2013 has been a rather tumultuous year for community hospitals like Newton Medical Center. From the Affordable Care Act to KanCare to the government shutdown, various changes at the state and federal level have all made an impact.

Although Newton Medical Center's President and CEO Steve Kelly has worked in the health care field for more than 40 years, he said he has never seen a year quite like this one, with so many complex and inter-related challenges.

"I've never experienced a time during that period when there's been so many challenges for health care," Kelly said. "Every one of those (challenges), though they seem very different, have some relationship."

As an employer of more than 600 people and a leading health care provider in the community, NMC has been impacted by federal health care reform, Kelly said.

The Affordable Care Act seeks to address the growing number of people who need health care but do not have a way to pay for it. About 46 million people reportedly are uninsured in the U.S., and those who are insured may struggle to meet a high deductible.

Kelly said NMC has seen an increase in the amount of charity care it provides — a number that will reach about $5 million this year. Some who already qualify for government health-care plans may not be taking advantage of the aid due to uncertainty of how to navigate the program.

"It's not just affordability, it's understanding how to progress through a very complex system of getting help," Kelly said.

He believes the key to moving forward will be to make sure care is both affordable and easily accessible for members of the community.

Another change that has impacted NMC — this time from the state level — is KanCare. Although Kelly believes applying the managed care system to Medicaid is a good idea, implementing the program has brought challenges.

The program started in January and brought a major shift to Medicaid, outsourcing the service to for-profit managed-care companies. Unfortunately, the shift has resulted in some backlog; hospitals have provided medical care but payments have been withheld due to bureaucracy.

Kelly said NMC and other hospitals also continue to deal with the fallout of the sequester earlier this year. In April, NMC received a 2 percent reduction in what Medicare pays them.

Although government changes have brought challenges to the health care industry, Kelly continues to be optimistic about NMC's future and said his staff has responded well to the changes.

"We've got to learn to be better with less reimbursement," Kelly said. "The ones that survive is how they adapt. ... I think we're well prepared. There have been good stewards of our resources here at the hospital. We're prepared to make decisions and implement changes."

The hospital continues to branch out, establishing clinics in other communities, such as Park City, Valley Center and Sedgwick. They are looking at expanding into Hillsboro and Halstead in the future.

"Our NMC team is outstanding," he said. "... They are committed to an independent, community run hospital that's focused on providing good care to their friends and neighbors."