But what many of their parents and grandparents don’t realize is that adults need immunizations as well. And the adults lag far behind the kids in getting the shots that they need.

A bill currently pending in the Georgia Legislature (SB 85) – which would permit pharmacists to administer some immunizations that are currently off-limits to them – might help rectify the situation.

Pharmacists are already authorized to give flu shots, so simply adding additional vaccines to the list should not be a problem.The Centers for Disease Control recommends that all adults have a “Tdap” shot, which combines the vaccines for tetanus, diphtheria and pertussis (whooping cough); that people over 60 have a shingles shot; and that those over 65 have a pneumococcus shot.

But in the most recent survey, fewer than two-thirds of adults had received a Tdap or a pneumococcus immunization, and fewer than 20 percent had received a shingles immunization. Rates are lower among African-Americans and Hispanics than among whites.

Adults with chronic conditions, such as diabetes, heart disease or HIV infection, may need additional immunizations, or the routine immunizations at an earlier age. And the CDC recommends a flu shot every year for everybody over 6 months old.

Teenagers need immunizations as well, including Tdap but also vaccinations that protect against pneumonia, meningitis and human papillomavirus (the virus that causes cancer of the cervix). However, teens are no more up to date than adults, and in Georgia they lag behind the national average.

One of the consequences is that we are suffering through a national whooping cough epidemic, with tens of thousands of cases reported since 2005. The disease is generally less severe in adults than in children, but adults can transmit the disease to children. Whooping cough is particularly severe in infants, in whom it can cause death.

Even if the bill becomes law, older adults and the parents of teens will need to be more conscientious about getting the shots they need – if not from a pharmacist or a private physician, then through the public health department, where immunizations are available at low cost. It is time for us adults to start acting like grown-ups!

Dr. Daniel S. Blumenthal is associate dean of Community Health at the Morehouse School of Medicine, works closely with the Centers for Disease Control and Prevention, and is a leading national expert on immunizations, and the racial, ethnic, and socioeconomic disparities in vaccination rates

By Dr. Daniel Blumenthal for Georgia Health News, 2013. | Permalink | One comment |

Unfortunately, this comes at a time when the agencies that fund cancer research face dire cutbacks.

Because Congress must make difficult decisions on what to cut, I went to Washington this week to speak to a committee of lawmakers about the relationship of the National Institutes of Health (NIH) to our nation’s cancer centers.

I felt it was important to offer tangible proof of the great strides that have been made in treating cancer because of NIH-funded research.

As the executive director of the Winship Cancer Institute of Emory University, and as a practicing radiation oncologist and cancer researcher, I see cancer patients every day. And I’ve seen how budget cuts are already slowing down the progress toward finding new cancer treatments that change a patient’s chances of beating the disease.

In Washington, I spoke on behalf of the Association of American Cancer Institutes, addressing members of the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies. The chairman of that subcommittee is Rep. Jack Kingston (R-Ga.), who’s from Savannah.

Rep. Kingston visited Winship in January 2012 and took away a new understanding of how research at a cancer institute translates directly into patient care. I urged other committee members to visit the cancer centers in their districts to see the outstanding work being done there.

The National Cancer Institute (NCI) is one of the NIH’s institutes. NCI awards its designation to cancer centers that demonstrate expertise in laboratory, clinical, and behavioral and population-based cancer research through successful competition for a Cancer Center Support Grant (CCSG). Winship first received NCI designation in 2009. It recently renewed its designation and CCSG through a competitive process, receiving a rating of “Outstanding” by a peer panel.

Winship is the first and only NCI-designated cancer center in Georgia.

While Congress continues to debate the remainder of the fiscal 2013 budget, NIH and NCI have prepared for cuts through fiscal 2021.

NIH will suffer a cut of $1.6 billion overall, with NCI losing approximately $250 million. These cuts will have a real impact on progress against cancer at Winship and other cancer centers. Continued progress in cancer research is dependent on the sustained efforts of highly skilled research teams at cancer centers across the country, supported by the NCI.

So much promise imperiled

A budget cut to NIH and ultimately NCI will decrease funding to cancer research in all parts of the country and affect many of the research teams working on new treatments and new cures. Rebuilding such teams, even after a short break in funding, could take years.

As an example, Winship has an outstanding research team making real progress understanding how to target newly discovered mutations causing lung cancer, the type of cancer causing the most deaths in our country.

We are seeing an increase in the number of lung cancer patients who have little or no history of tobacco use, and we are just beginning to understand the genetic risk factors of such individuals for developing lung cancer. A break in funding support of this and other projects could delay finding new and effective therapies for thousands of patients by years.

Our nation’s cancer patients deserve greater research attention to this deadly disease. More than 1.6 million Americans were diagnosed with cancer in 2012, with more than 570,000 people dying from the disease.

With 25 percent of all deaths in America caused by cancer — almost 1,600 per day — the disease is the nation’s second-leading cause of death. NCI estimates that 41 percent of individuals born today will receive a cancer diagnosis at some point in their lives.

But research has brought us to the point where we have better tools for treating cancer than ever before. At Emory’s Winship Cancer Institute, we are excited about the new proton beam therapy facility under construction in Atlanta, as well as the increasing number of our patients being enrolled in cancer clinical trials.

We also offer promising new therapies to patients in our specialized “Phase I” unit, which allows us to carefully study all the beneficial and any harmful effects of these therapies. We have offered such groundbreaking Phase I treatments to nearly 200 Winship patients per year.

We see that the impact of budget cuts through fiscal 2021 has already begun to affect our progress in research. Immediate effects will be felt in our research labs, with promising research slowed or even shut down; pending projects wiped off the boards; the next generation of bright young researchers unable to learn cancer research at the side of experts; and layoffs among trained cancer staffers, including those who coordinate clinical trials that test new cancer therapies.

At Winship, we enrolled more than 700 cancer patients, from all across the state of Georgia and beyond, in trials testing new treatments in 2012. We aspire to increase the number of cancer patients whom we can offer such hope, but we need sustained support to achieve this.

Cuts dangerous for economy

In addition to cancer centers, the NCI supports cancer research in communities all across America through the National Clinical Trials Network and its newly reorganized five cancer cooperative groups.

Twenty thousand to 25,000 patients participate in these network trials each year, and this research has defined many of the best treatments for today’s and tomorrow’s cancer victims. This research is well coordinated with our cancer centers and is necessary for outreach beyond our research universities into community medical practices, and for finding answers to some of the toughest cancer research questions as quickly as possible.

It is through this network that patients in such locations as southeastern Georgia are able to enroll in cancer clinical trials with their community oncologists.

Unfortunately, NCI support for these cancer cooperative groups has remained flat for more than a decade. Sustaining this support is critical to providing cancer patients the best access to the outstanding cancer care available through their participation in NCI-supported clinical trials.

NIH plays a vital role in our cancer centers’ research and also affects our nation’s overall economy. A United for Medical Research analysis released in January of 2013 projected the nation’s life sciences sector, which includes cancer research, would lose more than 20,500 jobs and $3 billion in economic output due to cuts to NIH.

These serious consequences for biomedical jobs and local economies mean that funding cuts will undermine U.S. competitiveness, at a time when other nations are aggressively boosting their investments in research and development.

We risk driving an entire generation of young cancer physicians and researchers out of the country — to practice their craft and advance their careers abroad — or out of the field altogether. At Winship, this threat is real, and we cannot afford to experience such loss. Such declines in funding will prevent Winship and other centers from quickly moving to a broader platform of personalized cancer care and research.

This personalized approach requires a time- and resource-intensive approach to every patients’ cancer to understand the very best plan for each patient’s care. This effort is well under way at Winship and other centers and will require a sustained and significant level of support to yield the positive results that we expect.

NIH’s full support of NCI-designated centers and their programs remains a top priority for our nation’s cancer centers. We are on a clear path to dramatic breakthroughs, both at Winship and at cancer centers throughout the country.

We have come too far in cancer research progress to lose Congress’ full support of NIH, and ultimately, NIH’s funding of NCI-designated cancer centers and the National Clinical Trials Network. Cancer patients and their families deserve the best that NIH, NCI and our cancer centers have to offer in order to provide lifesaving treatment.

Dr. Walter Curran is executive director of the Winship Cancer Institute of Emory University, the Lawrence Davis Professor and chairman of Emory’s Department of Radiation Oncology, and a practicing radiation oncologist.

By Dr. Walter Curran for Georgia Health News, 2013. | Permalink | One comment |

Charles Hayslett

The recent closing of Calhoun Memorial Hospital in tiny Arlington, Ga., comes not just as another body blow to health and health care in impoverished areas of rural Georgia — but as a dagger to the heart of hopes for any kind of economic development or improvement. It also adds more weight to an anchor that already holds down the entire state’s economy.

As it happens, news of the Calhoun Memorial closing came as the Partner Up! for Public Health campaign was finalizing research and analysis on health and economic disparities in Georgia — research that had documented that Calhoun County was part of a cluster of counties in southwest Georgia that constitutes the least healthy region of the state.

Of 156 Georgia counties ranked by the University of Wisconsin in its annual County Health Rankings (three are too small to rank), Calhoun County ranked 154th for Health Outcomes. Its neighboring counties fared little better: Randolph ranked 147th, Quitman 149th,
Early 150th, Stewart 153rd, and Terrell 155th. Only Clay County escaped the Bottom Ten, coming in at 100th.

The underlying data are just as startling. The premature death rate for the seven-county region is nearly 14 percent worse than that of Mississippi, the state that ranks worst in the nation. It’s also 130 percent worse than the premature death rate in the healthiest area of Georgia, the five-county region of north metro Atlanta made up of Forsyth County (2nd in the Wisconsin report’s ranking of Health Outcomes), Cherokee (4th), Gwinnett (5th), Cobb (6th) and Hall (9th).

