This is a clear indication that access to primary care is poor, probably a combination of the shortage of primary physicians in the community, and the loss of health insurance by those who lost their jobs or closed their businesses.

We'll no doubt see even more patients in our emergency rooms until there's a marked improvement in the economy and a commitment to train more primary care providers and to ensure those providers are financially rewarded for their work.

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Another interesting trend is a growing percentage of NorthBay Healthcare's revenue from our outpatient services. (See chart. Click to expand.)  More emergency service visits certainly accounts for part of this, but it's by no means the only reason. NorthBay Center for Primary Care - our primary care medical practice - added more family practitioners, internists and pediatricians during this period. Our distinguished Cancer Center also saw growth.

Revenue from services outside our two hospitals should continue to climb as we open our fourth Center for Primary Care later this year and ramp up services in our new and innovative Center for Women's Health.

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Finally, our "case mix index," which measures the complexity of the care provided in our two hospitals, is rising. (See chart. Click to expand.)  It's not surprising, since our mission -- providing compassionate care, advanced medicine, close to home -- is being demonstrated here.

NorthBay stands alone in Solano County in bringing more sophisticated inpatient services to our community. We were the first to bring intensive care services for newborns. We established Solano's first accredited cancer center. Last year, we started Solano's first advanced heart program, including cardiac surgery and advanced interventional vascular procedures.

On the drawing boards are a stroke program and improving trauma care in Solano. Expect to see that case mix index increase as we bring more advanced medicine close to home.

One more fascinating finding in the year-end review was some impressive figures about NorthBay's contribution to the local economy, which I may touch upon in a future post.