Workers expect their defined contribution plans to play a greater role in their retirement income than annuities.
In reviewing the past year, the medical director for the Cleveland Clinic Family Health Center said 2013 was one of major growth.
The Clinic added 12 physicians and five mid-level physicians' assistants and nurse practitioners, Medical Director Dr. Tony Tizzano said. There has been an emphasis on primary care as the organization prepares for the full implementation of the Patient Protection and Affordable Care Act.
There were more than 4,650 procedures performed at the Cleveland Clinic's Wooster Outpatient Surgery Center in 2013, an increase of about 5 percent.
Areas of growth include general surgery where surgeons are performing minimally invasive procedures for gallbladders and hernias, Surgical Director Dr. Richard Guttman said.
The Clinic also has added two full-time gastroenterologists, Drs. Brian Baggott and Nicholas Golden, who are expanding outpatient and inpatient GI services. Among the procedures they are performing are ERCPs, endoscopic retrograde cholangiopancreatography, which diagnose diseases of the gallbladder, bile system, pancreas and liver.
Guttman said Baggott and Golden are also doing breath tests to look for lactose and fructose intolerance, and they are doing esophageal dilatations for dysphagia. This is an important area because so many people have trouble swallowing, Guttman said.
Internationally recognized colorectal surgeon Dr. Gokhan Ozuner comes from the main campus in Cleveland to Wooster each week, Guttman said. He has expertise in advanced colorectal issues and incontinence.
Physicians also are performing minimally invasive sterilizations without incisions, using laser treatment of prostate and kidney stones and providing expanded pain management services.
While it is important to have the necessary physicians, access to those doctors also is important. Tizzano said the Clinic is working hard to make sure if someone needs to see a physician, then there will be same-day service.
Across the Cleveland Clinic system, about 1 million patients have seen physicians on the same day they called over the past year, Administrator Jim Madasz said.
An aim of the Cleveland Clinic is to put patients in the driver's seat when it comes to their health. To this end, patients have access to their electronic medical records, called MyChart. They also can schedule appointments online and see what is the best time available.
"Those are forming our foundation for primary care," Tizzano said.
As the ACA continues to be implemented, the Cleveland Clinic is also looking at how it can collaborate with other health care providers and systems.
One of the things the health care law is doing is moving the industry from a volume-based payment model to a value-based payment model, Madasz said.
"And who wouldn't want that?" Tizzano asked.
Over the past year, the Cleveland Clinic Wooster provided $6.5 million in free health care, Madasz said, adding it was not "uncollectable care."
"We're here to take care of patients," Madasz said. "We have to try to find a way to do it with declining reimbursements. It's a more complex market."
"Part of that is efficiency," Tizzano said.
Because health care reform is not fully implemented and some aspects have delayed, Guttman said no one is really sure how it will all "shake out." The Clinic was working with one patient who lost coverage and could not get covered in the exchange. The Clinic provided the needed care.
"A patient shouldn't have to worry about this," Guttman said. "I hope it gets better soon."
Reporter Bobby Warren can be reached at 330-287-1639 or email@example.com. He is @BobbyWarrenTDR on Twitter.