisions not to expand Medicaid under the ACA, and broader changes in the market.

Vidant Health is committed to delivering the needed health care services to our entire geography and all its communities. Take, for example, the town of Belhaven, with a population of just over 1,600 people. In 2011, Vidant took over Pungo Hospital, a small community hospital serving residents in Hyde and Beaufort counties. We worked with the community to provide a sustainable health care model, a path we continue today. On July 1, 2014, we closed the aging hospital facility and simultaneously opened a 24/7 clinic. Now we provide around the clock primary, preventative and urgent care to patients including lab work, X-rays and helicopter access for emergencies. Vidant Health’s commitment to serve the health care needs of Belhaven has never wavered. As part of our long-term commitment to provide health care services to Belhaven and surrounding communities, we have applied to begin construction of a new 12,000-square-foot, $4.2 million multi-specialty facility in Belhaven – a new model of ambulatory care. The facility will also be open 24/7 and will serve as a model for improving care in communities like Belhaven. Under this new model, people’s health will be improved with greater access to primary care, specialized services and specialty care, and sustainable under the new market conditions.

Vidant Health serves the health care needs of all of eastern North Carolina through our hospitals, clinics and medical practices. Our mission at Vidant Health is to improve the quality of life of the people and communities we touch, serve and support. We take that mission very seriously and have made long-term investments in this region and its communities. More than 70 percent of patients treated at Vidant Health hospitals and clinics are paid for by government programs with reimbursement rates set below the cost it takes to provide the care. In 2013, Vidant invested more than $135 million in unreimbursed charity care and community programs and services in eastern North Carolina. Our commitment is to provide these communities with access to sustainable and affordable care.

Vidant Health is adapting to these changes, developing new models and delivering new approaches to the region and communities we serve. Vidant’s health care model will continue to evolve to deliver health care services in a sustainable manner.

 

Roger A. Robertson is the president of Vidant Community Hospitals