By Kim Walter
WINCHESTER -- Mark Merrill, Valley Health's CEO, will be the first one to admit that health care reform is a "major challenge for the country," but he maintains a positive outlook.
During the health care session of the Top of Virginia Chamber's Community Leadership Program at the Our Health campus in Winchester on Friday morning, Merrill gave a comprehensive review of what the Affordable Care Act means.
Merrill said since 1980, health care expenditures have doubled, and accounted for almost 18 percent of the country's gross domestic product.
"This is a sizable part of our economy," he said. The statistics he referenced also included a dramatic increase in out of pocket costs when patients pay for care. Even with about $3 trillion going into United States health care, Merrill said the number will continue to rise over the next decade.
Merrill also mentioned the concerns that come with an aging population -- by 2020, about 54 million people in the United States will be over the age of 65. During his presentation, he asked those over the age of 50 to thank anyone who was younger for their continued financial contributions to health care.
In 1960, there was an average of 4.3 people working to cover every one person on Social Security, but Merrill said by 2030 that will change to 1.8 to every one working person.
"Think about that for a minute," he said. "You go from four people supporting one retiree, and in 2030 it will be fewer than two?"
In the end, Merrill said there are three basic options to make the health care reform "work."
The options sound pretty dismal, though, as they include making fewer people eligible for Medicaid through raising the qualifying age and changing other qualifying criteria; increasing taxes or borrowing more money; or reducing the benefits and coverage offered through Medicaid.
Merrill asked if anyone in the room had read the Affordable Care Act -- a 1,098 page document.
"I want to be nonpartisan here," he said. "The Affordable Care Act had noble intentions to get everyone health insurance and expand access to health care."
Merrill reminded those in the audience that there are 47 million people without health insurance. Unfortunately, even though Medicare is a federal program and is the same across the board, Medicaid coverage is up to each state and "Virginia is a very stingy supporter" of it.
"Our Medicaid coverage is ranked 47th in the country," Merrill said. To support the statistic, he said that even though employees who work 30 hours a week would automatically get insurance, the governor recently "sent out a memo" to departments in the commonwealth asking employers to look at any person working 30 hours, and see if their hours couldn't be deducted.
Starting next year, if someone doesn't have health insurance, they'll be penalized in the form of a fine. Merrill said the penalty starts small, but will increase over time. He still worries that folks would rather pay a $600 fine than $6,000 for a policy.
A positive to come of the reform is improving the overall quality of health care services. Merrill said for the last century, the health system's economic model was based on "fees for service."
"For instance, a surgeon realizes that a patient could be treated with surgery or therapy, but he knows that he'll get paid for the surgery, so he decides to give that a try," he said. "That's going to change. We've got to create a reimbursement model where health care providers are paid for value as opposed to volume."
Merrill said also starting this year is a system in which hospitals will be penalized for patient re-admittance rates going over a certain amount. While it might sound negative, the CEO doesn't think it is.
"There will be a penalties and rewards system for hospitals in order to improve the outcome of a patients care ... I think that's a positive thing," he said. "We've got to improve care management from the time a patient comes in the door, to when they go back out into the community."
Part of that means better communication and collaboration between doctors, free clinics, nursing homes and families, among other things. Merrill said physicians need to do a better job at making sure their patients know what they're on and know and understand directions upon being discharged from the hospital. According to him, a patient understand less than 50 percent of what a doctor tells them before they're sent home.
Merrill held up his debit card, saying that with it he had access to his bank account no matter where he was in the country or world.
"How about a health card?" he asked. "Why don't we have access to our health status -- surgeries, medications, doctors, family history -- at all times?"
Patients will be able to check physician reports and hospital ratings soon through a government resource, Merrill said, in an effort to increase hospital transparency.
"Our mission statement is 'serving our community by improving health,'" Merrill said. "It's not to provide acute, although we do, and it's not to have state of the art technology, although we do. It's to serve the community by providing the best health care possible."
A positive of the health care reform can already be seen at a local level.
Thanks to federal Affordable Care Act funds, Healthy Families Northern Shenandoah Valley is receiving a grant for $520,600 to help first time parents and their children in Winchester and Warren County.
Marjorie Lewis, a founding member of the Healthy Families chapter, said the funds will provide home visitation outreach to an additional 100 families and expand in-hospital assessment by 240 families.
In 2012, 635 first time parents were screened and assessed at Winchester Medical Center and Warren Memorial Hospital through the Healthy Families outreach.
"This push for preventive care is part of health care reform," Merrill said.
Lewis agreed, adding that 100 percent of the families served by the organization had a primary physician for their child, reducing the number of emergency room visits.
After thanking Valley Health and all the people who worked with her 15 years ago to start the program, Lewis ended with a quote from Margaret Mead.
"'There is no greater insight into the future than recognizing ...,'" she began, her voice shaking. "' ... when we save our children, we save ourselves.'"
em>Contact staff writer Kim Walter at 540-465-5137 ext. 191, or firstname.lastname@example.org