FARMINGTON — Tom Dean, San Juan Regional Medical Center's Chief Administrative Officer, addressed health care reform issues Wednesday at the San Juan College Encore monthly brown bag meeting.

Encore is a college program designed for individuals 50 and over, and offers free monthly presentations on various topics to its members and to the public.

Dean presented a Power Point presentation entitled, "The Affordable Care Act Survived: Now What?" The act is popularly known as "Obamacare."

Outlining the various ramifications of the new law, Dean described it as one of the biggest things to ever happen to health care. The Supreme Court upheld the law's constitutionality in June.

Dean went on to say that most of the new healthcare reform measures are not focused on Medicare, which provides healthcare coverage for individuals ages 65 and over, as well as some individuals under 65 with certain disabilities.

"Medicare provides blanket coverage, which will stay mostly untouched for individuals following health care reform," he said.

Most of the changes, he said, will be centered around Medicaid, which, beginning January 2014, will be expanded to cover 42 million previously-uninsured individuals nation-wide who fall into the low income bracket. Low income, in this instance, is defined as a family of four with less than $30,567 of annual income.

Since 20.


8% of San Juan County residents live below the federal poverty level, this translates to about 25,000 local individuals suddenly having access to health insurance and seeking physicians, Dean said.

While most of the uninsured in the past have either refrained from seeking care when medical issues arose, or have gone to clinics and emergency rooms for care, Dean echoed the opinion of other local professionals that we are facing a massive shortfall in physicians when these newly-insured individuals begin to seek out primary care physicians.

"To just give a routine yearly physical for each patient would take up all the time of all of the available physicians we just don't have enough physicians to provide this care."

Dean said another shortfall is a lack of regulating guidelines to ensure that proper implementation of the plan takes place.

"The idea was that there was going to be a whole body of regulations telling us how it would work, but in fact there are 1,651 places in the act where it says the Secretary of Health and Human Services shall' see that the regulations are enforced, which means someone else will be figuring it out. I might be retired before we see the last regulation passed," he said.

Dean said the backup in regulatory actions that is likely coming down the pike as officials attempt to enact the law with fewer resources could be a blessing in disguise.

"The gridlock may give us some phasing-in time as we get used to the new regulations."

One positive and effective step that has been in place for several years is better screening for fraud and abuse among Medicare and Medicaid providers, Dean said.

"Auditors review computer records of health care providers to spot impossibilities," he said. "For example, no one should have had two hysterectomies. The auditors are watching for this kind of thing, and this measure does have value."

As far as the impact of the law on San Juan Regional Medical Center, Dean said the hospital, like all not-for-profit hospitals, faces some negative effects.

Medicare reimbursement to hospitals will drop by 150 billion dollars over the next 10 years, and Medicaid share funding will also be cut by $14 billion.

Bundled payments will further lower the hospital's reimbursement, and readmission penalties will rise. If patients are re-admitted within a certain timeframe for a previously-treated condition, the hospital faces a penalty.

Dean acknowledges that understanding the act's staggering 2,500 pages and learning to navigate the new system will be difficult. He echoed the sentiments of other healthcare officials when he said that to truly understand what reform will mean will be a waiting game. 

"It's really kind of a black hole for those of us who have to work in this universe, and we are left with unanswered questions," he said.

Leigh Irvin may be reached at Follow her on Twitter @irvindailytimes