The state Department of Behavioral Health and Developmental Disabilities told GHN that Southwestern State Hospital currently has a patient census of 116, divided between people with mental illness and development disabilities, and those housed in the facility’s forensic unit.

The closing of the hospital continues the revamping of the state’s services for people with mental illness and developmental disabilities in the wake of Georgia’s landmark 2010 agreement with U.S. Department of Justice, which aims to move people from mental hospitals into community living situations.

Since then, the state DBHDD has closed its mental hospital in Rome and downsized services at its historic Milledgeville facility.

About 600 employees work at the Thomasville hospital. A DBHDD spokesman, Matt Carrothers, said the workers can apply for open state jobs and similar positions newly created by private providers, and can receive services such as GED preparation and testing, workforce training, and employment assistance.

The mental health patients at Southwestern State will be served in various facilities located across the southwestern region of Georgia, and those with more acute needs will be served in an alternate psychiatric hospital, state officials said.

In addition, the state agency said it will increase the mental health services in the region, including Behavioral Health Crisis Centers, Crisis Stabilization Units and Intensive Case Management Teams.

“I’m always supportive [of the closing] of state hospitals because I believe that where people recover and maintain wellness is in the community,’’ Sherry Jenkins Tucker of the Georgia Mental Health Consumer Network told GHN. “It’s an opportunity to free up resources to enhance our continuum of care and create more and better community-based services for people.’’

Carrothers of DBHDD said patients in the Southwestern State forensic unit — those under court jurisdiction — will be transferred to the state forensic facility in Columbus.

Those with developmental disabilities will be moved to community-based services, most of them in group homes.

The state has reduced the hospital population of people with developmental disabilities from roughly 1,000 to 342 currently. But DBHDD Commissioner Frank Berry last week said he is imposing a 45-day delay in moving people with disabilities out of the hospitals. He cited concerns about quality of care.

The DOJ accord — hailed by consumer advocates as a model for other states — aims to increase community services across the state, including housing, crisis teams and stabilization units, so people with disabilities can avoid the need for hospitalization.

At a Carter Center forum last week, Berry spoke of the difficulty of telling parents when disabled people are to be moved into the community, with support services, after living for decades in a hospital. Parents often want their disabled offspring to remain in the institution they’ve known for so long, he said.

He also spoke of the difficulty of telling employees of state-operated hospitals that they may be losing their jobs due to the changes, but that the state needs them to stay on until that happens.

Here’s a link to a GHN article on the mental health forum Friday.

Eric Spencer, executive director of the Georgia chapter of the National Alliance on Mental Illness, told GHN that his organization’s hope is that sufficient services will be in place prior to the Dec. 31 Thomasville closure. Spencer said that with the facility closures in Rome and Milledgeville, many individuals wound up without services or in jails.

Any savings from the closure should go to strengthen community services in southwest Georgia, Spencer added.

By Andy Miller for Georgia Health News, 2013. | Permalink | Comment | Disabilities, Mental Health, Safety Net

Republican governors in Georgia, South Carolina, Alabama, Mississippi and Louisiana, along with their GOP-controlled legislatures, have bucked proposals to open their states’ Medicaid programs to hundreds of thousands of uninsured people, as outlined under the 2010 Affordable Care Act.

But a newly released survey of adults in those five Southern states shows a different sentiment among the public. Across the region, 62.3 percent of respondents view Medicaid expansion favorably, including 61 percent in Georgia, according to the survey results released Tuesday.

When people were asked a more detailed question about expansion — whether the state should keep Medicaid as it is or expand it to cover more uninsured people, with the state eventually paying part of the cost — the percentages dropped a bit but still showed a majority, 53.8 percent, in favor. Georgia’s favorable figure of 51.6 was the lowest of the five states.

A large majority of African-Americans (78.4 percent) in the survey favored Medicaid expansion, compared to a substantial but smaller number of non-Hispanic whites (44.2 percent). A majority of women favored expansion (57.2 percent), while slightly less than half of men did (49.6 percent).