And while Calhoun County and its neighbors suffer with a premature death rate worse than the worst in the country, the north metro area boasts a rate better than the best-ranked state, Minnesota.

If that doesn’t tell you all you need to know about health disparities in Georgia, consider this: The low-birthweight rate in the southwest Georgia cluster is 14.3 percent versus 7.6 in the north metro area; the adult obesity rate is 34.2 percent versus 25.13 percent, and the teen birth rate is 76 births per 1,000 women aged 15-19 in southwest Georgia compared to 39 in the north metro counties.

All these conditions come with massive costs in health care, social services and lost opportunities. If all those costs were confined to southwest Georgia, the rest of the state might be able to dismiss the problem as simply a localized tragedy.

It is not. Those costs are — to use a dirty word — effectively “socialized” in a variety of ways: higher Medicaid expenditures for citizens of those counties, and higher state job tax credits that go to employers in poor counties, among others. Like it or not, the north metro Atlanta counties are stuck with a share of southwest Georgia’s tab.

This is not an appeal to spend less on Calhoun County and its sick and impoverished neighbors in southwest Georgia, let alone send a message that they’re on their own. Short of sawing the state in half at the “gnat line” and quit-claiming South Georgia to Florida, there exists a shared interest in continuing efforts to build the economy in that area.

We at Partner Up! for Public Health have long argued that people’s relatively poor health status and poor access to health services in rural Georgia constitute a major strategic threat to the economic prosperity of the entire state. We have also argued that state government needs, on some meaningful level, to integrate its health planning and economic development efforts (and, for that matter, education). Currently it does not.

This is not a new or radical idea. As far back as 1970, gubernatorial candidate Jimmy Carter talked about the importance of improving access to health care in rural areas as a prerequisite for economic growth. (As president a few years later, he sought and won passage of the Rural Health Clinic Services Act of 1977, which expanded access to care in rural areas nationally.)

As recently as 2004, Gov. Sonny Perdue’s Commission for a New Georgia produced a report that identified health care (along with education) as a fundamental building block for economic development. In an email exchange with me several months ago, the chairman of the task force that produced that report, David C. Garrett III, said he had told audiences at the time that “economic development in the absence of quality health care was an illusion.”

That was true in Carter’s day and in Perdue’s, and it’s true now. Just ask the folks in Calhoun County.

Charles Hayslett, CEO of Hayslett Group LLC, a public relations firm, is manager of Partner Up! for Public Health, funded by Healthcare Georgia Foundation.

By Charles Hayslett for Georgia Health News, 2013. | Permalink | 3 comments |

Suzanne Newkirk

Looking at the lush greenery of the Georgia mountains or the enticing beaches and barrier islands along the Georgia coast, few people would describe the state as a desert, except for the thousands of Georgians who lack dental insurance or funds for basic preventive dental care.

The U.S. Department of Health and Human Services (HHS) defines a ”dental desert” as an area with a shortage of dental health professionals. As of 2011,  there were 49 million Americans living in dental deserts. According to HHS, it would take nearly 10,000 additional dental practitioners to meet the current needs of these Americans.

Georgia ranks among the top 10 states both in current population and rate of population growth. But with just one dental school, Georgia is ranked 46th among states for its number of dentists per capita. This means that too many people in Georgia don’t have access to dental care.

Regrettably, the Georgia Dental Association (GDA) denies there is a shortage of dentists in the state, despite the number of uninsured and low-income Georgians who seek emergency dental care at hospitals. Statewide in 2009, the 60,000 emergency dental visits cost taxpayers $25 million.

Lynne Slim

Administering dental care in an emergency room is prohibitively expensive and inefficient. And it doesn’t solve long-term dental problems . . . problems that are preventable.

Dental caries remains the single most common, chronic disease of childhood. When left untreated, caries (commonly referred to as cavities or tooth decay) results in pain, infection, distraction from learning, missed school days and sometimes an inhibition of general growth and development because of associated nutritional liabilities. Severe abscesses, caused by untreated decay, send many Georgians to emergency rooms.

Periodontal disease (which affects tissues around the teeth) is primarily a disease of adulthood – typically established during adolescence and continuing throughout life. It is the most common cause of adult tooth loss.

Low-income Georgians know only too well the impact these untreated diseases have on one’s overall health, speech, appearance and self-esteem.

Lack of access to dental care has become a national crisis. Thirty-five states now allow dental hygienists to provide care directly to patients; 15 permit direct Medicaid reimbursement from the state to dental hygiene providers. Forty-four states allow general supervision, meaning dental hygienists can provide care without the direct supervision of a dentist.

Because oral diseases are mostly preventable, many states are adjusting their rules to allow hygienists to provide services in nontraditional dental settings, such as clinics, nursing homes, hospitals, and facilities that treat people with developmental disabilities. But Georgia is not one of these states.

A former Georgia public health director said the state’s current rules governing hygienists “are among the most stringent in the nation.’’ This is bad news for low-income adults in Georgia because there are no viable government programs for adults. Unless low-income adults are lucky enough to find a dentist who accepts Medicaid for an emergency visit only — or are unlucky enough to be behind bars — they generally do without dental care.

In January 2010, the GDA voted to establish the Georgia Mission of Mercy, a two-day dental clinic to provide free access to dental care for about 2,000 adults unable to pay for treatment. This effort took 15 months of planning and involved 1,400 volunteers, including 300 dentists and 150 hygienists.

In August 2011, the event took place, with the first patient in line arriving 17 hours early. By early morning, thousands of people created a line 2,000 yards long. The two-day event provided $1.7 million in free dental care to 2,179 Georgians suffering from oral disease and pain. Along with providing dental care, the project’s goal was to educate patients and family members about the importance of dental hygiene.

While the GDA professes the importance of dental hygiene education, it fiercely restricts people’s access to dental hygienists.

It is estimated that by 2014, under the Affordable Care Act, 5.3 million more children will be entitled to dental benefits from Medicaid and the Children’s Health Insurance Program. Unfortunately, Georgia Gov. Nathan Deal has said he will not expand the Medicaid program under the ACA, even though the federal government has promised to pay 100 percent of the cost for the first three years and 90 percent thereafter.

Expanding the state-based health insurance program for poor Georgians in 2014 would provide health coverage for approximately 650,000 low-income people. About 20 percent of Georgians do not have health insurance, making Georgia one of the leaders in states with the most uninsured residents.

In July 2012 in Atlanta, dental providers, researchers, legislative leaders and health professionals gathered at a regional oral health conference sponsored by Morehouse School of Medicine, to focus on Georgia’s dental deficits and explore opportunities to improve access to oral health care.

Dr. David Satcher, a former U.S. surgeon general, and Dr. Louis Sullivan, a former U.S. secretary of health and human services, expressed support for the idea of dental therapists providing care in underserved communities.

Although Minnesota is currently the only state to license dental therapists, 20 states are actively exploring this innovative approach to expanding oral health care.

The American Dental Association (ADA) and its state dental associations vehemently oppose the creation of midlevel dental providers as a solution to the problem, denying there is a shortage of dentists. These groups usually win the legislative battles, but it’s the general public that loses out.

Of the 6,787 licensed dental hygienists in Georgia, many are unemployed due to an oversaturated market. And the state’s restrictive rules make it illegal for dental hygienists to provide services to the public without the direct supervision of a dentist, thus making dental care for low-income people even more cost-prohibitive.

A combined, consistent effort is urgently needed in Georgia to improve oral health care. If policymakers were to adopt legislation similar to that of Massachusetts, Georgia’s licensed dental hygienists could increase access to care for the poor and help lower the cost of preventable emergency dental visits, thus saving the state’s taxpayers millions of dollars, and expand employment for an existing workforce of licensed professionals.

Although the Georgia Dental Association asserts there is no lack of dentists in the state and continues to restrict hygienists’ ability to assist thousands of low-income people, eventually consumer advocates and oral health coalitions will persuade policymakers to make changes for the good of the public.

Until then, the dental forecast for Georgia is expected to stay hot and dry.

Suzanne Newkirk has been a dental hygienist for more than 30 years. She is is a periodontal therapist, dental hygiene coach and mentor, perioscopy instructor and national speaker. Ms. Newkirk is a member of the American Dental Hygienists’ Association, Georgia State Dental Hygienists’ Association and moderates the Perioscopy Users Forum on LinkedIn. www.perioscopyprofessionals.com

Lynne Slim is the periodontal therapy columnist for RDH magazine and an award-winning dental author who has published extensively in dental/dental hygiene journals. In 2003, she founded Perio C Dent, a dental practice management company that specializes in the incorporation of non-surgical periodontal therapy into the hygiene department of the general dental practice. She coaches dental hygienists and dentists in ultrasonic instrumentation and other advanced hygiene initiatives. She is owner and moderator of the periotherapist yahoo group: www.yahoogroups.com/group/periotherapist.

By Suzanne Newkirk and Lynne Slim for Georgia Health News, 2013. | Permalink | 2 comments |

Peter Canfield

In the late 1980s, total health care fraud recoveries from whistleblower lawsuits averaged $5 million to $10 million a year.

Last year, the U.S. Department of Justice recovered a record $3.06 billion in health care fraud settlements and judgments — more than 80 percent of it in suits initiated by whistleblowers.

That says two things: Health care fraud is booming, but so is the power of its most effective opponent, the whistleblower.

In 1986, Congress rejuvenated the Civil War-era False Claims Act by permitting citizens with knowledge of fraud involving Medicare, Medicaid and other government programs to not only sue on behalf of the government but to be compensated for their part in fighting fraud with a portion of the funds recovered, typically 15 percent to 25 percent.

In the years since, the whistleblower has become the single most effective weapon in the fight against health care fraud.

Today, beyond the billions of dollars actually recovered each year in judgments and settlements, there is anecdotal evidence that just the potential threat of whistleblower lawsuits is saving billions more by encouraging pharmaceutical, medical device and other health care corporations to change their corporate culture and police themselves.

