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To help struggling hospitals, replace Georgia’s malpractice system

Wayne Oliver

Wayne Oliver

A panel of health care and political leaders appointed by Gov. Nathan Deal kicked off its work this summer to address the ongoing crisis in rural medical care. Its focus: the very survival of hospitals outside metropolitan communities through the state.

The Rural Hospitalization Stabilization Committee is holding hearings to identify potential solutions to keep open the doors of these struggling hospitals – from Eastman to Royston, from Byron to Hiawassee, among many others.

Four rural Georgia hospitals have closed in the past two years. They include Lower Oconee Community Hospital, which suspended operations for a second time in late June – sending emergency patients 30 minutes away for care.

Under the Affordable Care Act (Obamacare), the federal government is about to cut a little-known government subsidy to hospitals that covers uncompensated care and Medicaid shortfalls.

Reductions under the Medicare and Medicaid Disproportionate Share Hospital (DSH) programs will reach $17.6 billion across the country by 2020. In Georgia, cuts to hospitals could total an estimated $390 million from 2016 to 2020, thereby putting many rural facilities in grave peril.

While some continue to urge the governor to expand the state’s Medicaid rolls as a solution to the hospitals’ financial challenges, there is a healthier avenue to create revenue to sustain these hospitals.

Under the proposed Patients’ Compensation System (PCS) before the General Assembly, state taxpayers could save $6.9 billion over the next decade. That state revenue could be reinvested in rural hospitals that are barely surviving and others losing these federal grants.

Under PCS, which the Legislature is expected to consider again in January 2015, no doctor or hospital would ever be sued again. As a result, health insurers (private and public plans) as well as individuals would see billions in health care savings, as doctors would no longer feel the threat of litigation and would reduce the practice of defensive medicine (doing unnecessary tests and treatments to avoid lawsuits).

The health care economics firm BioScience Valuation issued a recent report on what the PCS solution would mean for Georgia taxpayers. The economists at BioScience Valuation found savings to Medicaid at $3.1 billion and an additional $3.8 billion in savings for the state employee benefit plan over 10 years. Those funds could then be used to help ailing rural hospitals that formerly received DSH payments.

Under the PCS plan, patients who are medically injured would no longer take their cases to court. Instead, they would file claims with an administrative panel of experts who would determine if a patient had been injured by a medical treatment or procedure.

With litigation eliminated, health insurance costs are expected to drop for all of us – those with private health plans and those with government plans including Medicaid, Medicare and the state employees’ insurance program.

Since most rural hospitals serve a large population of patients on Medicaid or Medicare, the PCS solution is particularly appealing as it will provide this huge cost savings to Georgia taxpayers and big revenue that could be redirected to essential rural hospitals.

Our governor has repeatedly said that the state cannot afford to expand its Medicaid program to save these hospitals. The PCS solution may be the best way to not only reduce health care costs for all of us – bringing quick access to justice for patients who have been harmed – but also to provide a financial route to saving our state’s hospitals on the critical list.

 

Wayne Oliver is executive director of Patients for Fair Compensation, a nonprofit working in several states to replace the malpractice system with a no-blame, administrative system that reduces the practice of defensive medicine, increases access to justice and allows for more patient safety.

Graduates who need help the most

The last day of high school is a bittersweet one for most parents. But for those who have children with developmental disabilities, it can be terrifying as well.

Kathy Keeley

Kathy Keeley

From a young age, children with developmental disabilities have been cared for during the day in school, learning life and social skills. When high school ends, as it must by age 22, these young people often return to their homes and struggle to organize their days and plan for their future.

This is a time of angst, stress and high emotion for parents as they realize they no longer have the school safety net to help them. Fully 87 percent of individuals with developmental disabilities are unemployed. The high cost of care for day programs, caregivers or aides and the lack of any income for this population exacerbate an already difficult situation.

All too often, parents we deal with either quit their own jobs or get fired as a result of having to care for their adult child. That creates a double impact on the financial stability of the family.

The state gives waivers covering services to support individuals who want to live with their families or in other community living situations, but the waiting list is currently years long. As of this spring, there are more than 7,000 Georgians who have applied and are waiting for assistance. We expect that number to continue to climb.

