Seton adjusts to health care changes

Medical center in Kyle increases emphasis on preventive efforts

Seton Medical Center Hays is expanding its focus on preventive care in response to the Affordable Care Act and the changing health care environment, said Herb Dyer, vice president and chief operating officer of the hospital.

Because of decreasing payouts from Medicare, Medicaid and insurance companies, patients are putting off non-emergency procedures, which has lowered the bottom lines of hospitals throughout the nation, Dyer said.

"Our Seton system has seen a reduction in volume—we have 11 acute-care hospitals—and we've seen across-the-board reductions in volume," Dyer said. "We're not seeing as many patients or as many procedures in the operating room. People are making conscious decisions about whether or not to do things, especially if they can delay it."

The reduced volume has forced the hospital to reduce some staff members' hours, but it has not resorted to layoffs, Dyer said.

Hays County's growth has kept Seton Hays from seeing a decline in patient volume, but Dyer said because the Affordable Care Act—also known as Obamacare—is accomplishing its goal of lowering health care costs to the patient, which in turn lowers the hospital's bottom line, Seton officials are keeping a close eye on expenses.

Preventive care

In an effort to more efficiently allocate resources, the hospital has put what Dyer calls a stronger focus on preventive care, including procedures and practices aimed at keeping patients who are not experiencing medical emergencies out of the emergency department.

"The [emergency room] is costlier, and it's not a preventive approach to that person's health care needs," Dyer said. "An emergency department should be for emergency purposes."

The hospital's preventive care methods include discharge phone calls, in which a nurse checks in with a recently discharged patient to ensure that the patient is maintaining his or her medication regimen and seeing a specialist regularly, and connecting patients with family practitioners.

The ACA holds hospitals accountable for 30 days after a patient is discharged. If a patient is readmitted within that period, the hospital will receive a deduction in its Medicare and Medicaid reimbursements.

"It incentivizes as well, having physicians in the hospital who can work collaboratively to make sure that that patient is taken care of properly, discharged appropriately and managed in an appropriate way after they're discharged so they don't end up back in the hospital unnecessarily," Dyer said.


The hospital's preventive care focus has also included the formation of partnerships aimed at leveraging Seton's resources with grass-roots organizations such as Healthy Communities Collaborative, a group of health care organizations and individuals partnering to provide better access to health care for residents in northeastern Hays County.

Dyer, who serves on the board of HCC, said the organization has played a major role in helping the hospital increase its focus on preventive care. In 2010, HCC was instrumental in bringing Communicare, a San Antonio–based health care provider that has partnered with Seton to provide its patients with a family practitioner, to Hays County.

Some of the organization's efforts are put toward connecting patients with doctors and educating residents about maintaining good health, but much of what HCC does happens away from hospitals and doctor's offices.

HCC President Bobbi Ryder said two recent pushes by the organization have involved enforcement of leash laws and improvement of sidewalks along the roads east of I-35. In April, the organization surveyed residents of northeastern Hays County about their health and exercise needs and found that those two issues were deterring many residents from getting daily exercise.

"One of the things that came out in our needs assessment was, 'Do you feel safe walking on sidewalks?'" Ryder said. "Their response was, 'What sidewalks?' The other answer to that question was, 'No, we don't, because there are a lot of dogs hanging around that are not on leashes.'"

Effecting change can be expensive, and to help defray those costs the organization applied for and received a grant from the Centers for Disease Control and Prevention that will amount to $740,000 over five years and will allow HCC to continue its outreach efforts.

Ryder said she hopes by organizing and empowering residents to effect change in their communities, sidewalks will get built, laws will be enforced and residents east of I-35 will feel safe enough to walk around their neighborhoods. That exercise might be enough to keep them from developing health issues that will land them with costly hospital bills.

"We see a growing trend," Ryder said. "Being overweight and being obese is the cornerstone to an array of health ailments including cardiac issues, diabetes [and] hypertension, and all of them can be tracked back to weight management."