Whistleblower success has been met by efforts in the courts to whittle back whistleblower power. However, a rare bipartisan coalition in Congress has consistently rebuffed these efforts.

Major changes to the False Claims Act were enacted in 2009, expanding liability and making it easier to conduct investigations and win recoveries.  These changes were primarily intended to combat fraud in the nation’s financial markets but were made applicable across the board, including health care fraud cases.

Additional changes to facilitate whistleblower actions were made in 2010, in the Dodd-Frank Wall Street Reform and Consumer Protection Act, and, with specific attention to fraud in the health care industry, as part of the Patient Protection and Affordable Care Act.

Strengthening the federal power of whistleblowers has been accompanied by enactment of potent whistleblower statutes at the state level.  For many years, Georgia had a weak whistleblower law directed at Medicaid fraud.  Last year, with prodding from federal officials, the Georgia Legislature significantly encouraged whistleblower actions directed at fraud of all sorts at the state and local governmental level by enacting the Georgia Taxpayer Protection False Claims Act.

Blowing the whistle on health care fraud is not easy or trouble-free. A mere tip is not enough. A successful whistleblower case requires evidence, preferably documents. And although federal whistleblower cases are initially filed under seal, the whistleblower’s identity will eventually become known. Once that happens, the whistleblower often becomes a target, facing isolation, humiliation and loss of employment.

Federal and state whistleblower laws do offer special protection to the whistleblower, but it can be a long time coming, as whistleblower cases typically take years until resolution.

Yet, people with the stamina and courage to be whistleblowers continue to step forward. A 2010 study published by the New England Journal of Medicine on health care fraud whistleblowers suggested they are driven to do the right thing. Often, they have tried to fix the problem from the inside and failed.

The study revealed four common motivators: justice, public safety, integrity and self-preservation. Not one of the whistleblowers  interviewed for the study said financial reward was a primary driver for their action.

As one of the whistleblowers interviewed said in describing motivation, “It’s not an act of heroism. It’s not an act of bravery. It’s an act of responsibility.”

That said, the law is now framed so that when the fraud is substantial and the recovery is large, the whistleblower can also receive a substantial percentage of the recovery as reward for his or her involvement in stopping the fraud.

Because the process is usually long and difficult, potential whistleblowers on health care fraud are advised to be careful and deliberate before starting the process. A whistleblower is not required to have a lawyer to proceed, but having one is a good idea.  There are pitfalls to avoid and important requirements to follow, including restrictions on public disclosure if you wish to remain eligible for an award.

It’s advisable early on to talk with a lawyer who knows how to bring a False Claims Act case and can explain what’s at stake in doing so. That discussion should be without charge. False Claims Act lawyers work on contingency, which means their success is dependent upon your success.

Peter Canfield is a partner at Dow Lohnes PLLC in Atlanta whose practice has focused on protecting the constitutional rights of his clients, including the  reporters, authors, newspapers, broadcasters and other media organizations involved in exposing wrongdoing by and against the government. He has also served as a federal prosecutor and as a deputy district attorney.

For more information, visit whistleblowerprotection.com.

By Peter Canfield for Georgia Health News, 2013. | Permalink | 3 comments |

Ellyn Jeager

Our nation is now engaged in a discussion about what to do in the wake of recent mass shootings. I believe such a discussion is essential to the overall well-being of our country.

Part of this national conversation is about legislating more gun control. But the current emphasis of the discussions, in many instances, is about legislating control of people with mental health conditions. I believe this is a bad idea.

While those of us in the mental health profession agree that more resources need to be allocated for mental health, it is imperative to understand that violence and mental health issues are two different subjects. What needs to be done to prevent violence should not, therefore, be linked to national databases of people with mental illnesses.

A database containing the names of people with mental illnesses would be impractical, stigmatizing and ineffective. There is no evidence that such a database would effectively control or limit violent behavior. People with mental health conditions are no more likely than others to commit homicides or other violent acts. Most violent crimes are committed by people who do not have a mental illness.

Would the various legislative bodies consider a database of every American citizen who might potentially commit a violent act? The Orwellian universe this suggests should horrify all of us. Why, then, should those with mental illnesses be subject to such gross violations of civil rights?

While a small number of people with untreated mental health conditions, particularly those with co-occurring and active substance abuse problems, pose a higher risk of harm to themselves or others, there is no known way of identifying which persons in this group will commit violent acts in the reasonably foreseeable future.

Additionally, individuals in this group who are most at risk of harming themselves or others are not connected to evidence-based treatment, and therefore are not connected to the treatment staff who are best equipped to make an assessment of their risk or harm.

Only people connected to a treatment system would be included in such a database. This would violate medical privacy and would have the effect of scaring people away from needed treatment. Confidentiality is essential to effective treatment and recovery.

More involuntary treatment, however, is not the answer. There is no reliable way to identify particular individuals who might harm others. We would be required to confine very large numbers of people with mental health conditions in order to achieve even a modest reduction in the risk posed.

Failure to engage people with serious mental illnesses is a service problem, not a legal one. Outpatient commitment is not a quick fix that can overcome the inadequacies of under-resourced and underperforming mental health systems. Coercion, even with judicial sanction, is not a substitute for quality services.

The problem with our mental health system is not that we fail to hospitalize people with acute mental health conditions. Rather, it is that we fail to take reasonable steps to prevent those conditions from occurring. Risk and resiliency factors are well understood, and the science behind them should be applied to our country’s public health efforts.

What we need is adequately resourced and recovery-based community care. The most effective way to reduce the risk of harm that can be posed by some people with mental health conditions is to make a comprehensive array of evidence-based, recovery-oriented community mental health services available in a timely fashion to all who need them.

In addition to treatment, those services should include supported housing, supported employment, peer support services and psychotropic medications.

Because Medicaid is the largest single source of funding for mental health services in each of the 50 states, states should be encouraged to take advantage of the Affordable Care Act’s Medicaid expansion provisions. Medicaid programs should be immediately required to fully implement Early and Periodic Screening, Diagnosis and Treatment for youth. These are the easiest short-term financial solutions to our underfunded and broken mental health system.

So, yes, let us have a national discussion about the health of our nation, but let’s make sure we do not engage in magical thinking. Rather, let us engage in ideas that come out of knowledge, reason, and compassion.

Ellyn Jeager is the director of public policy and advocacy for Mental Health America of Georgia.  She has held that position for 15 years.

By Ellyn Jeager for Georgia Health News, 2013. | Permalink | 9 comments |

Ronald Bachman

Medicaid has several components, but at its core it is a health insurance program for the poor. States can differ on eligibility for the program, but most provide for those below the poverty level.

Federal health reform envisions expanding Medicaid to those earning up to 138 percent of the poverty level (about $25,000 for a family of three). The U.S. Supreme Court has ruled that each state can accept or reject the expansion. Like other states, Georgia must make its own choice.

This analysis addresses the human impact – not state financing, the national debt, or deficit spending. The key question: Is Medicaid expansion beyond the poverty level a “hand up” or a “handcuff”?

For a person in the bottom 20 percent of income, getting ahead is less likely than in other income levels in America. The Economic Mobility Project of the Pew Charitable Trusts shows 65 percent of children born in the lowest 20 percent of incomes stay in the bottom two quintiles.

If the core principle of conservatives is producing upward economic mobility, and progressives are for helping the poor, why have both ideologies failed the poorest among us? Scott Winship, a researcher at the Brookings Institution, has said, “The bottom 20 percent in the U.S. looks very different from the bottom 20 percent in other countries.” Americans are more likely than foreign peers to grow up with single mothers. In poor communities, drugs, alcohol, violence and ineffective primary and secondary schools represent a huge barrier to economic mobility. The U.S. also has uniquely high incarceration rates and a longer history of racial stratification in society.

With all those challenges, the Brookings study showed a hopeful fact: Regardless of your race or ethnic background, if you stay in school at least through high school, don’t have a child until you’re married and over 21, and work full time at any job, your chances of being poor are only 2 percent and your chances of joining the middle class are 74 percent.

More than people in other countries, poor Americans have to educate themselves and work their way up from the lower levels. The United States provides many benefits for the poor, disabled and unfortunate. No one of any rational political or ideological persuasion is opposed to helping those in need.

The key part of Medicaid is also called “Temporary Assistance for Needy Families” or TANF. Under health reform, Medicaid would be expanded to 18 million to 20 million new lives. Other health reform subsidies through exchanges are available up to 400 percent of the poverty level (about $92,000 for a family of four). Programs affecting larger percentages of the population can create an attitude of entitlement and a culture of dependency that traps large numbers of people in multi-generational poverty.

A study of entitlement programs in Colorado illuminates the concerns for Georgia and other states. Programs are available for low-income families to provide housing, food, health care, and educational and other subsidies. A single mother with two children making $25,000 could be eligible to receive about $18,000 in government benefits.

Medicaid expansion and other health reforms add new subsidies for low- and middle-income families. Using the same example of a single mother with two children, Medicaid expansion to 138 percent of the poverty level can provide an additional $7,500 in benefits to those making $25,000.

What are the effects on real people as they try to advance economically? The marginal effective tax rate from federal income taxes, payroll taxes, and state income taxes for a single mom with two children earning $25,000 is about 29.4 percent. If one includes other programs, SNAP (food stamps), state children’s health insurance programs, and the new health reform subsidies, the marginal tax rate rises to 54.5 percent. If benefits like TANF, federal housing subsidies, and WIC (nutritional program for Women, Infants, and Children) are considered, the marginal tax rate is as high as 81.9 percent, because families lose even more benefits due to higher earnings.

Who would work harder, take that extra job, or seek a promotion when most of the added earnings would be taxed away, or government benefits reduced? The destruction of initiative can be the inevitable consequence of expanding Medicaid with an additional $7,500 (for a total of over $18,000) to someone making $25,000, but providing nothing to a similar family making $75,000.

