Editor's note: As CEO of Carolinas HealthCare System, Charlotte, N.C., Michael Tarwater leads one of the largest public hospital systems in the U.S. and faces carrying out its mission in two states that have shunned the coverage expansions of the Patient Protection and Affordable Care Act. With $4 billion in operating revenue last year, the organization owns, leases or manages 19 hospitals in North Carolina—including the 874-bed Carolinas Medical Center in Charlotte—and another four in South Carolina. Modern Healthcare reporter Maureen McKinney spoke with Tarwater about the federal healthcare reform law, other changes afoot in North Carolina's Medicaid program, and the system's participation in new payment models and quality initiatives. Here is an edited excerpt:
Maureen McKinney: North Carolina blocked the Medicaid expansion that is part of the healthcare reform law. Tell me how your facilities and the patient populations that you serve will be affected by that?
Michael Tarwater: I think it is pretty clear that that means there is money that is going to be left on the table, not available for the expansion of Medicaid in North Carolina. It is going to be more than $4 billion over the next 10 years. With the passage of the ACA in 2010, provider payments from Medicare began to be cut and that's continued. And what we see from this point going forward is that's another $7.4 billion for North Carolina Hospitals.