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.”

UNC Health Care Requests Public Records From WakeMed

For the past year, UNC Health Care has answered all questions asked of us and throughout, remained transparent. At the same time, WakeMed has done nothing to back up their claims. Even though we asked on numerous occasions, they were unwilling to provide any information about the care they provide Wake County citizens, their business operations, and how limiting choice will improve quality of care or reduce costs for Wake County citizens.

We want to be open and honest about our operations with the communities we serve and we hope that WakeMed will do the same for the citizens of Wake County.

Last week, UNC Health Care issued a public records request for the following information from WakeMed — information which the community is entitled to given their legal status as a public agency:

  1. Minutes of all meetings of the WakeMed Board of Directors since January 1, 2009.
  2. Agendas for all meetings of the WakeMed Board of Directors, and all materials provided to the Board in conjunction with such agendas, since January 1, 2009.
  3. Any annual financial audits of WakeMed, Inc. submitted to Wake County as required by the Transfer Agreement between Wake County and Wake County Hospital System, Inc.

You can view our request for WakeMed’s records here.

We look forward to WakeMed’s response to these requests.

Editorial Boards Weigh in Across the State

As WakeMed’s proposal to purchase Rex Healthcare from UNC Health Care has gained publicity, several newspapers from around the state have weighed in with their views – largely that a one-time cash infusion to the state is not a good reason to sell a high-performing asset that brings great benefits to the people of North Carolina.

Below are some excerpts from editorials that ran in various newspapers. To share your view, click here to visit the UNC/Rex Partnership online portal.

On October 7, a Southern Pines Pilot editorial said:

“Accordingly, a special committee of the N.C. House of Representatives has been tasked with the job of examining state-owned assets and recommending which ones might be put on the block. Those properties could range from a vacant lot here to an underutilized building there to the state-owned Rex Hospital in Raleigh, for which crosstown rival WakeMed has offered $750 million.

“On the hospital offer, the one-time boost to the revenue side of the state budget would hardly be worth the long-term damage inflicted by accepting the Rex offer, which appeared to be little more than a publicity stunt anyway.

“The same principle should apply across the board as properties large and small come under scrutiny. In general, the idea of selling off property and getting it back on the tax rolls — with the possible creation of new jobs in the private sector — is an attractive one at the moment. But it is important to keep things in long-term perspective. If mistakes were made, property sold under present market conditions would likely be much more costly to buy back or replace in the future.”

The Winston-Salem Journal wrote on October 6 that:

“If there is any area where legislators need to exhibit perspective, however, it is on this topic. An asset sold today, in the current down market, will cost a lot more to buy back when the economy improves. Therefore, legislators must be aware of long-term needs for these assets.

“Such decisions can be based only on practical considerations. We fear that the committee will be consumed by political ideology, conservatives arguing to sell the Capitol and liberals for preserving every acre in which bluebirds ever nested.

“The central question must be asked: Is this sale good in the long-term for the people of North Carolina?

“A prime example is the debate over Raleigh’s Rex Hospital, a part of UNC Hospitals. In that case, there is a $750 million offer from a private hospital company to buy it. Legislators must weigh the role that $750 million could have in restoring the state’s reserves against UNC’s needs for Rex in its teaching and research hospital system.”

UNC’s The Daily Tar Heel opined on October 4:

“WakeMed has spun its unsolicited $750 million offer for Rex Healthcare not for what it is — a hostile takeover — but as a quick fix to inject funds into the financially troubled UNC system. That offer was rejected by UNC Health Care, but now, a state committee on state-owned assets is assessing whether Rex Hospital should be put up for sale. Representatives on that committee must look past the spin and see WakeMed’s interest as short-term support that would create long-term hardship for the health system that does more for North Carolina.”

“The House committee is just beginning its deliberations about Rex, but it could ultimately recommend to the General Assembly that the hospital be sold. The committee must realize exactly what stakes are involved in its decision.”

“Selling Rex may be a tempting one-time injection of funds, but it will cause irreversible damage to the future of health care and education in North Carolina.”

On September 30, the Fayetteville Observer editorial board wrote:

“One property that will get a close look is Rex Healthcare, owned by the UNC Health Care System. The system’s board last month turned down an unsolicited $750 million cash bid for Rex by WakeMed Health & Hospitals.

“UNC officials told the House committee that Rex is an integral part of its physician-training program. It’s hard to depend on the good will of private hospitals to get those training opportunities,” UNC Health Care CEO Dr. Bill Roper said.

“It’s also hard to ignore a one-time $750 million cash infusion for a state facing continuing financial problems.

“But in all these possibilities, the committee needs to keep its eye on the horizon. One big paycheck doesn’t mean much in a plan that needs to look ahead for decades. That’s the big question for the committee: How would a property sale fit with the state’s needs over the next two or three decades?

“We know the trend: We are growing and it’s likely to be that way for years to come. The state’s popularity means we need more roads, better access to recreation and the coast, more hospitals and doctors, and so on. It also means we’ll need more government employees – police, highway maintenance, park workers, social services workers, and others.

“Are we going to sell the places where they might work, then buy new property to house them later? Let’s be penny-wise in this review of state property. Let’s sell the truly unneeded land and buildings (we’ll bet there’s plenty of it) and hang on to those that fit our future needs. Let’s get leaner, but let’s be smart about it, too.”