Clearly, even the most compassionate among us can see that accumulated effects of entitlement programs can break the spirit of personal responsibility and the motivation for upward mobility. Medicaid expansion and the new health reform subsidies to over 50 percent of the population are likely to produce the same dependence and economic barriers to upward mobility already evident in the lower 20 percent.

The standard of living in Georgia is directly related to its citizens’ ability to produce goods and services that others want to purchase. Subsidizing able-bodied populations does not create economic growth for those individuals or for the state. In our compassion to help those in need, we tend to look away from the politically driven expansion of those programs and the debilitating culture of dependency they enable. Georgia has apparently decided not to play that destructive game. Good for us.

As we look to the future and seek better ways to solve the problems of health care and health insurance, maybe Georgia can create an island of opportunity within a sea of growing dependency. Maybe we can remove the handcuffs of those chained to the programs and ideas of the past and offer a hand up rather than a handout.

Ronald E. Bachman is president of Healthcare Visions, an organization dedicated to lowering the number of uninsured, improving mental health coverage, and advancing the concept of health care consumerism.  Bachman is a senior fellow of the National Center for Policy Analysis, the Wye River Group on Health, and the Georgia Public Policy Foundation (GPPF).  Ron is chairman of the Editorial Advisory Board for the Institute for Healthcare Consumerism.  Bachman is also on boards for Skyland Trail, Bryan University, the Georgia Charity Care Network, HINRI Labs, and Jacobs Ladder Autism Center.

By Ronald Bachman for Georgia Health News, 2013. | Permalink | One comment |

Dr. Jacqueline Fincher

Last week, I sent a report documenting the many benefits of accepting federal dollars to expand Medicaid to Gov. Nathan Deal from the Georgia chapter of the American College of Physicians (ACP). We represent 2,676 internal medicine physician specialists and medical students.

I spoke for our patients when I asked Gov. Deal in a letter to do the right thing and accept this unprecedented opportunity to provide coverage to our poorest patients.

The five-page report I sent is called “How Will the Medicaid Expansion Benefit Georgia?” It explains why it is in the best interests of residents, physicians, hospitals and the state itself to adopt the expansion. It notes that extending Medicaid coverage will reduce the number of uninsured Georgians, most of them from working families, by as much as 42 percent.

States now have the option of expanding their Medicaid programs to all individuals with incomes up to 138 percent of the federal poverty level, which in 2012 is equal to $14,856 for an individual or $30,656 for a family of four.

The federal government will cover 100 percent of the cost of the expansion for the first three years. States will gradually assume a portion of the cost, topping out at only 10 percent of expenses starting in 2020, while the federal government will finance more than 90 percent of the expansion’s cost. Currently the federal government covers about 67 percent of Georgia’s Medicaid expenses.

The Georgia chapter of ACP believes that it is imperative that our state accept the unique opportunity that is now available to use federal dollars to expand Medicaid to the working poor and near-poor in our state.

I have many patients in my rural Thomson practice whose very lives may depend on whether Medicaid is expanded.

I think of “Mrs. Ellie,” who is now 60 years old and provides full-time care to her mentally disabled husband of 40 years, her 85-year-old mother, and a couple of grandchildren during the day.

Mrs. Ellie has not had health insurance in more than 15 years. She has multiple chronic medical problems, including high blood pressure, high cholesterol, thyroid disease, gout and anemia, and is on eight daily medications to control them. She and her husband live on his monthly Social Security disability check.

When you live below the federal poverty level and have no insurance, every dollar is already being spent on food and housing. Sometimes Mrs. Ellie can get her medications and sometimes she can’t. But if she ends up in the emergency room or requires hospitalization for want of a $10 or $20 dollar medicine, we will all pay thousands of dollars to care for her, especially the local hospital and the doctor.

I also think of “Mr. Jim.” He’s a 43-year-old married man with four children. He had a good job at a manufacturing plant here with good health insurance until two years ago, when he was laid off. His wife, who had also been working full time, was laid off a year ago.

They both found temporary jobs, working full time but at almost half the salary and no benefits. Unfortunately, Mr. Jim has insulin-dependent diabetes, high blood pressure, high cholesterol and chronic kidney disease, and has started having chest pain. He can’t afford the stress test and cardiology evaluation. My prayer is that he doesn’t have a heart attack before we can get him the help he needs.

Both of these patients would qualify for Medicaid under the expansion. These are my patients who are hardworking citizens of our state. If these patients, who are heads of households, can’t get the medical care they need and either become disabled or die, their families will then become our collective responsibility to support through the state welfare programs and nursing homes.

Some 22 percent of Georgians — nearly 2 million people — were uninsured between 2009 and 2010, according to the Kaiser Family Foundation. It is estimated that 843,000 Georgians will be eligible for Medicaid coverage, including 648,000 newly eligible recipients, under the new health reform requirements.

No matter where one stands on the Affordable Care Act itself, the evidence is clear: Georgia will benefit by accepting federal dollars to extend Medicaid, and will be harmed if it does not.

Other major findings in the report include:

* Medicaid expansion to Georgia’s low-income uninsured will improve health status, reduce preventable deaths, and enhance the quality of life.

* Medicaid expansion will help the “safety net” of physicians, hospitals and academic medical centers better serve their low-income patients and reduce cost-shifting.

* Medicaid expansion will benefit the state fiscally, with the federal government paying almost all of the costs of extending the program to more Georgians.

* Accepting federal funding to expand Medicaid will reduce the amount of uncompensated care provided by physicians and hospitals — costs that are shifted to everyone else in Georgia in the form of higher premiums and taxes.

If Georgia turns down or delays accepting this unprecedented offer of federal money to extend Medicaid, we will be leaving our poorest citizens with no other way to get coverage. The result will be poorer health outcomes for our citizens, more uncompensated care for physicians and hospitals that take care of them, more cost-shifting for the rest of us, and ultimately, higher costs to the state’s taxpayers.

Jacqueline Fincher, M.D., MACP, is the managing partner of McDuffie Medical Associates, a private practice of internal medicine in Thomson, and is the governor of the Georgia chapter of the American College of Physicians.

By Jacqueline Fincher for Georgia Health News, 2012. | Permalink | 5 comments |

Brad Alexander

Victor Moldovan

With the 2012 elections behind us, the biggest immediate policy question many Georgia businesses face is determining how to make their way forward in a health care reform landscape. That landscape appears stable in the near term, but fundamental changes are ahead.

Based on the election outcome, which ensured that the 2010 Affordable Care Act is here to stay, Georgia business owners and managers are going to be contending with three trends that have been set in motion by the health reform legislation and are unlikely to change. Those trends are elimination of high coverage plans, decentralization of health care delivery, and a focus on tying provider reimbursements more directly to outcomes.

On the first issue, health care reform simply provided a compelling reason for corporate America to take decisive action to drive down the rate of increase on spending for employee health care benefits sooner than many had planned.

Most firms have begun taking steps to use pricing, incentive and availability strategies to discourage employees from selecting so-called “gold plated” plans. Rather, employees are being pushed to select plans with high deductibles, health savings accounts, coinsurance and tools that encourage wellness. This trend has accelerated as a result of health care reform and is unlikely to stop.

Employers will have to work carefully to encourage employees to make wise health decisions in an environment where consumers are being asked to take more direct responsibility for their spending on health care. And doctors, hospitals and other providers will need to adjust their payment mix models to anticipate some reduced demand from higher-paying commercially insured patients — presuming the new system succeeds in driving down utilization.

In other words, the ability to shift costs will decline over time. That said, no one really has a good econometric model for how far down utilization may go, so leaders of medical practices will need to watch trends closely and adjust on the fly in many cases.

In the second area, decentralization of health care delivery, Medicaid policy changes will be a huge factor in what comes next. The Supreme Court decision on health care reform has given states the option of determining whether they will move forward with a major expansion of Medicaid coverage, an option states did not have under the law as it was originally passed.

An eclectic but generally Democratic-leaning group of states – located in the Northeast, in the Midwest and on the West Coast – have already accepted the Medicaid expansion. The largest of these are California and Illinois.

On the other side of the equation, six states in the South have announced their decisions to opt out of the expansion. Georgia is among the six, although our leaders have expressed some willingness to reconsider this decision if the Medicaid program is significantly redesigned to give states more flexibility in implementing it.

Combined with likely implementation of health care exchanges – that are designed to cover currently underinsured workers – these changes will likely increase use of preventative and routine care services.

The expansion of Medicaid, and the push to treat conditions in lower-cost settings, will continue to make hospital-centered delivery of health services a difficult model to sustain. In turn, larger hospitals will focus on establishing networks of clinics by purchasing medical practices and extending beyond their campuses. At the same time, physician groups that have the leadership and vision to remain independent will be able to follow the same course, expanding on their ability to deliver services in lower-cost settings.

Some of this activity will be fueled by a focus on preventive care services, which are not delivered in a centralized setting. A key sector that will feel the impact of this change is health care real estate, which will likely see less spending on centralized higher-end facilities and more spending on smaller, geographically dispersed buildings. The medical industry itself will also see changes, as smaller hospital and physician groups face enormous pressure to cut costs and consolidate.

The final trend we anticipate is a more direct link between payment for services and outcomes delivered. The debate over Medicare payments for patients who are readmitted to hospitals for the same condition represents a key front in this battle. Because it can be difficult to measure outcomes for many patients, this will be a harder piece of policy to implement. However, government and private-sector health plans are increasingly trying to do it, and we can expect to see more focus on this area over the next several years.

This focus will open up some unique opportunities for the private sector to apply technology and process management solutions to health care delivery. Whether “value-based” health care payments take hold will depend partly on the effectiveness of those solutions and partly on whether health care providers embrace the concept.

