Assessing health care: public policy, personal habits and changing demographics make providing health care in North Carolina a complex process.

• Author: Canfield, Brian
• Position: HEALTH CARE ROUNDTABLE - Interview

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NORTH CAROLINA health care providers are dealing with changes in population and procedures, the latter brought by the Patient Privacy and Affordable Care Act. They also manage growing rates of chronic diseases, one disturbing trend that Minnetonka, Minn-based United Health Foundation used to determine that North Carolina falls to 31st place on its list of healthiest states. Combined, these factors make providing care more challenging than ever. Business North Carolina assembled a panel of health care experts to examine these issues and prescribe solutions.

The discussion was moderated by Ben Kinney, Business North Carolina publisher. It was hosted and sponsored by High Point University. Additional support was provided by FirstHealth of the Carolinas and High Point Regional Health, part of Chapel Hili-based UNC Health Care. The transcript was edited for brevity and clarity.

HOW IS NORTH CAROLINA'S HEALTH CARE INDUSTRY?

SELIGSON It's thriving. There are more than 210,000 physicians employed in the state that are responsible for about $30 billion of annual revenue. People are accessing health care services more than ever before. There are challenges with reimbursements and creating a value-driven, rather than fee-based, environment.

ERB In 1994, 4.5% of North Carolina adults were diagnosed with diabetes, according to the Centers for Disease Control and Prevention. In 2014, that number was 9.8%. As the rate of chronic diseases grows, so does the need for health care providers. When I came to North Carolina five years ago, there were four physician-assistant programs in the state. There are 11 now. The PA class that [High Point University] seated last year had 20 spots, and we reviewed more than 800 applications. The class exceeds the national average for GPA and GRE scores and clinical hours served.

CANFIELD Demand keeps growing. The move afoot is toward ambulatory care and ambulatory surgery. We have struggled to find medical-surgical beds for adults every day for the past 12 to 15 months.

HOW IS THE AFFORDABLE CARE ACT. WHICH BECAME LAW IN 2010, STILL SHAPING HEALTH CARE?

HAND The dust is still settling. Unlike a traditional business, hospitals can't close, rebrand or renovate and reopen the next day. There are always patients that need care. We've had to make this transition with one foot on the dock and one foot in the boat. As a patient, I like that it focuses providers on creating the best outcome for me. As a hospital, I'm figuring out how we move to that and still work in this world. I do a lot of federal lobbying, so I talk to legislators about ACA effects. It continues to cost hospitals at leas $100 million a year industrywide. That's not just because Medicaid expanded under the ACA. It's because more money is sent elsewhere--about $75 million to Massachusetts, for example--because of Medicare Wage Index calculations, which determine reimbursements based on regional salary costs. Then there are the audits. Medicare recovery audit contractors are paid on denials. Appeals first go to the auditor and then to the auditors supervisor. Two or three years later, a court hears the appeal, and 75% to 80% of denied audits are overturned. We're spending an enormous amount...