We are one of several organizations that are working to create more opportunities and resources to help parents transition their teenagers and young adults out of high school. It is recommended that parents begin making a plan for their child’s transition as early as fourth grade, but no later than ninth grade. Most find they spend five or six years figuring it all out.

Those who wait until the child is 17 or 18 waste many years and much money finding a plan of care for their child. In some cases, all the social development the child learned in school is gone after many years of isolation and lack of socialization.

We recommend a focus on five specific areas for transition: independent living, post-secondary education, employment, social engagement and health care.

Independent Living – One of the important considerations for parents is to plan for independent living. Most young adults hope to live independent of their parents and students with disabilities are no exception.

Post-Secondary Education – Many students want to further their education, but while post-secondary opportunities are increasing in Georgia they still are very limited. Many jobs now require additional training or various types of degrees or educational certificates. Parents may consider and investigate post-secondary opportunities for their child.

Employment – Supported employment refers to the well-defined approach to helping people with disabilities participate in the competitive labor market. Individuals are matched with well-fitting jobs in their communities and supported with any needed coaching to ensure their success and the satisfaction of the employer. This process would be made easier if more employers offered internships to individuals with developmental disabilities during their later high school years.

Social Engagement – Dating, relationships, marriage and community participation are important, and all take more effort after school. Social engagement is an important part of having a quality life, but it means many different things to different people.

Health Care – Young adults often must transition within the health care system. There are different issues, resources and services needed as individuals become adults. Health care can mean leaving a pediatrician and moving to a different medical provider. Some people with developmental disabilities may face new health issues as they age, while others may see previous health problems improve.

Georgia ranks 49th in the nation in funding for programs and services for people with developmental disabilities. Our state relies on a disjointed system of services and support that cannot be sustained in the long term. We must encourage our elected officials to increase the funding to meet the needs of young people with developmental disabilities.

 

All About Developmental Disabilities (AADD) is an Atlanta-based nonprofit organization dedicated to creating lifelong support, education and opportunities for children, adults and families living with developmental disabilities. For more information, go to www.AADD.org or call us at (404) 881-9777.

Kathy Keeley is the executive director of All About Developmental Disabilities.

People with developmental disabilities need more job opportunities

Finding a job is often a challenge, but for people with developmental disabilities it is often nearly impossible.

Kathy Keeley

Kathy Keeley

Georgians with disabilities such as autism, Down syndrome, or cerebral palsy have experienced how society focuses on their limitations instead of their strengths. The overall unemployment rate in the U.S. hovers at 7 percent, but it’s closer to 80 percent for people with developmental disabilities (severe, lifelong disabilities that limit critical life functions).

Currently, Georgia’s Department of Behavioral Health and Developmental Disabilities (DBHDD) has authorized just $7.4 million for supported employment services, but the need is many times that amount.

A coalition of advocacy groups is asking the General Assembly to support an appropriation of state funds in the fiscal year 2015 DBHDD budget for a program to provide supported employment services to help students with developmental disabilities. The program would help young people who are finishing high school in 2014 find and keep good jobs in the regular workplace.

The coalition is grateful that the state House added $250,000 for this program, and now the Senate has increased that to appropriate $500,000 to fund supported employment services for Georgia students. It is critical to keep that money in the budget during conference committee deliberations and as the budget is sent to the governor.

For 40 years, children with developmental disabilities have been mainstreamed in the classroom, but once they graduate from high school, most are not transitioned into the workforce. Georgia lags far behind the rest of the nation in helping people with disabilities find gainful employment.

Many employers allow misinformation and preconceptions about developmental disabilities to pose obstacles to hiring. They worry that such employees will not be able to keep up with the pace of work or that customers will disapprove of the employees. Yet in fact the opposite is true: Studies have shown the benefits of hiring people with developmental disabilities.

“Supported employment” is an answer to those challenges. It provides an individualized approach to match individuals with developmental disabilities with employment opportunities in typical workplaces in the community. It also provides the needed follow-up support and job coaching to keep workers successful and employers well satisfied.

The goal is to have people with developmental disabilities working alongside people without disabilities, earning minimum wage or above. The economic return to the state from investing in supported employment programs exceeds $1.61 for every $1 spent.