The bottom line on all of these trends is that the business of health care is going to fundamentally change over the next several years. And Georgia companies are going to be significantly impacted by that change, regardless of whether or not they are directly in the health care business.

Victor Moldovan is an attorney with over 20 years of experience working with the health care industry.  He advises companies and trade associations that operate in the health care arena and offers analysis to clients on state and federal proposed rules.

Brad Alexander is a senior vice president who leads the state government relations team in the Georgia office of McGuireWoods Consulting.  He is former chief of staff to Lt. Governor Casey Cagle.

By Brad Alexander Victor Moldovan for Georgia Health News, 2012. | Permalink | Comment |

 Richard L. Jackson

Health care costs continue to spiral upward for all of us, and the latest studies show a primary cause is the vast number of unnecessary tests and procedures that doctors order to keep from being sued. This is known as defensive medicine.

A study commissioned by Patients for Fair Compensation, released in July, showed that Georgia’s economy could save $8 billion in health care costs annually if we eliminated the practice of defensive medicine within our borders.

That is an astounding figure that should give pause to our governor and lawmakers as they brace for some more tough decisions about future budgets and budget cutting.

Defensive medicine isn’t just costing those in the private sector. It costs taxpayers as well. According to BioScience Research, a health care economics firm, an estimated $4.5 billion is spent each year on Georgia Medicare patients and another $4 billion annually on Georgia Medicaid patients for unnecessary tests and procedures that doctors order in fear of being dragged into court.

BioScience Research found that five years after the implementation of a Patients Compensation System, doctors would change their behavior and stop ordering medically unnecessary tests such as CT scans and MRIs. The savings would total $5 billion annually.

Gov. Nathan Deal has ordered $553 million in budget cuts for fiscal 2014 and has asked that nearly half of that money come from the Department of Community Health (which includes Medicaid) and higher education.

State policymakers could find tremendous savings in Georgia’s budget if they took a step toward ending the practice of defensive medicine. We could do that by ending doctors’ fear of lawsuits by replacing our medical liability system with a Patients Compensation System.

A recent poll by Oppenheim Research of Tallahassee found that 96 percent of Georgia doctors believe a Patients Compensation System – one that resembles a workers’ compensation model – would stem the practice of defensive medicine.

Under a Patients Compensation System, a patient who was medically harmed could file a claim for review by a panel of experts. If that panel deemed the injury was “avoidable,” the claim would be forwarded to a compensation board to award compensation.

This would create a predictable model where patients are assured their cases would be heard. Injured patients would have access to justice. And unlike the current tort system, low-value claims would be heard. The system would provide compensation to more injured patients. They would receive predictable settlements in much faster time. Doctors would know they wouldn’t be hauled into court for frivolous reasons.

Florida’s Legislature is currently reviewing the proposed Patients Compensation System, which would bring more predictability to the medical liability system, eliminate defensive medicine and reduce health care costs.  Georgia has more tough fiscal times ahead and needs to find health care savings as well. An $8 billion cost savings is something our leaders should not pass up, and a Patients Compensation System would be welcomed by patients and doctors.

Richard L. Jackson is the chairman and CEO of Jackson Healthcare, an Alpharetta-based health care staffing company, and is chairman of Patients for Fair Compensation, an organization dedicated to educating citizens and policymakers on the negative impact of defensive medicine on patient care.

By Richard Jackson for Georgia Health News, 2012. | Permalink | One comment |

Pat Gardner

Opponents of the Affordable Care Act have stepped up their misinformation campaign about the law now that the U.S. Supreme Court has upheld it. There are all sorts of false numbers and dire predictions about what the act will cost and what it will and won’t do that are circulating on the Internet, being posted on Facebook, political blogs and making their way into print.

Now we see that Gov. Nathan Deal’s office is backing away from the prediction that expanding the state’s Medicaid program to cover more Georgians without insurance would bankrupt the state.

Indeed, the opposite is true. Georgia stands to benefit from a grand bargain under the new health care law. The federal government will pay 100 percent of the cost of the Medicaid expansion for the first three years, and no less than 90 percent after that.

Thus, at a minimal cost to Georgia, 650,000 people will no longer rely on hospital emergency rooms to get their care for free. Thanks to the new law, a similar number of the state’s uninsured residents will be able to purchase affordable coverage for the first time through private carriers selling plans on a statewide insurance exchange – two goals our state has tried by other methods, and failed to achieve for decades.

Both of these major changes in providing access to care are to be implemented in 2014,  less than 18 months from now. There are no alternatives on the table, in Atlanta or Washington, to get that many Georgians affordable health insurance that fast or that effectively.

It’s heartening that governor’s spokesman acknowledged to PolitiFact Georgia recently that his analysis of the cost of Medicaid expansion was wrong and won’t impact the state budget as much as he originally claimed. Still, he and his boss have suggested it may not be worth it.

Even with the faulty budget analysis aside, the governor’s estimate for how much it will cost the state seems inflated when compared to other projections. The Urban Institute, using current spending figures, believes that the state portion of Medicaid costs will go up a total of about $715 million over six years beginning in 2014 over what it would have paid without the expansion. That’s about $120 million a year, against a state budget this year of $19.3 billion.

Gov. Deal’s office has projected additional state spending of  $4.5 billion over 10 years, although we still don’t know what calculations went into that figure. Even if it is accurate, that would still amount to less than a 2 percent increase in the state’s overall spending in any given year.

With the expansion, an estimated $35 billion in federal funds will flow to the state for 10 years starting in 2014. Turning away that amount of money to benefit Georgians – funds that will go to other states that will happily use it to expand their programs – seems a fool’s game. While we play that game, our people will remain uninsured and New York, Pennsylvania and other states will get to use our taxes to help control their health care costs.

Georgia has spent the last two decades trying to come up with private, market-based plans to make insurance affordable. Many of these ideas are being recycled again as an alternative to implementing the law.  Those efforts have demonstrably failed as the ranks of the uninsured have swelled and total 1.8 to 2 million Georgia residents.

Moreover, expanding Medicaid is also the best option right now for those of us who are lucky enough to have insurance.

For years we have been paying higher premiums and co-pays because hospitals, doctors and others have to offset the cost of caring for the uninsured. By some estimates shifting the cost of care for the uninsured to those with insurance inflates premiums $1,000 a year for the average American family. Why wouldn’t we want to get rid of this unofficial and uncontrollable premium surcharge as soon as we can?

And then there’s this: Expanding Medicaid is simply the right thing to do. The people impacted by the expansion are not freeloaders. They are the working poor – Georgians with an annual income up to $15,400 for an individual or $26,300 for a family of three, or 138 percent of the federal poverty level. Think about paying the rent, buying food and clothing and other necessities on this amount of income. Is it any wonder why so many of them risk going without insurance?

With the election just a few months away, it’s easy to be frightened by inflated numbers and dire predictions about what the new law will do. But resorting to scare tactics and misleading analysis is not leadership.

Georgia needs to reduce the ranks of the uninsured and stop cost-shifting their care to the insured. Doing so will lead to better health for our most vulnerable residents, a more stable state economy and a better chance at controlling costs for all of us. Expanding Medicaid and implementing the rest of the Affordable Care Act gets us there quickly and cost-effectively. We should not miss this opportunity.

Rep. Pat Gardner (D-Atlanta) recently completed her 11th session as a state representative in 2012. She presently serves on the House Appropriations, Transportation, Higher Education and Natural Resources & Environment committees and the Appropriations Committee’s Health Subcommittee. She is the treasurer of the Working Families Caucus , chair of the Health and Welfare Subcommittee of the Fulton County delegation, and immediate past chair of the Women’s Legislative Caucus.

By Pat Gardner for Georgia Health News, 2012. | Permalink | 3 comments | Health Insurance, Health Reform

 Ronald E. Bachman

Oh, the games people play, especially politicians.

Only political junkies really care about the difference between taxes and penalties contained in Obamacare. What Americans care about is “What is it going to cost me?”

Sure, the Republicans can holler that the president lied when saying that the health reform costs were not taxes. And the Democrats can stick with the falsehood that the now constitutionally defined taxes are still penalties.

The reality is that are no new costs in Obamacare. They have been there all along. But most Americans never knew.

As Nancy Pelosi famously said, “We will have to pass the bill for you to find out what is in it.” That is how they did it. Politicians violate Americans’ trust with the “Fooled Ya” game.

The “Fooled Ya” game is played by the unique Washington, D.C., rules of the Congressional Budget Office (CBO). Costs are estimated over a 10-year period. What happens after 10 years doesn’t count in this game.

Here is a Real Life vs. Washington, D.C. example of how the “Fooled Ya” game works:

If you have a 10-year contract to lease a car for $500 per month, what is the cost? Most would say $500 for 12 months
yields an annual cost of $6,000. Therefore, the cost of the contract over 10 years would be $60,000.

But what if your 10 years of payments for that contract were delayed by four years?

Under the “Fooled Ya” rules, your contract costs would be only $6,000 for six years, or $36,000. The last four years
of the contract are initially ignored as outside the calculation period.

Of course, in the real world, the actual cost of your contract is still $60,000. In the “Fooled Ya” game, the actual total costs are not disclosed until time passes and the added years are made a part of a new 10-year calculation period. That is, only after four years would the full $60,000 cost be recognized under “Fooled Ya” estimates.

That is the essence of the initial “Fooled Ya” Obamacare cost estimates. The original 10-year, $940 billion cost
estimate was made in 2010 for the period 2010-2019. The public was told health reform would cost less than $1 trillion.

But the act is not fully implemented until 2018. The actual ongoing 10-year costs will be more fully disclosed with each
passing year, until we get to full implementation in 2018. In 2012, the CBO cost was updated to be $1.8 trillion. By 2013, the cost will be about $2 trillion. By 2018, the full implementation’s 10-year costs will be closer to $2.5 trillion.

