The Pulse

Insurers to pay $11 million in Georgia rebates

A federal rule on health insurers’ spending will bring $11 million in rebates to Georgia individuals and employers this summer.

Federal figures released Thursday show that 304,000 Georgians will benefit from the refunds, with an average rebate of $53 per family, as a result of the “Medical Loss Ratio” (MLR) rule on 2013 insurance plans.

1088819262-1249Created by the Affordable Care Act, the MLR standard generally requires health insurers to spend at least 80 percent of the premium dollars they collect on medical care or activities to improve the quality of health care.

In Georgia, $5.5 million will go to refunds to 180,000 individual consumers, while $5.4 million will go to employers in the small-group market. In both these sectors, the required threshold is 80 percent.

The large employer market, where the minimum requirement is 85 percent, accounts for just $270,000 in refunds in Georgia for last year’s health plans.

Humana plans in Georgia will have to pay the highest amount in rebates — $4.5 million combined in the small-group and large employer market. full story

Merger shows health IT still blooming in Georgia

Seven years ago, Baha Zeidan and two of his Valdosta colleagues entered a local competition for business plans, looking to build on their idea for a health care software startup.

At the time, the three young men, all graduates of Valdosta State University, were working at a medical lab company in the South Georgia city.

The group saw a need for better software for the health care industry, which still was bogged down with paper medical records.

Baha Zeidan

Baha Zeidan

The Valdosta-Lowndes County Chamber of Commerce awarded Zeidan, Douglas Swords and Daniel Henry the first prize of $15,000 for their business plan. The contest award also came with legal and other services.

“That was the start of the company,’’ Zeidan said Wednesday.

Azalea Health, launched in 2008 in Valdosta, “the Azalea City,” focused on providing electronic health records and billing software for physicians, along with software for laboratories.

On Tuesday, seven years after the contest award, the company announced a merger with Alpharetta-based simplifyMD, another private health IT firm. The merged company will have 70 employees and will have offices in Valdosta, Alpharetta and Macon as well as in Gainesville, Fla. full story

Exchange subsidies draw conflicting court rulings

More than 190,000 Georgians are enrolled in the health insurance exchange created by the Affordable Care Act.

But if a D.C. federal court ruling announced Tuesday on exchange subsidies is ultimately upheld, that Georgia number could shrink precipitously.

Healthcare Cost

The U.S. Court of Appeals for the District of Columbia ruled Tuesday that the language of the ACA allows subsidies, or discounts, only for people who obtain coverage through exchanges run by the states, and not by the federal government.

Georgia is among 36 states whose insurance exchanges are federally run.

About 95 percent of Georgians enrolled in health plans in the exchange have received subsidies to help them afford their premiums, according to the state insurance department.

The 2-to-1 ruling by a three-judge panel of the court — if not overturned on appeal — would be a tremendous setback for President Obama’s health care law.

Without subsidies, the price of health insurance for millions of people in Georgia and the 35 other states with federally run exchanges would rise sharply, making it generally unaffordable.

The judges suspended their ruling pending an appeal by the administration. The Obama administration said it would appeal to the full circuit court, a process that could take up to six months, and stressed the ruling would have no impact on consumers receiving monthly subsidies now, Reuters reported.

Also Tuesday, a three-judge panel of the 4th U.S. Circuit Court of Appeals in Virginia ruled unanimously to uphold the subsidies provision, saying the wording of the law was too ambiguous to restrict the availability of the funds. The ruling was announced shortly after the D.C. decision.


full story

Financial first aid for a mountain hospital

An unusual financial arrangement has taken Habersham Medical Center in Demorest off the critical list.

In a deal with the local hospital authority, Habersham County has agreed to make monthly bond payments on the northeast Georgia hospital’s $37 million debt, and will eventually take over the assets of the facility.


Habersham Medical Center

Habersham’s financial move “has been already beneficial to the hospital,’’ Demorest Mayor Rick Austin told GHN on Monday. “It immediately puts us back in the black.”

“This hospital is incredibly crucial to our community and our county,’’ Austin said.

Habersham strongly promotes itself to tourists and potential retirees. The availability of good health care is essential to attracting such people.

The agreement comes at what some experts consider the most pressing financial time ever for the state’s hospital industry.

Rural hospitals, such as the Demorest facility, are under heavy fiscal strain. Four hospitals have closed in rural Georgia over the past two years, with others many experiencing cash problems. full story

State agency loses federal ‘family planning’ grant

A federal health agency has awarded a three-year, $7.8 million Georgia “family planning services” grant to a coalition led by an Atlanta-based community health center.

Family Health Centers of Georgia will work with other federally qualified health centers in the state, Grady Health System and Planned Parenthood to deliver these services to individuals, primarily low-income women. The services are funded through the federal Title X program, and the funds come from the U.S. Department of Health and Human Services.

It’s the first time in 30 years that this family planning grant did not go to Georgia’s public health agency, though the agency did apply for it.

Dr. Brenda Fitzgerald

Dr. Brenda Fitzgerald

Ryan Deal, a spokesman for the Georgia Department of Public Health, said in an email to GHN that Gov. Nathan Deal (no relation) and the agency’s commissioner, Dr. Brenda Fitzgerald, “are deeply concerned about the federal government’s decision.”

“At this point, we are uncertain as to the statewide services provided by the Family Health Centers of Georgia, Inc., and their approach to implement services in rural Georgia,’’ Deal said in his statement.

“The federal government has not shared with Georgia Department of Public Health their new approach to ensuring all of Georgia is covered,’’ the statement continued. “Governor Deal has requested that Dr. Fitzgerald review options affecting all Georgians, as more details are shared by the federal government.”

Family Health Centers said Friday that the consortium of federally qualified health centers (FQHCs), Grady and Planned Parenthood will provide statewide coverage, with more than 170 locations in the state. full story

Consumer Corner

Teen use of HGH on the rise

Teen usage of synthetic human growth hormone rose 120 percent from 2012 to 2013.

Around the State

CDC lab is reopened

Operations can resume at a TB lab at Atlanta-based CDC that was shut down following two accidents that could have exposed workers to anthrax and the lethal H5N1 flu virus.

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Atlanta Business Chronicle

Phoebe appeal hearing set

An appeal hearing requested by Phoebe Putney regarding a possible purchase of what is now Phoebe North will be held Sept. 8.

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Albany Herald

Bibb: Healthier school food

Cafeteria employees, parents and students are invited to sample some of the new food that will be served in school cafeteria.

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Macon Telegraph

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Rise in staff cuts DFCS backlog

More cases are being reported to Child Protective Services, but the number of cases with overdue investigations is dwindling both statewide and in Hall County.

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Gainesville Times

Input on WIC program

Georgia health officials are seeking public input on the Special Supplemental Nutrition Program for Women, Infants and Children, or WIC.

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Associated Press


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