Beyond that, the return to the workers and their families is incalculable. Without this program, these students would likely finish high school, only to return home and sit on the couch, waiting until they qualify for a Medicaid waiver to pay for support services. With a waiting list that has ballooned to 7,000 people in the last three years, they can wait for years.

Georgia employers have experienced the benefits of hard-working, reliable, committed and caring workers who can outperform their non-disabled peers. Publix, Walgreens, The Home Depot, the Georgia Aquarium, PF Chang’s, Kroger, and Hamilton Health Care in Dalton can testify to the strengths and abilities of these workers and the value of supported employment services.

Lower turnover, lower absenteeism rates, strong job loyalty, increased employee morale, and enhanced corporate image are just a few of the benefits that accrue when employers hire people with disabilities.

By giving unconventional employees an opportunity to prove themselves, Georgia employers have already begun to demonstrate that this group of motivated workers has untapped potential. By focusing on their abilities, not their disabilities, we can promote workplace success and improve the lives of many individuals.

As a community, we need to work together to make sure opportunities exist for all. We need this funding to provide necessary job development and job coaching so that people with developmental disabilities can experience what many of us take for granted — the satisfaction and economic security that only a job can provide.

 

Kathy Keeley is executive director of All About Developmental Disabilities

Fix the primary care shortage before it’s a crisis

Georgia’s primary care physician shortage is dire and only getting worse.

The state has only 200 physicians for every 100,000 people. That ratio makes it 39th in the nation. (Some states have ratios as high as 350 per 100,000.)

Denise Kornegay

Denise Kornegay

This shortage is a direct result of the Congressional Balanced Budget Act of 1997, which froze Medicare-funded graduate medical education residency numbers and locations across the country.

Since that time, Georgia’s population has grown nearly 77 percent, while national population growth was 36 percent, and several Northern states showed only minimal population growth or none at all.

So even as our state population surges, our Medicare-funded slots remain capped at 20.8 residents per 100,000 population, which cripples our efforts to produce more primary care physicians.

Our shortage is such that Georgia would need 1,450 additional residency positions to match the national average and 315 additional residency positions to match the Southeast average.

It is critically important that aggressive action be taken sooner rather than later to retain and expand our primary care workforce. To that end, the Georgia Statewide Area Health Education Center’s (AHEC) Primary Care Summit has been held annually since 2008 and brings together more than 200 stakeholders from around Georgia.

Matt Caseman

Matt Caseman

The focus of the summit is to determine the best and most practical recommendations to address Georgia’s primary care shortage across all phases of the medical education pipeline. Through the efforts and hard work of participants, an ambitious agenda has been developed for the 2014 legislative session.

Although Georgia is known for having five great medical schools with many talented students, the state is too often not retaining these individuals once they graduate. They wind up working as doctors in other states.

Research indicates that medical professionals tend to stay within 30 to 60 miles of where they received most of their training. But many Georgia medical school graduates are not choosing to complete their residency training here. In 2011, only 15.8 percent of Georgia’s first-year residency slots were filled by Georgia medical school graduates.

The 2013 Primary Care Summit recommendations address challenges in educating our existing medical students by advocating tax credits for primary care community-based faculty members who host 3rd- and 4th-year Georgia medical students, physician assistant students, and nurse practitioner students in their practices for required training.

It is imperative that the training of these students be secured in communities across the state, as these three disciplines form the core primary care workforce. Estimates show such a tax credit would cause a minuscule loss  of revenue to the state, but would have a major impact on the primary care workforce available to our rural citizens. Additionally, funding for student housing and travel must be increased to reflect the significant growth in our medical school enrollments.

We also must significantly increase the total number of Georgia Graduate Medical Education slots in primary care disciplines. We, therefore, strongly support the Board of Regents request for $3.2 million in new funds for the creation of new residency slots in Georgia, with a goal of funding an eventual 400 new residency slots in the state. These slots must be supported financially, and recruitment for all residency programs in the state needs to be heightened, if we are to retain Georgia medical school graduates.

We must also increase both the number and total monetary amount of loan forgiveness awards available through the Georgia Board for Physician Workforce. This board has submitted budget requests to the governor to allow for such increases in these critical awards. Loan forgiveness is offered to those who complete Georgia residency programs and are willing to work in smaller communities in Georgia. The funds go toward covering their educational loan debts on a year-by-year basis.
This is a vital recruitment and retention tool to keep physicians in the state.

