Posted by: Duke Raleigh Hospital | April 11, 2013

Delivering Healthcare in a Post-Election Environment

Rick Gannotta, president of Duke Raleigh HospitalBy Rick Gannotta, NP, DHA, FACHE, Duke Raleigh Hospital President

Healthcare leaders in our state and across the country are facing unprecedented change and challenges due to healthcare reform – and harsh current economic realities. Among the challenges are the following: North Carolina not expanding Medicaid (along with many other states), Medicare and managed care rate reductions.

In their latest report called “Ensuring a Healthier Tomorrow,” the American Hospital Association (AHA) outlines the current growth rate for health care spending as the central focus for policymakers.  This rise in spending is brought on by changing demographics, aging baby boomers, growth in chronic illness, medical advances and system inefficiencies.

Almost 40 percent of North Carolina hospital patients are covered by Medicare which currently pays hospitals approximately 80 percent of the costs.  Thus, hospitals must cover the remaining costs which in 2011 reached more than $800 million.  North Carolina hospitals are facing Medicare reimbursement cuts of more than $7.4 billion during the next decade which will leave hospitals with an even larger amount of costs to cover.

This model is not sustainable, as it only affects payments to providers and will not have the desired result of reducing government spending on services.  Rather than across the board financial cuts, we need to look for a more integrated and long-term approach to our health care system.  We need to be as efficient as possible with our healthcare dollars and provide the very best care to our patients by looking at prevention and better coordination of the care continuum.  In addition, developing a system that promotes and rewards accountability with an eye toward quality, transparency and disease management is key.

This is an extremely challenging era in healthcare as we all work together to reform the current delivery system and look for ways to expand coverage so that it is more accessible & efficient with better outcomes.  Duke Raleigh Hospital and the Duke University Health System are working diligently toward necessary collaboration and innovation in meeting these challenges and ensuring we can continue to provide quality care to everyone we serve.

I encourage you to learn more about changes to our healthcare system by visiting the American Hospital Association web site at and the North Carolina Hospital Association web site at

American Hospital Association:
North Carolina Hospital Association:

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