So when you read that the cost of Obamacare is increasing, the truth is those costs have always been there. The
true costs are becoming part of each new 10-year calculation. The previously unrecognized “Fooled Ya” costs are now being exposed.

Some supporters of Obamacare don’t care what the costs are. They believe that whatever the costs are, the benefits of universal coverage matter most.

The Supreme Court decision has provided a new opportunity for the general public to become aware of the real costs and the “Fooled Ya” game. The game now shifts from the Supreme Court to the Court of Public Opinion and the November election. Americans can now make their choice through an honest discussion, knowing the act’s taxes and future cost estimates.

It is time we and the politicians stopped fooling around with our kids’ future. You know the old saying, “Fool me once shame on you; fool me twice, shame on me.”

Don’t be fooled twice.

Ronald E. Bachman is president and CEO of Healthcare Visions, a firm dedicated to advancing ideas and policy initiatives that are transforming the U.S. health care market.  Bachman is also a Senior Fellow of the Georgia Public Policy Foundation (GPPF), the National Center for Policy Analysis (NCPA), and at the Wye River Group on Health. Mr. Bachman is an actuary with extensive experience in health care strategy for payers, providers and employers, and is a retired partner from PricewaterhouseCoopers.

By Ronald Bachman for Georgia Health News, 2012. | Permalink | 4 comments |

Mark Mulligan

HIV Vaccine Awareness Day occurs every May 18 to raise awareness of, and encourage participation in, HIV vaccine clinical trials in humans.

We need an HIV vaccine. Every year for 15 years, about 56,000 Americans have become newly HIV-infected. This number has not fallen despite behavioral education efforts.

Over the same period, HIV treatment has improved tremendously, and AIDS deaths are down dramatically, from 55,000 to 16,000 annually.

In a disturbing calculus, treatment success paired with prevention failure means the United States is adding 40,000 more people living with HIV each year. The global trend is similar: 900,000 more people are living with HIV each year. So a vaccine for HIV is a key missing prevention tool.

Earlier, candidate vaccines in four large clinical trials failed to prevent HIV infection or lower virus levels after infection. Then, in 2009, an HIV vaccine study of 16,000 heterosexual men and women in Thailand demonstrated — for the first time ever — a modest reduction (31 percent) in HIV infections in vaccinated people over a three-year follow-up period.

When the analysis was limited to the first year after vaccination, a 60 percent protection rate was observed, suggesting that a booster was needed.

However encouraging these findings are, the hard truth is that we are still several years away from a widely available vaccine. Sadly, that means millions more women and men will become HIV-infected before we have the vaccine we need.

Last week, a panel of experts recommended that the FDA approve preventive use of the HIV medication Truvada, a combination of tenofovir and emtricitabine, in people who are HIV-negative but at high risk of infection. Emory scientists were the inventors of emtricitabine, which has helped transform treatment for infected individuals over the past decade. The FDA, which usually accepts such expert panel recommendations, will decide by mid-June on Truvada for prevention.

The prevention pill could be a supplement to — but not a replacement for — condoms, counseling, and safer sex. If it is not taken daily, its effectiveness goes down. One barrier to broad uptake is the cost, $14,000 per year, and there’s more we need to learn about its long-term side effects and the development of resistance.

Still, it is good to know that we may soon have a new FDA-approved HIV prevention tool for some truly high-risk people who can afford the drug and take it faithfully. Ultimately, however, we still need a vaccine!

The Emory Vaccine Center at Emory University, along with the Yerkes National Primate Research Center, is a global leader in laboratory-based HIV/AIDS vaccine research. The Hope Clinic at Emory conducts cutting-edge AIDS vaccine clinical trials in volunteers who are not HIV-infected.

On Friday, HIV Vaccine Awareness Day, consider becoming a local participant in these trials at the Hope Clinic. If you are not infected with HIV, this is a powerful way to — literally — roll up your sleeves, take a shot, and help fight HIV.

To learn more, visit www.hopetakesaction.org or call 877-424-HOPE.

Or, you can support HIV vaccine research through advocacy. One community organization that for 10 years has been a model of support and tireless fundraising for HIV vaccine research is Action Cycling Atlanta, which puts on the AIDS Vaccine 200 Bike Ride this weekend. Learn more at http://actioncycling.kintera.org

It’s inspiring that more than 200 people are choosing to bike 200 miles this weekend to fight AIDS.

Dr. Mark J. Mulligan is a professor of medicine within the Division of Infectious Diseases at Emory University. Dr. Mulligan serves as co-director of the Clinical Core for the Emory Center for AIDS Research. He is also executive director of the Hope Clinic of the Emory Vaccine Center, a human research clinic focused on clinical trials of vaccines and other prevention technologies, translational immunology studies, education and training the next generation of vaccine researchers.

By Mark Mulligan for Georgia Health News, 2012. | Permalink | Comment | Public Health

Ralph Hudgens

On March 23, 2010, President Obama signed the Affordable Care Act into law.

The Act itself is a 2,700-page behemoth that was hastily cobbled together in secrecy and through backroom deals by Speaker of the House Nancy Pelosi, Senate Majority Leader Harry Reid and a bunch of health insurance lobbyists.

The Act was the culmination of a tumultuous year for health care “reform” that witnessed several false starts and a near mutiny in the Congress. Pelosi and Reid, along with Obama, embraced the Act despite its obvious flaws. In doing so, they ignored the American people.

The Act has been in place for more than two years now and it has already earned a dubious track record. For starters, the Act had to undergo a major amendment because one of its provisions threated to wipe out countless small businesses. The Act has also led to the near extinction of child-only health plans.

The Act has not brought down health care costs or the cost of insurance, as was promised by the promoters of it. Moreover, the Act would have caused an exodus of health insurers from Georgia had I not intervened and requested a waiver of one of the requirements of the Act.

Tellingly, my waiver request was granted by the U.S. Department of Health and Human Services, the executive agency that is charged with implementing the Act and is led by President Obama’s appointees — presumably supporters of the Act.

Even they agreed with me, at least in part, that the Act was harmful.

Not only does the Act not work as promised, I believe it is unconstitutional. Though I am not a lawyer, I understand, as all Americans understand, that our Constitution is a document that limits the power of the federal government.

If the federal government can force you to enter into an unwanted contract of insurance under the Commerce Clause, then, as was observed by an Obama appointee, Justice Sonia Sotomayor, “there is no limit to that power.’’

I can put it no better than did Justice Anthony Kennedy when he said that the Act “changes the relationship of the federal government to the individual in a very fundamental way.”

I, along with millions of my fellow citizens, oppose the Act, not because we oppose reform of health care, but because we oppose a government takeover of health care and we oppose the destruction of individual freedom that the Act portends.

The Act does not reform health care because on balance it does not improve health care. Quite the opposite. It changes health care into a commodity that will be more expensive and less effective, and will render a free people less free.

The real solution and the real reform is to be found using free-market principles, not in an overbearing government program.  I hope that Georgia gets that opportunity.

Ralph Hudgens  was elected Georgia’s insurance commissioner in 2010. A Republican, Hudgens is a businessman and served in the Georgia General Assembly for 14 years.

By Ralph Hudgens for Georgia Health News, 2012. | Permalink | One comment |

Dr. Harry Heiman

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) — historic legislation designed to transform our health care system.

Unfortunately, the health care reform debate, both before and after the legislation’s passage, has been hostage to a highly partisan political process that has had little to do with health and health care. Now two years later, most Americans remain uninformed about the legislation. Lack of knowledge, however, has not precluded strong and passionate feelings on both sides of the political and ideological divide.

It is time to repeal and replace — time to repeal and replace the rhetoric. It’s time to take an honest look at why we embarked on health reform in the first place and how the ACA addresses the underlying problems in our health care system.

Our current health care system, by any measure, is broken and unsustainable. The U.S. has the most expensive health care system in the world, yet our outcomes are no better. We pay much more, but don’t get more in return.

We are the only developed country in the world that doesn’t provide universal access to care. We have the greatest disparities in health and health care of any developed country in the world. Quality of care and life expectancy vary based on your income, where you live, the color of your skin, and whether you have health insurance.

Otis Brawley, chief medical officer at the American Cancer Society, in his recent book “How We Do Harm,” describes our health care system as one that combines famine and gluttony, depending on your ability to pay. Famine for those who are uninsured or underinsured and suffer for lack of access to basic medical care, and gluttony, for those who are well off and insured, but who, in fact, may suffer as a result of overtreatment and unnecessary treatment.

Almost 50 million Americans are uninsured. The rate in Georgia is even higher, with more than 20 percent, or one in five Georgians, not having health insurance.

A recent CDC study reported that those without health insurance are seven times more likely to go without needed health care because of cost.

Physicians see these patients every day — suffering complications from what are often preventable problems. These are the patients we see putting off refills of their essential medications for high blood pressure and diabetes, delaying important cancer screening tests like mammograms and colonoscopies, and often ending up in the emergency department or being admitted to the hospital for preventable illnesses and complications. They suffer and we collectively pay the costs. We share the costs in dollars, while uninsured people pay with their lives.

The ACA is designed to achieve goals most Americans agree are necessary. It expands access to health care for an estimated 32 million Americans who are currently uninsured. It eliminates pre-existing exclusions for those with chronic medical problems or a history of a serious illness. It eliminates rescissions of insurance policies and annual or lifetime caps on coverage and extends dependent coverage to age 26.

Already, as a result of the ACA, children with diseases like diabetes, autism, or asthma cannot be denied coverage. More than 50,000 adults previously denied coverage have obtained health insurance. Almost 2 million young adults are now covered through their family’s insurance plan. For the first time, co-pays and deductibles for preventive services are eliminated, removing barriers to lifesaving tests like mammograms and colonoscopy, PAP smears and immunizations.