While the recommendations from the Primary Care Summit focus largely on state-level solutions, there is recognition that Georgia’s U.S. congressional delegation needs to push for action at the federal level.

The national cap on residency slots must be expanded and adjusted to allow states with significant population growth the ability to open new slots. Payment differentials between primary care disciplines and specialty practices must be addressed to incentivize medical students to choose primary care. And the medical education debt (estimated to be $200,000 per student by 2015) must be addressed.

Studies show rural Georgians are less healthy than those living in urban areas. They are more likely to have insufficient insurance or none at all. There’s more diabetes, obesity, heart disease and cancer among rural populations, and people living in the countryside are more likely than those living in the city to die in traumatic accidents. Primary care providers are desperately needed to increase the quality of life and longevity of rural and medically underserved populations.

With the implementation of the Affordable Care Act, more Georgians are going to have financial access to health care through programs that expand insurance coverage. However, if there are no physicians practicing in our rural communities, many of these people will have no real, physical access to the care they have signed up for. We have 159 counties in our state. Of these, 6 are currently without a family physician, 31 are without a general internist, 63 are without a pediatrician, 79 are without an OB/GYN, and 66 are without a general surgeon.

With increasing financial access adding to the numbers seeking health care, our already thin primary care workforce will be stretched well beyond its limited capacity, unless there is immediate and dramatic action. Next year is too late. Actions must be taken immediately and aggressively pursued if Georgia is going to have the workforce it needs to provide for its citizens now and in the near future.

Denise Kornegay is the executive director of the Statewide Area Health Education Network, an associate professor of Family Medicine at Medical College of Georgia / Georgia Regents University, and immediate past president of the Georgia Rural Health Association.

Matt Caseman is the executive director of the Georgia Rural Health Association.

Don’t fall for ‘Patients’ Compensation Act’

Dr. William E. Silver

Dr. William E. Silver

As the president of the Medical Association of Georgia (MAG), I get a chance to hear from physicians in every specialty and practice setting in the state on a daily basis.

I consequently believe that I’m qualified to state with confidence that the vast majority of our physicians agree that we need to continue to look for responsible and sustainable ways to improve Georgia’s tort system so they can spend more time with their patients – delivering what I believe is the best medical care in the world.

Yet I also know with certainty that the “Patients’ Compensation Act” (S.B. 141) that is under consideration by lawmakers in Georgia is a losing and unsustainable proposition.

It’s no surprise that with just three abstentions, MAG’s Board of Directors unanimously rejected this medical malpractice administrative tort system concept – which has no proven track record in the U.S. – at a meeting in early 2013.

At that meeting, S.B. 141 advocates told MAG’s board that the legislation would solve their problems because it would “lower premiums and save tax dollars and pay injured patients quicker.”

But having studied the concept in great depth and detail for more than a year, MAG knew that S.B. 141 was nothing more than a new tax – one that would be levied on physicians and hospitals (in the form of a “bed tax”) and other health care providers.

MAG determined that S.B. 141 would . . .

** Increase the number of claims that are filed

** Increase costs for physicians and other health care providers

** Repeal the remaining provisions of the tort reform bill (S.B. 3) that passed in Georgia in 2005, which has proved to be instrumental in creating a better medical practice environment in the state – an important consideration when it comes to ensuring that the state has enough physicians

MAG also learned that a study that Aon Risk Solutions conducted for the Patients for Fair Compensation organization projected that S.B. 141 would result in a 1,700 percent increase in claims for insignificant injuries like lacerations, bruises, minor scars, and rashes.

And MAG became even more convinced that the S.B. 141 model would fail when lawyer Mike Bowers, a former Georgia attorney general, determined that it would be ruled unconstitutional by the Georgia Supreme Court.

Finally, it is worth pointing out that other state medical societies have joined MAG in opposing this flawed bill.

As the leading voice for the medical profession in Georgia for 164 years, MAG will indeed continue to look for responsible and sustainable ways to improve Georgia’s tort system. Unfortunately, S.B. 141 is neither responsible or sustainable.

Dr. Silver is the president of the Medical Association of Georgia, which has nearly 7,500 physician members who represent every specialty and practice setting in the state.

 

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