Commentary: No easy answers for complex health care system

As the president and CEO of Carson Tahoe Regional Healthcare, I am often asked what I think about health care reform. The complicated world that is the United States health care system is not one that can be fixed overnight, and I believe we need to examine and understand all the major components before we change any specific component hoping to improve the system.

I do not hold myself out as a national expert on health care reform, but I would be surprised if other hospitals around the nation didn't experience the same issues and challenges as Carson Tahoe.

I felt compelled to pen this editorial as I have yet to see an article, commentary or analysis that laid out what I consider to be the key components of our health care system. In my opinion, these components must be addressed in order to eliminate waste, increase efficiency and allow us to continue to provide care that will enhance the overall health of our communities.

One definition of a system is, "a complex whole formed from related parts." This is an accurate description of today's health care system. Meeting our mission to deliver safe, quality, compassionate care is a delicate balance of numerous working parts including physicians, staff, patients, payers, facilities, technology and government oversight. None of the aforementioned components work independently; when one is impacted it ultimately affects the others. As our nation continues to debate health care reform, I hope we will do so keeping in mind the following issues:

1. There is currently a significant shortage of primary care physicians in the U.S. Experts estimate that the shortage could double in the next 10 years. This issue will affect access to care for many Americans.

2. Health care providers spend enormous amounts of resources practicing "defensive medicine" to curb the threat of lawsuits or other legal consequences due to the way in which our legal system functions.

3. Local, state and national regulation and oversight cost hospitals, collectively, millions of dollars a year. Combined with the growing number of entities that seek to report on the quality of physicians and hospitals, this causes health care to be the most regulated industry in the country.

4. Payments to hospitals and other providers frequently have no basis on actual cost of services rendered. Insurers generally negotiate the best rates they can obtain from providers; government payers don't negotiate at all, they mandate what they are willing to pay physicians and hospitals.

5. Inappropriate use of the emergency department for primary care puts a burden on the entire system. Over half of all emergency department visits are for non-emergent conditions.

6. Without any regard to ability to pay, hospitals are required to treat any and all patients, regardless of whether that is the appropriate level of care. Hospitals must discharge patients not only when their medical condition is stable, but also when various social situations are resolved. In many cases the latter causes extended hospital stays.

7. Despite the obvious need to focus on prevention of disease, the reimbursement system provides negligible financial incentive to keep us well.

8. Curtailing the cost of care is severely challenged by the constant increase in pharmaceuticals, medical devices, diagnostic and treatment equipment and information technology that we must have to remain the best health system in the world.

I am fortunate to work for a health care system that employs great caregivers, retains and recruits excellent physicians, is financially solvent, delivers extraordinary care and is directed by a board of trustees that truly cares about its community.

As the weeks unfold I hope to look for ways to address in more detail the bulleted points above through targeted commentaries. It is our hope that reform will only occur following careful study of each of the important elements of health care and with a full understanding of how any change affects the whole.

• Ed Epperson is president and CEO of Carson Tahoe Regional Healthcare.