"As a non-profit organization, we have an obligation to bring value to our community," Maroc said. "We show that every year in our annual report."
Cox Monett Hospital provides around $2.5 million in uncompensated care in a year's time. The law upheld by the Supreme Court is seen as providing economic stability to institutions serving poor and uninsured populations by putting broader insurance coverage in place.
"When people come to our emergency department, we evaluation and stabilize them whether we know if they have insurance or not," Maroc said. "We do the right thing. Our mission is to care for those in the community we serve. The clarity the court provided will be essential as we move forward to build a better system."
Cox Monett is too small a hospital to be included in some of the pay-for-performance measures used in the healthcare industry. Maroc said the local hospital is nonetheless following the same path and is striving to show its effectiveness.
"I'm getting a sense that the whole provider community needs to work together more effectively," Maroc said. "That's what the law envisioned. I anticipate we might see a shift from people going to the emergency room to primary care providers with the law. I've only been here a year, but it seems the availability of primary care providers and access to care is a bit of a problem in southwest Missouri."
The number of patients coming to the emergency room at Cox Monett Hospital for treatment increased around 5 percent in the past year, representing around 700 visits. Maroc said the challenge for the hospital is to find ways to manage such volume but putting operational tools and visual controls in place. A lean study of the emergency department has found ways to improve the flow.
"Hopefully we'll know what works and what doesn't, and be able to address the need," Maroc said.
While the court ruling addressed the constitutionality of the law, the political debate continues. Maroc said Missouri lawmakers discussing opting out of the law will bring uncertainty to the poorest people who may be cut off from affordable care.
"The Cox Health System has a health plan that it proposed to Medicare's Center for Innovation," Maroc said. "Cox's Care Improvement Initiative would involve disease processes and how we think we could improve service to our population."
Through such strategies, Maroc said Cox is working to find better ways to address healthcare issues. The Cox Health clinic system has focused on "taking care of the entire you," a model to address more than episodic crises that prompt emergency room visits. Maroc sees this approach arising out of the healthcare debate, just as the business end of the industry is moving more toward a bundled payment system.
"One of the things that attracted me to the Cox system was its broad spectrum of pieces, from home care and parental services to the kind of urgent care offered in Springfield," Maroc said. "Cox Monett is a swing bed facility. Patients who have had a hip repaired can come here for skilled care before going home. In Springfield, we have acute rehabilitation.
"I came from a sole community hospital in Iowa that was not affiliated with any larger organization," Maroc said. "That was challenging. I want to be part of something bigger. The Cox health network offers a lot of support, including specialists who travel here. I'm looking to increase those as I hear about a need."
The healthcare law is very complex in its length and detail. Maroc said Cox's administrators benefit Monett through their expertise in passing along what the law specifies and how to meet its requirements. The evaluation of hospital services is a focus already employed by Cox, as is the move toward providing guidance that will help keep patients well.
"Getting the public to think in terms of wellness is a big deal," Maroc said. "We've got to get control of supersizing everything and to think about obesity and smoking as avoidable behavior. We have wonderful programs. The Committed to Kids program we're offering this summer is a family-based service that involves the entire family."
Maroc sees the trend toward services like the Cardiac Kids screening of fifth graders for weight problems and the Journeys program for adults with weight issues as a direction for the future in healthcare that will not change, regardless of federal law.
"We're committed to providing quality care in the most efficient manner and to give the public access to the care that they need," Maroc added.