At the same time, the poll showed that only one-third of adults in the five states view the Affordable Care Act favorably, with 43.8 percent not liking the law. Especially unpopular is the requirement that individuals obtain health insurance or pay a penalty.

But large majorities (75 percent in the region) support ACA provisions for health insurance exchanges, where individuals and small businesses can shop for coverage; and for financial subsidies for people to afford insurance (68.8 percent, and 66.2 percent in Georgia).

“When you talk about the [Affordable Care Act] as a whole, people get into their political mindset,’’ said Cindy Zeldin, executive director of the advocacy group Georgians for a Healthy Future. “But when you take it out of the political context, many of these individual provisions are common sense.’’

Southern states generally need expansion the most because of their large numbers of uninsured, Zeldin said.

The survey shows “strong support for Medicaid expansion,’’ Zeldin added. “Hopefully, our elected officials will see this. It’s clear that this is what Georgians want.’’

The poll was conducted by the Joint Center for Political and Economic Studies, a Washington, D.C.-based think tank that analyzes a broad range of public policy issues of concern to African-Americans and other communities of color. Joint Center officials noted Tuesday that the five Deep South states have a large African-American population, including 30 percent of Georgia residents.

About half the states in the nation plan to expand their Medicaid programs. If Georgia were to expand Medicaid – which the state’s current leadership says it won’t do – more than 650,000 people would be added to the program’s rolls.

Gov. Nathan Deal has remained firm in his opposition to it, citing an estimated $4.5 billion cost to the state over 10 years. And his fellow Republicans in the state’s political establishment are not pushing for it.

Deal, who has voiced skepticism about the law’s federal funding guarantees, says Medicaid expansion would prove too costly to the state in any event, adding to the expense of a financially strapped program.

Deal spokesman Brian Robinson, responding to the survey results in an email Tuesday to GHN, said an expansion would cost the state “vast amounts of money.”

“And it depends on never-ending largesse from a federal government drowning in debt already,’’ Robinson added. “If you asked respondents to write a check for their share of the new costs, I dare say the number of supporters will drop precipitously. It’s the easiest possible thing to be for new entitlements when you’ve come to believe they’re free.”

The survey’s results mirror those in an AJC poll conducted in December, when 65 percent said they believed the state should accept increased federal funding for Medicaid under the Affordable Care Act, often known informally as Obamacare.

The new survey interviewed 500 adults in each of the five states.

Besides racial differences, the survey also found class divisions over the ACA. Respondents who were well educated, earned good incomes, and had health insurance — and whose acquaintances also had health coverage — were cooler to the ACA and its provisions than were those less well-off and those having friends, family, and neighbors who were uninsured.

Separately this week, the Los Angeles Times reported that Republican opposition in many statehouses to expanding Medicaid will likely widen the divide between the nation’s healthiest and sickest states.

Residents of the states that plan to expand — concentrated in the Northeast, upper Midwest and West Coast — currently have better access to doctors and are less likely to die from preventable illnesses.

Colon cancer deaths in states opposing Medicaid expansion, for example, are an average of 16 percent higher than in pro-expansion states, according to a Times analysis of state health data.

Deaths from breast cancer are 8 percent higher on average in anti-expansion states. And adults under 65 are 40 percent more likely on average to have lost six or more teeth from decay, infection or gum disease.

Yet most state leaders fighting the Medicaid expansion have advanced few alternative plans to tackle their states’ health shortfalls, the L.A. Times article said. That means that, at least in the short term, America’s unhealthiest states could fall even further behind as the Affordable Care Act is implemented, the Times article reported.

The Medicaid program’s conservative critics, who contend it could ultimately sap state budgets, say poor Americans would be better helped by alternative strategies, including limits on government medical aid to encourage people to take responsibility for their own health care.

“If history has proven anything, it’s that there is no such thing as a temporary entitlement program,” South Carolina Gov. Nikki Haley said, thanking state legislators there for rejecting Medicaid growth, which she called a “looming public policy nightmare and fiscal disaster,” the  Times article reported.