Some have argued that this is an unnecessary expansion of government.  I challenge them to show me how the free market has created opportunities for those who are poor — especially the working poor, and those with chronic medical problems, who need access to care the most, but are unable to purchase health insurance.

Health care providers understand how the current system is failing the most vulnerable in our communities. This is why the ACA has been supported by the American Medical Association, with more than 200,000 members, the American Academy of Family Physicians, with more than 100,000 members, the American Academy of Pediatrics, with more than 60,000 members, and the American College of Physicians, with almost 130,000 members. The ACA is about the government providing a framework and support for many of the most vulnerable in our society when market systems have failed.

The “mandate” being challenged in the Supreme Court requires that each person take responsibility for their health care by having health insurance. To suggest that we all won’t require health care services at some point in our lives is ludicrous.

From birth to death, we are all subject to the unpredictability of life. Who hasn’t had a friend or family member with a sudden, unanticipated injury or illness requiring medical treatment?  If personal and community responsibility is a value we support, then shouldn’t everyone be held accountable?

The Affordable Care Act is not perfect. Legislation rarely is. But it goes a long way toward improving our current system by expanding access, improving quality, controlling costs, and creating value; goals that most Americans agree will move us in the right direction.

Physicians are professionally bound by the Hippocratic Oath of “do no harm.” To perpetuate a health system that denies basic access to care for 50 million Americans is both harmful and unconscionable. It is time to repeal and replace the rhetoric of division and distraction. The ACA takes a major step forward in assuring that all Americans have access to affordable, high-quality health care.

Harry J. Heiman, MD, MPH, is director of health policy for the Satcher Health Leadership Institute at the Morehouse School of Medicine. He is active in Georgians for a Healthy Future and the Georgia Academy of Family Physicians.

By Dr. Harry J. Heiman for Georgia Health News, 2012. | Permalink | One comment |

Robert McNally

According to numbers circulated by UNAIDS and the World Health Organization in November, the worldwide population of individuals living with HIV/AIDS in 2010 stood at 34 million.

Yet despite the continuing importance of developing HIV vaccines, a range of research groups and small biopharma companies are finding challenges in obtaining the amount of funding that is required to conduct effective research and clinical trials.

As an example, HIV researchers in India recently asked that nation’s government to raise funding levels for their programs, and researchers at an international symposium on HIV and infectious diseases in Chennai pronounced funding levels “largely insufficient and disappointing” in light of the number of individuals with the virus. Elsewhere, the National Research Council of Canada recently awarded Sumagen Canada Inc. $728,000 for a Phase 1 human clinical trial for its HIV vaccine candidate; yet the lead researcher, Chil-Yong Kang, remarked that the entire trial is “going to take almost ten times that amount.”

The challenges being experienced by scientists and small biopharma companies working on HIV vaccine research can be ascribed to a variety of sources, but three stand out: First, the idea that the epidemic has improved since it initially came to the public’s attention in the early 1980s; second, the opinion that the absence of a viable vaccine up to the present time means that none is forthcoming; and third, the nature of financial support from the National Institutes of Health and potential investors.

Let us analyze each of these views.

First, why has the HIV/AIDS crisis diminished in the public consciousness, domestically and elsewhere, despite the continued high cost of present treatment regimens?

Consider sentiments within the United States. There are portions of the American populace that think HIV is a non-issue, rooted in the fact that antiretroviral therapy drugs can be effective and provide an extended life to those with HIV. What they seem not to realize is that the expense and considerable side effects of these treatments are still problematic — not a long-term solution, and definitely not a solution for developing regions worldwide.

The populations of developed nations in 2012, and their governments, may be tempted to believe the HIV/AIDS crisis is an issue for other regions of the globe. Yet this is contradicted by facts. Note, for example, that in the U.S. there are 55,000 new HIV infections annually, a number that has stayed the same since the mid-1990s in spite of the use of counseling, medications and protective measures.

In this sense, government sentiment may be echoing media coverage of HIV/AIDS, which, according to a recent study, fell more than 70 percent in developed nations during the last two decades. This study — the Trends in Sustainability Project — tracked coverage of a range of sustainability issues in 115 leading broadsheet newspapers in 41 countries from 1990 until May 2010.

Although newspaper readership has been steadily eroding over the past decade due to the rise of online news, this study is still a powerful indicator of the priority that traditional news organizations assign to various subjects. In the early 1990s, an average of 1.5 articles about HIV/AIDS was found in every issue of these newspapers; since 2008, that average has fallen to less than 0.5.

Now consider the second principal factor possibly driving government reluctance to provide long-term HIV/AIDS research funding: the spotty record of vaccine efforts to date. Over the last couple of decades, there have been several false hopes, and plenty of failures, on the road toward a vaccine. Consequently, it is tempting to doubt that a cure or treatment lies in our future.  But those in government with this belief are disregarding good news from clinical studies that shed a very real ray of hope on finding a safe, inexpensive, universal treatment.

Substantial advances are being made toward the creation of a viable vaccine. In autumn 2009, a collaboration between the Ministry of Health in Thailand, the U.S. military, and the U.S. National Institute of Allergy and Infectious Disease (NIAID) announced the first encouraging results from an efficacy trial — 31 percent prevention of infection in a 16,402 person community-based trial in Thailand. This result achieved significance in an analysis that excluded seven subjects who were determined to have been infected at the time of the initial vaccination, showing for the first time that an HIV vaccine could prevent infection.

Meanwhile, an Emory University research group may be one step closer to finding a vaccine that will provide long-lasting protection against HIV/AIDS. Dr. Harriet L. Robinson, senior vice president for research and development at GeoVax Inc., our biotech company specializing in the development of HIV/AIDS vaccines, along with her team at Emory University, showed that a novel class of vaccines against HIV has demonstrated significant protection against the most potent strains of HIV infections in animal models.

The novel class of vaccines is a combination vaccine. Using a vaccine candidate in monkeys, Dr. Robinson’s team has been able to demonstrate that this combination is capable of achieving a highly encouraging prevention of infection. Most notably, the GeoVax candidate has shown effectiveness against SIV251, the most difficult simian version of HIV in humans. Such an encouraging result demands attention by funding decision makers.

Finally, consider the nature of National Institutes of Health (NIH) funding for biopharma companies, as well as the tendencies of investors.

The NIH is very supportive of new protocols and the running of clinical trials.  However, during the long clinical trial period, the company must separately fund general overhead and vaccine production.  Once a vaccine candidate exhibits human efficacy in later stage trials, equity investors and partnering opportunities are more prevalent.  Meanwhile, finding equity investors is a challenge due to the long time scales involved in developing a viable vaccine; investors are more likely to seek out opportunities that pay off in a relatively shorter term.

As argued above, there are certain factors behind the roadblocks currently faced by small biopharma companies engaged in HIV/AIDS vaccine research.  An enhanced recognition of these and other factors could lead to a more suitable level of funding for a disease that still threatens millions worldwide.

Robert McNally is president and CEO of GeoVax, an Atlanta-based biotech company that is developing vaccines that prevent and fight HIV infections.

By Robert McNally for Georgia Health News, 2012. | Permalink | Comment |

Dr. Patrice A. Harris

Congress’ pattern of procrastination has led to a series of fiscally irresponsible compromises that threaten Medicare’s physician foundation and endanger access to care for more than 40 million seniors, veterans and military families.

Unless Congress acts, Medicare payments are scheduled to be slashed by 27 percent on March 1, and physicians will be forced to make unwelcome choices, including limiting the number of Medicare patients they take on. In Georgia, the cut threatens access to care for the 1.2 million seniors who rely on Medicare. Almost half a million veterans and military families in Georgia will also be affected, since TRICARE – the military’s health program – ties its payment rates to Medicare.

Congress has intervened 13 times in the past decade with temporary patches, postponing drastic Medicare payment cuts mandated by a broken government formula. Failing to take decisive action to eliminate the broken formula has made the problem worse by compounding the cost of a solution for taxpayers and mandating steeper cuts in physician payments year after year.

As recently as 2005, the cost of eliminating the broken payment formula would have been $48 billion. Today, the cost stands at $300 billion. If Congress continues its temporary interventions instead of fixing the problem once and for all, that eventual cost will escalate to $600 billion in only five years.

Another temporary patch is fiscally irresponsible. The price of a long-overdue solution will never be less than it is right now. It is irrational to spend increasing amounts of taxpayer money to support a payment policy that is a proven failure.

Since Medicare was founded in 1965, advances in medical research, education and training have helped increase the average senior’s life expectancy to age 78 – an eight-year increase. While the practice of medicine has evolved, Medicare’s payment formula created in 1997 remains stuck in the last century. Now is the time for a prudent, permanent solution that will preserve the security and stability of health care for seniors and military families.

As a practicing physician in Atlanta, I know Medicare patients are already having trouble finding physicians in Georgia and around the nation. The government’s own Medicare advisory committee has said 22 percent of seniors have had trouble finding a new primary care physician. The president of the Military Officers Association of America has called the scheduled cut the No. 1 threat to military beneficiaries’ health care access.

There is a unique opportunity right now to use projected spending for the wars in Afghanistan and Iraq to eliminate the flawed formula and protect access to care for seniors and military families. As these wars wind down, projected spending that won’t be spent on them becomes available to pay for eliminating the fatally flawed Medicare physician payment formula to ensure access to care for seniors and military — without adding to the nation’s deficit. Using this funding to help military members and their families maintain access to care makes sense and is simply the right thing to do.

A recent poll found that 94 percent of Americans believe the impending cut is a serious problem for seniors who rely on Medicare. Doctors have already given Congress their opinion. Patients now need to give their representatives in Washington a second opinion. By using the AMA’s Patients’ Action Network at www.patientsactionnetwork.com or calling 888-434-6200, you can learn more about this important issue and identify and contact your members of Congress.

