FROM THE COVER
PROS AND CONS of health care legislation enacted in 2010 Implementation will begin in 2014
Eements of reform that St. Mary believes will greatly benefit the High Desert • Expanded Coverage - The Patient Protection and Affordable Care Act expands health care coverage to 32 million people nationwide by 2019, and includes insurance reforms that are important to patients, consumers and providers. The law won’t change today’s job-based private insurance system and the Medicare system for those over 65 years of age or permanently disabled. However, it does provide new ways to obtain insurance for people who today cannot afford coverage because of pre-existing conditions or inability to afford insurance. Additionally, insurers cannot cancel policies due to illness. • Improvements for Senior Care - By 2020, we will see an end to the Part D Medicare drug coverage “donut hole”—the point at which older adults on Medicare must start paying the full prescription drug expenses themselves. Also, seniors no longer need to put off preventive care or yearly check-ups because of cost. Since 2011, they have been eligible for free cancer screenings, wellness visits, personalized prevention plans, vaccines, flu shots, and more. • Accountability – Health reform also directs the Centers for Medicare and Medicaid Services (CMS) to track hospital re-admission rates for certain high-volume or high-cost conditions and use new incentives to encourage hospitals to reduce preventable re-admissions. In 2015, the law creates a physician value-based payment program to promote increased quality of care for Medicare beneficiaries.
Rreform also poses several challenges for the medical community. • Introduction of health exchanges – People without insurance will be able to shop for a health plan or insurance plan on a state exchange that will be called Covered California. Health care plans offered on the exchanges will be standardized and include a package of required benefits. Heavy emphasis will be on cost, which means health care providers will face significant reimbursement reductions. In the High Desert, there are about 85,000 residents currently without health insurance who could benefit through the state health exchange. This would mean 85,000 more residents in need of a physician and health care home. • Lower overall rates – Even outside the exchanges, hospitals and doctors will experience a number of changes over the next four years in Medicare and Medi-Cal reimbursement rates. • Capacity – As access increases, the situation could mean that there may not be enough physicians and nurses to take care of every patient. San Bernardino County has a low physician-to-population ratio with only 40 physicians for every 100,000 residents. This also impacts our need for more hospital beds. For many years, the High Desert has lacked the needed number of hospital beds to care for the number of residents in the area. The High Desert has 1.1 beds per 1,000 residents compared to the national average of 2.7 beds per 1,000 residents. By St. Joseph Health, St. Mary Strategic Services
HEALTH CARE From PAGE 1 “Many of the changes that will occur through reform are consistent with a vision that has inspired our organization for several years.” • New partnerships – St. Mary recognizes the need for like-minded partners to meet all the needs of those it serves. Presently, St. Mary is developing a new partnership with High Desert Primary Care Medical Group, which was recently purchased by a sister ministry, St. Joseph Heritage Healthcare. The partnership will welcome 32 physicians and St. Mary CEO care providers into the St. Joseph Health network. Alan Garret Additionally, the entire St. Joseph Health family is thrilled that the Attorney General has approved St. Joseph Health’s affiliation with Hoag Memorial Hospital Presbyterian in Newport Beach. With Hoag, St. Joseph Health will work to address some of health care’s biggest challenges – access, quality care, affordability – and develop new programs and services for Southern Californians. • New facilities – The St. Mary Victorville campus is on track with sewer lines and other infrastructure work already underway. More than a hospital, the new campus will also provide many services for maintaining the community’s health and wellness. The new campus is expected to open in 2016. • New thinking –St. Mary is situated to offer the High Desert “real reform,” such as a wide network of quality-focused care, more affordability, prevention and wellness efforts, programs for the whole person and services that are relevant to every stage of life.
HOSPITAL PERFORMANCE MATTERS TO CONSUMERS Consumers don't feel informed about how hospitals perform in caring for patients. As shown in American Hospital Quality Outcomes 2013 report, 45% of consumers are not aware that data is available on hospital performance related to surviving a care episode or experiencing unexpected complications. This kind of hospital quality information could mean the difference between a smooth surgery and complications, or even worse, life and death. In addition, 86% would be more likely to choose (or not choose) a hospital if they could learn ahead of time their risk of dying for a given procedure or treatment. Consumers should do their homework before becoming a patient and take advantage of hospital and doctor performance information based on objective measures, such as mortality rates. Source: Harris Interactive. Consumer Research: America’s Readiness to Choose a Doctor or Hospital. Prepared by Harris Interactive for Healthgrades.
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The new campus is expected to open in 2016
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