Yet Ron Pollack of consumer advocacy group Families USA, commenting on the poll results, said Tuesday that a governor who turns down expansion “is committing financial malpractice.’’

Expansion would not only improve many people’s access to health care, but it would also save money for states in covering the cost of the uninsured and would create jobs  and boost economic activity, Pollack said. “It’s a win-win-win proposition.’’

By Andy Miller for Georgia Health News, 2013. | Permalink | One comment | Health Insurance, Health Reform, Medicaid, Safety Net

A young woman who was institutionalized for a dozen years now lives in her own home, and is using the bathroom by herself for the first time in her life.

The two individuals’ transitions are among the success stories of Georgia’s 2010 agreement with the U.S. Justice Department to revamp the state’s system to care for people with mental illness and developmental disabilities.

On Friday, state officials described these two people’s new situations in an update on the settlement agreement at the Rosalynn Carter Georgia Mental Health Forum, held at the Carter Center in Atlanta.

Officials with the state Department of Behavioral Health and Developmental Disabilities (DBHDD) also detailed the hurdles and problems in remaking the public system of care, in the wake of the Justice Department settlement.

The agreement includes providing supported housing and employment for people with mental illness, and moving individuals with developmental disabilities from state hospitals into residential settings.

“It is not an easy task,’’ said Frank Berry, commissioner of the DBHDD. “It’s about providing better care to people who had lived in institutions [and are] now out in the community.”

The number of people with developmental disabilities in state hospitals has shrunk from roughly 1,000 at the beginning of the agreement to 342 now.

But Berry said he is imposing a 45-day delay in moving people with disabilities out of the hospitals. He cited concerns about quality of care.

“We can’t mess up on quality,’’ he said.

He also spoke of the difficulty of telling parents when disabled people are to be moved into the community, with support services, after living for decades in a hospital. Parents often want their disabled offspring to remain in the institution they’ve known for so long, he said.

Georgia also agreed to establish community services for about 9,000 people with mental illness, and to create community support and crisis intervention teams to help people with developmental disabilities and mental illnesses to avoid hospitalization.

More than 800 people with mental illness now are using housing vouchers, with a goal of more than 1,400 by next July, said Chris Gault, assistant commissioner for Behavioral Health. Hundreds of individuals are receiving supportive employment, Gault added.

The new array of services includes 22 Assertive Community Treatment (ACT) teams in place across the state, with about 1,100 people enrolled. Mobile crisis teams will cover 128 of Georgia’s 159 counties by July, Gault said.

Berry acknowledged that there have been high turnover rates on those ACT teams and among other state-contracted providers. Maintaining a high-quality workforce through recruitment and retention of good workers “is one of our biggest challenges,’’ he said.

He noted that state employees have gone several years without a pay raise.

Berry said it’s not easy to tell employees of state-operated hospitals that they may be losing their jobs due to the changes, but that the state needs them to stay on until that happens.

Another forum panelist, Josh Norris, legal director of the Georgia Advocacy Office, noted that “there are some fantastic stories of people finally getting the support they needed’’ in the wake of the settlement agreement.

The reduction in the number of institutionalized people with developmental disabilities, Norris said, “is monumental.’’

Still, Norris said, problems remain, including a need to have more people using housing vouchers rather than living in group homes.

By Andy Miller for Georgia Health News, 2013. | Permalink | 5 comments | Disabilities, Mental Health

The ruling had been sought by the Federal Trade Commission. Phoebe Putney officials said in a statement that the judge’s action won’t alter day-to-day operations at the former Palmyra, which was purchased from HCA and has been renamed Phoebe North.

The FTC’s Richard Feinstein noted Wednesday in a statement that the ruling also prohibits “any price changes to existing health-plan contracts, pending our Motion for Preliminary Injunction.” A hearing on that motion has been scheduled for June 14, said Feinstein, who is director of the agency’s Bureau of Competition.

