Care Regardless of Ability to Pay

In recent months, the UNC Health Care System, including Rex Healthcare, has received criticism about the amount uncompensated care we provide in Wake County. (Uncompensated care is the cost of care for which we are not paid). We are proud of our commitment to treat every patient who enters our doors, regardless of their ability to pay – so we’d like to address this criticism head on.

UNC Health Care System providers delivered more than $300 million in uncompensated care last year. Much of that care was delivered to patients in Wake County. We don’t just deliver care to Wake County patients at UNC Hospitals in Chapel Hill, Rex Healthcare in Raleigh, or our affiliated physician practice groups throughout the Triangle. The UNC School of Medicine also employs more than 30 faculty members and 55 residents who practice full time at WakeMed.

Those UNC School of Medicine residents and faculty provide much of the uncompensated care that is delivered at WakeMed – particularly in OB/GYN. By our calculations, the value we provide to WakeMed well exceeds $20 million annually.

The UNC Health Care System provides uncompensated care to patients from across the state. Our most recent data shows that our care is almost double what is provided by WakeMed. We are proud of our role as the state’s health system and will continue to provide our excellent standard of care to any North Carolinian who needs our services, regardless of their ability to pay.

UNC and Rex: Excellence in Nursing

Nurses from UNC Health Care and Rex Healthcare know how to work together.

Both hospitals were represented among the more than 7,500 attendees at the American Nurses Credentialing Center’s 2011 National Magnet Conference.

The event was held Oct. 4-6 in Baltimore for hospitals that receive the prestigious Magnet designation, which recognizes the best nursing practices worldwide. Attendees also shared their best practices and discussed new strategies for improving patient care.

UNC and Rex employees at the ANCC 2011 National Magnet Conference

Among Triangle hospitals this year, Rex and Duke University Hospital were recognized as redesignated organizations. UNC Hospitals received its initial magnet designation.


Comparing Uncompensated Care

The UNC Health Care System, and Rex Healthcare in particular, have been unfairly criticized about the amount of uncompensated care we provide in Wake County. (Uncompensated care is the cost of care for which we are not paid).

Specifically, WakeMed CEO Bill Atkinson has said that WakeMed provides more than its fair share of the uncompensated care in Wake County and that Rex Healthcare needs to provide more. This is false.

Rex Healthcare is a community hospital, integrated into the UNC Health Care System. Similarly, WakeMed Cary is a community hospital affiliated with the WakeMed system. That’s why it makes more sense to compare apples to apples – and parent hospital to parent hospital and affiliated community hospital to affiliated community hospital.

We know that the UNC Health Care System provides significantly more uncompensated care than WakeMed’s system – $309 million to $162.4 million, respectively in fiscal year 2010. And we know that Rex Healthcare provided $85.2 million in fiscal year 2010. But we don’t know how much uncompensated care is broken down within the WakeMed system. Since fiscal year 2008, WakeMed has elected not to submit data for WakeMed Cary to the North Carolina Hospital Association for charity or community benefits – instead rolling up WakeMed Cary’s data into the larger WakeMed total.

While WakeMed’s lack of transparency keeps us from comparing dollar amounts spent on charity care, we can look at some of the patient data. According to state licensure records, WakeMed Cary has fewer uncompensated patients than Rex. Approximately 10 percent of Rex’s outpatient visits are uncompensated, while only 3 percent of WakeMed Cary’s outpatient visits are uncompensated. On any given day in the emergency department, Rex sees an average of 50 percent more uncompensated care patients than WakeMed Cary. Even after factoring in size, WakeMed Cary sees fewer uncompensated care patients than Rex does.

Given the opportunity, we’d welcome the chance to conduct a more comprehensive comparison of uncompensated care at WakeMed Cary and Rex Healthcare, or of UNC Hospitals to WakeMed. All entities affiliated with UNC Health Care will continue to provide our standard excellent care to all patients who walk through our doors, regardless of their ability to pay.

Rex Employees Hug Hospital

Last Thursday, more than 700 Rex Healthcare coworkers took a short break outside, joined hands and formed a human chain more than half a mile long around the hospital.Then they hugged the hospital.