Decisive congressional action is needed now to stop spending billions on patches and eliminate the flawed Medicare payment formula that threatens Medicare’s promise for current and future generations.

Dr. Patrice A. Harris is an Atlanta psychiatrist and a board member of the American Medical Association.

By Dr. Patrice A. Harris for Georgia Health News, 2012. | Permalink | Comment |

Matt Caseman

Lack of trauma care remains the single most critical issue facing our state.

The hard reality is that Georgia still needs a dedicated revenue stream to upgrade and expand its trauma center network. Thirty-three states have found ways to permanently fund trauma care, but our state lags behind.

Here are some facts:

•  Georgia has 150 acute-care hospitals, but it has only 15 designated trauma care centers.

•  More than 1 million Georgians live at least 50 miles from a Level 1 trauma center, the kind that handles the most serious cases. That distance makes it virtually impossible to get them to such a facility within the “golden hour” — the period after a major trauma when emergency responders have the greatest chance to save a life. Many Georgians commute through areas that are similarly remote from lifesaving facilities.

•  In metro Atlanta, there’s one fatality in every 339 accidents. In rural Georgia, it’s one fatality in every 74 accidents. (Georgia defines a rural county as having a population of 35,000 or less, and 108 of the state’s 159 counties are in that category.)

In the 2010 legislative session, the General Assembly came together over the need to fund trauma services. It passed Senate Resolution 277, which asked voters to change the Georgia Constitution by adding $10 to each vehicle registration fee. If the initiative had passed, the new fee would have provided approximately $80 million annually for trauma care.

Sadly, the initiative was defeated, with only 47 percent of voters supporting it. The momentum to do something about trauma care was temporarily lost.

In the 2011 session, Sen. Greg Goggans (R-Douglas) introduced SR 140, which would dedicate funds for trauma care from existing tag fees already paid to the state. Because of Georgia’s $1.5 billion shortfall at the time, Sen. Goggans said he would wait until January 2012 to push the measure, if revenues increased.

That time has arrived, the economic outlook has improved in Georgia, and SR 140 deserves immediate consideration.

Along with Sen. Goggans, there have been countless champions for more trauma care funding, and they all should be commended for their passion and commitment. From the business community to elected officials, to those on the front lines keeping people alive, these fine individuals have done their part.

To those united in their passion for improving health care in rural counties, I want to say, “Thank you.”

I would also ask our citizens to be aware of how critical this issue is to our state. Expanding trauma care for all Georgians will save lives, and we should not wait any longer.

Matt Caseman is executive director of the Georgia Rural Health Association,  a nonprofit network of health care providers, educators, and individuals united in a commitment to improve the health and health care services of rural Georgians.

By Matt Caseman for Georgia Health News, 2012. | Permalink | Comment |

Ronald Bachman

In July 2012, that just might be the headline that throws the country into turmoil.

Everyone is wondering whether the 26-state challenge to the Patient Protection and Affordable Care Act will succeed. But a bigger question is: If it succeeds, then what?

If the court rules against the constitutionality of the health reform law, part or all of that law will immediately be null and void. Insurance markets will revert back to inadequate state laws that existed before the federal law was passed in 2010.

We know that under those laws, 1.8 million Georgians were uninsured, and fewer than 1 in 4 Georgians working in small businesses had coverage. Does Georgia want to go back to that situation? Or is it prepared to make needed changes to improve its insurance market and lower the number of uninsured?

In preparation for a possible voiding of the federal law, the Georgia Public Policy Foundation facilitated a multi-stakeholder, bipartisan discussion group that resulted in a detailed plan for comprehensive health insurance reform for Georgia. The plan is built on six basic principles: (1) Free Markets (2) Personal Responsibility (3) Competition (4) Choice (5) Transparency (6) a Level Playing Field for All. Recommendations include three major areas of reform to be pursued simultaneously:

First, Georgia must restructure the insurance market to increase competition, transparency, access and portability. Four major restructuring ideas emerged. One, Georgia should show leadership in creating a regional marketplace with consistent insurance laws and interstate reciprocity of policy approvals. A greater Southeastern marketplace — 24 million to 50 million people — will bring Georgia lower-cost products, more responsive wellness incentive programs and increased choices through competition. Two, Georgia should encourage the development of nascent private health insurance information marketplaces. These entities will provide transparency of costs, quality and consumer health literacy to both private and public insurance. Three, Georgia needs a “Personal Responsibility High Risk Pool, which would stabilize the small-group and individual markets, provide affordable coverage to those otherwise locked out of coverage, and increase access to insurance for all. Four, Georgia laws should allow for a group conversion policy for those who lose their jobs and coverage. A group conversion would maintain consistency with other group policies and add a valuable aspect of portability.

Second, Georgia needs new laws to strengthen the private-market safety net. Needed changes include: equalizing pre-existing conditions between self-insured and fully insured policies; expanding coverage to tax-dependent children until age 26; allowing policy rescissions only for fraud and material misrepresentation; and providing lower-cost options for those selecting COBRA and continuation of coverage. In addition, the state can provide planning, expansion grants and HIT support for Georgia’s Charity Care Network.

Third, in addition to the above, the “Comprehensive Health Insurance Reform for Georgia’’ includes more than 30 specific recommendations to lower the cost of insurance for individuals and small businesses. Existing laws add unnecessary costs, limit incentives, and unfairly tax individual policies at higher levels than group plans.

In summary, the Georgia Public Policy Foundation has produced a broadly accepted “Georgia-centric” health insurance reform roadmap for the 2012 Georgia General Assembly.

This is a chance for states to say “Yes” to a positive agenda even as they wait for the Supreme Court to say “No” to federal encroachment on their health policies. Passing state reforms now will prevent the chaos that could come from the very court ruling that Georgia is hoping for. These are real solutions that will show that states are prepared and positioned to help their own citizens.

The Georgia solutions include ideas that could be useful to other states. Other states will have their own ideas and may need different reforms for their own situations. That is how it should work if the constitutional challenge to the federal law is upheld and states truly believe in their rights and responsibilities under the 10th Amendment.

Ronald E. Bachman is president and CEO of Healthcare Visions, a firm dedicated to advancing ideas and policy initiatives that are transforming the U.S. health care market.  Bachman is also a Senior Fellow of the Center for Health Transformation (CHT), the Georgia Public Policy Foundation (GPPF), the National Center for Policy Analysis (NCPA), and at the Wye River Group on Health. Mr. Bachman is an actuary with extensive experience in health care strategy for payers, providers and employers, and is a retired partner from PricewaterhouseCoopers.

By Ronald Bachman for Georgia Health News, 2012. | Permalink | 4 comments |

Doug Wojcieszak

Almost 14 years ago, I lost my oldest brother, Jim, to medical errors.

Jim walked into a hospital at 2 a.m., complaining of severe chest, shoulder, neck and stomach pain — classic signs of a heart attack. But because he was only 39 years old and in seemingly excellent health, the doctors thought he was suffering from stomach issues.

The attending physicians never ordered bloodwork, but instead gave Jim an ulcer cocktail and sent him home while he was still in pain.

Later that morning, Jim showed signs of passing out, so my parents took him back to the emergency room. This time, doctors drew blood and, sure enough, his enzyme levels indicated his heart muscles were undergoing damage.

By early afternoon, Jim was admitted to the intensive care unit where, surprisingly, the computer monitor over his bed read my father’s name instead of Jim’s. This was very significant. A couple of months earlier, my father, Ray, had undergone a heart stress test in that same hospital, and it had shown no blockage.

The computer monitor was eventually changed to read “Jim,” but the physicians were still using my dad’s charts, and they diagnosed Jim with a bacterial infection of the heart. Jim actually had four blocked arteries and suffered several heart attacks under their care. My brother ultimately died during emergency open-heart surgery three days later.

The hospital and doctors tried to cover up their mistakes –- no one would speak to my parents. My parents ultimately won a malpractice award, but (at the time) no physician apologized or admitted a mistake. Too often, doctors won’t admit their errors, even those that have been proved, making future patients vulnerable to the same mistakes being repeated.

Often, doctors don’t talk about mistakes because they are afraid of our legal system. However, physicians might not be so fearful of fulfilling their ethical responsibilities if we could replace our current medical malpractice model.

Lawmakers in Georgia and Florida will soon consider a proposal to replace the current tort system with one similar to the workers’ compensation system, which has been around for a century. Known as a Patients’ Compensation System, it would allow patients and their relatives who have been harmed to be compensated faster, and it would let physicians avoid being dragged into court for years.

Under a Patients’ Compensation System, patients would truly be the focus. While my family had to endure lengthy and stressful litigation to be compensated for the loss of Jim, families instead would earn a settlement within months.

First, the patient or family, represented by counsel, would file a claim before a review panel, which would determine if harm had truly been committed. If so, the panel would then forward the claim to the Compensation Board to determine compensation following consistent national norms, including consideration for pain and suffering and other non-economic losses.

The system would be overseen by an administrative law judge, include multiple appeal options, and would be financed by doctors and hospitals through their malpractice premiums — no different than what they pay today.

In my family’s case, we got something for Jim’s life, though nothing will ever replace losing him. On average, though, fewer than 20 percent of patients or families earn any kind of an award when harmed by a doctor. By eliminating defense costs and providing consistency in the claims process, the Patients’ Compensation System would provide compensation to more injured patients and their families.

Most importantly, by removing some of the legal “fear factor,” the Patients’ Compensation System would help doctors be more open about their errors, apologize and learn from their mistakes, and be better able to prevent tragedies such as the one my family experienced.

Doug Wojcieszak is a member of the national board of Patients for Fair Compensation, a nonprofit that will ask the Georgia General Assembly to adopt a Patients’ Compensation System. He also is the founder of Sorry Works!, a leading advocacy and training organization for disclosure after medical errors.

By Doug Wojcieszak for Georgia Health News, 2012. | Permalink | One comment |