Here’s a link to Sands’ order.

It’s the latest legal step in a battle that has lasted more than two years.

The FTC, which has fought the merger since it was announced, says allowing Phoebe to own the only two hospitals in Albany is anti-competitive. The sale itself was completed in 2011.

Phoebe Putney’s legal team rattled the industry statewide recently by sending subpoenas to all non-specialty hospitals in Georgia, requesting financial and other information as it pursues its legal fight with the FTC.

The subpoenas sparked a flurry of legal work for hospitals and concern about the scope and cost of such an effort. Facing protests from the Georgia Hospital Association, the Phoebe legal team subsequently pared back the document load for hospitals.

Phoebe officials told GHN on Thursday that they had exempted small rural “critical access” hospitals from delivering the financial documents, citing the concern that the burden of producing them would be greater for these facilities.

The FTC recently won a favorable ruling in the case from the U.S. Supreme Court. The justices unanimously set aside two previous court decisions upholding the Phoebe-Palmyra merger and ruled that the legal challenges to it can continue.

Phoebe attorney Tommy Chambless said in a statement Wednesday that the order from Sands “is not intended to change the way Phoebe currently operates Phoebe North Campus, the former Palmyra Medical Center.”

“This will have the effect of slowing some of the progress we have been moving toward, on Phoebe North Campus as well as on our main campus, and naturally, we will not yet be able to immediately undertake our plans to develop a women’s and children’s center for our community,” Chambless added.

By Andy Miller for Georgia Health News, 2013. | Permalink | 2 comments | Health Costs, Hospitals

Prevent Child Abuse Georgia aims to re-establish a 1-800 helpline by the end of the year, thanks to a foundation grant.

The helpline went out of service in 2011, when PCA Georgia itself was closed down for financial reasons. The helpline had handled more than 10,000 calls in the first four years of its operation, GHN reported in 2011. It provided Georgians concerned about the welfare of a child with access to information, support and links to community resources.

The Prevent Child Abuse organization reopened several months after closing, and is now housed at the Center for Healthy Development in Georgia State’s Institute of Public Health.

A $165,000 challenge grant from the Arthur M. Blank Family Foundation will put the helpline back in business, said Julia Neighbors, director of PCA Georgia.

The helpline “was an important and valuable resource,’’ Neighbors said Wednesday. “This was a gap we want to close.’’

PCA Georgia says the leading request the organization received from professionals working with children and families is to re-establish 1-800-CHILDREN

The Blank Foundation’s president, Penelope McPhee, said in a statement, “With the support of Georgia State University, PCA Georgia ensures that the community’s highest priority needs are met. The 1-800-CHILDREN helpline is a critical resource for children and families across the state.”

Child abuse and neglect can decrease victims’ levels of self-esteem, potential lifetime earnings, and positive social functioning while simultaneously increasing the likelihood of substance abuse, teen pregnancy, mental health diagnosis, criminal behavior and physical injuries.

In 2011, Georgia had 21,205 substantiated cases of abuse or neglect, and 76 children died.

A 1-800 information line would be helpful for people to know the signs of child abuse and how to report possible cases, said Dr. Lee Heery, a pediatrician in the St. Simons/Brunswick area. She chairs the committee on child abuse and neglect for the Georgia chapter of the American Academy of Pediatrics.

Ultimately, a physician suspecting abuse or neglect should call local law enforcement or local office of the Division of Family and Children’s Services, she noted.

Educating communities about child abuse is important. “In certain places, there’s more awareness of it, and more cases are reported,’’ said Heery.

By Andy Miller for Georgia Health News, 2013. | Permalink | Comment | Children's Health, Safety Net

The measure, House Bill 193, had overwhelming legislative support. It passed the House unanimously during the 2013 legislative session, and the Senate approved it 52-2.

The legislation would have restored sales tax exemptions for community health centers and volunteer charity clinics – tax breaks that had sunset (expired automatically) in 2010. Other exemptions would have gone to food banks; hunger relief nonprofits; food donated for disaster relief; and for Goodwill.