“Hug Rex Day!” celebrated Rex being named as one of the nation’s 100 Best Places to Work by Modern Healthcare Magazine. Rex was the only North Carolina hospital to win that honor.In showing their appreciation for Rex, many coworkers also reinforced the importance of Rex’s partnership with the UNC Health Care System by wearing “Rex [heart symbol] UNC” T-shirts and “No Wake Zone” pins.

What do WakeMed Employees Think?

When the Special Committee for the UNC Health Care Board of Directors called for public comments on WakeMed’s proposal to purchase Rex Healthcare, the majority of responses – 80 percent – were against ending the partnership.

Many of the responses came from health care professionals in our area, including current and former WakeMed employees. We’ve included some of these comments below, and they raise several questions:

  • If WakeMed employees and affiliated physicians are against a WakeMed/Rex organization, why does Bill Atkinson continue to press forward with their proposal?
  • Why do they think competition and choice are important, regardless of where they work?
  • Why are WakeMed employees unhappy with their benefits and uneasy about finances?

Together, UNC Health Care and Rex Healthcare provide a great value to Wake County and to the state as a whole. And many WakeMed employees, along with a great majority of other members of the community, appear to understand and support the UNC/Rex partnership.

We still want to hear your thoughts about the UNC Health Care/Rex Healthcare partnership and health care in Wake County. Please share your thoughts here.

Note: We’ve redacted the names of the people who made the below comments to protect their anonymity. They were not edited for content, spelling or grammar.


“I am a physician in private practice who works primarily at WakeMed. I can say that the physicians I have spoken to overwhelmingly oppose WakeMed’s proposal to purchase Rex. Moreover, the subset of physicians considering hospital integration prefer not to be employed by WakeMed, if given a choice.”


“Having worked as a supervisor at WakeMed for over 5 years and now at Rex, I am certain that it would NOT be in the best interest of the citizens of Raleigh and other nearby communities. The culture of both organizations is notably different with Rex being by far better. Furthermore, the team-up of UNC and Rex is far better than that of WakeMed and Rex since UNC has a Medical School and WakeMed does not.”


“I work at WakeMed and do not support this for several reasons. First, competition is good. Second, having multiple choices of healthcare providers is good. Third, I will give credit where credit is due regardless of who is providing it, but my last few experiences at WakeMed were horrible. The care from the nursing staff was pathetic and I was actually scared to leave my father alone. Lastly, I am not a fan of Bill Atkinson, I think the least of amount of power he has is better.”


“I am a current employee at WakeMed and this is a terrible business decision. I think it will make allot of nurses leave WakeMed and other ancillary staff. This move creates no competetion for WakeMed and in turn wages will be effected. To me this just seems a very greedy move and not a smart one.”


“As an employee of WakeMed, I am concerned that adding Rex to the WakeMed system will cause a further drop in salaries for those employed by both systems. My salary has been cut over 20% in the last three years….and feeding my family is a little harder. With fewer hospital systems in the triangle area, I fear that there will be less competition for talented workers and even less of a paternalistic attitude of employers who may have lost touch with the folks at the bedside.”


“I realize that you are required to consider the proposal of Wake Med’s to purchase Rex Healthcare. I work at Wake Med and I think that is probably one of the most insane ideas Bill Atkinson has ever come up with. Wake Med has treated their employees terrible in the last two years,and to have autonomy and power over that many people would be extremely bad for the community. We stood by when Bill asks us to give several of our benefits so that Wake Med would not be in the red. Wake Med never was in the red-and now Wake Med has surplus monies to buy another hospital! Bill Atkinson (crazy and narcissistic).”


“I have been an active Staff member at WakeMed and Rex Hospital since my arrival here in 2000. As a busy plastic and reconstructive surgeon -I spent the majority of the first 7 years of my career in Raleigh doing reconstructive cases at WakeMed. Now I utilize Rex on the vast majority of the cases. My switch in preference dates back to Dr Atkinson’s arrival and several years thereafter. My world is the OR and ease of use and efficiency of the scheduling process are critical. I have found a general decline in quality and organization of the OR at the Raleigh Campus to the point that I prefer not to go there. When I do, the cases are often running late. Thankfully there are some veteran staff members there who make an extra effort to work with non WakeMed surgeons to facilitate things. I worry that the managerial practices of Wakemed will lead to a deterioration of surgical services at Rex.”