If the bill had not been vetoed, medical and other supplies that these nonprofits buy would not have a sales tax imposed. The fiscal impact of the bill would have been a total of $9 million over three years in state and local tax revenue.

Deal’s veto message on HB 193 notes that a 2010 tax reform council recommended that all non-government and non-business exemptions sunset so the Legislature can decide whether they justify being renewed.

Deal said in his message that he would ask the Competitiveness Initiative task force to review the bill and render an opinion on whether it is justified.

But Alan Essig of the Georgia Budget and Policy Institute told GHN in an interview Tuesday that this principle of reviewing tax breaks “was used selectively’’ by the governor. Deal signed a tax break bill that will benefit Gulfstream, and that will cost the state more in tax revenue than the break for charities would have, Essig said.

There are “clear public benefits’’ to the charities bill, Essig said, and “no public benefits to House Bill 164,’’ which renews a sales tax exemption for parts used in repairing and upgrading aircraft registered to out-of-state owners. It will primarily benefit Gulfstream, a luxury aircraft maker headquartered in Savannah.

Deal’s use of the Competitiveness Initiative task force, Essig said, ‘‘came out of left field.’’ That body mainly has to do with economic development, he said, and it hasn’t met since last year.

Brian Robinson, a spokesman for the governor, said, ‘‘The Gulfstream tax issue was a renewal. Moving forward, we want to have a system in place for groups seeking exemptions so that [the process is] not piecemeal. Yes, the Competitiveness Initiative council will be meeting again, and that’s where this process will begin.’’

The veto came as a surprise to people who followed the charities bill, including its sponsor, state Rep. Ron Stephens (R-Savannah), a pharmacist.

Duane Kavka, executive director of the Georgia Association for Primary Health Care, whose members include 28 federally qualified health centers (FQHCs) with 141 clinic sites, said ‘‘any money our members save is put back into services to the uninsured.’’

Donna Looper, executive director of the Georgia Charitable Care Network, which has more than 100 clinics, told GHN that the veto was puzzling to her. “Any money that the clinics don’t have to spend paying sales tax goes right into patient care,’’ she said.

The free clinics and the FQHCs are a major part of the health care safety net in Georgia, serving the state’s large number of uninsured.

By Andy Miller for Georgia Health News, 2013. | Permalink | 6 comments | Safety Net

Then she took the leap.

“I’ve always wanted to do something to help other people, but I also had to be practical,” said Tench, who graduated from Habersham County High School in northeast Georgia in 2011 and attends nearby North Georgia Technical College.

“Everyone hears about the tangible benefits of going into nursing nowadays, from other nursing students, from schools. It pays well, and people will always require health care, so there will always be a need for nurses,” said Tench.

It’s true that the need for nurses will never disappear, and the U.S. Bureau of Labor Statistics has projected that 711,900 new nursing jobs will be created by 2020.

But in the current economy, the job prospects for a nurse are surprisingly uncertain.

For years, the profession suffered from labor shortages, and a nursing degree was considered a sure ticket to a job. Now many new graduates struggle to find work.

More than one-third of newly licensed RNs graduating in 2011 had not found employment four months after graduation, according to a September 2011 survey of more than 3,700 new RN grads by the National Student Nurses Association.

Eighty percent of the grads said employers were hiring only RNs with at least two years of experience; 70 percent said the market was flooded with new graduates like themselves; 45 percent encountered hiring freezes; and 20 percent said that even previously employed RNs were being laid off.

“I’ve seen so many television ads sponsored by nursing schools, and I’ve listened to several recruiters from local and state schools, and they all really focus on the need for new graduates,” Tench said.

Today, unemployed nurses – with and without experience – are sharing their frustrations by joining allnurses.com, a social media site for nurses. New graduates dominate the site’s opening page. A sampling of four posts from the site shows the level of worry, even desperation:

“I can’t get a job. I have a degree and I have a license and I have many loans and bills that are due.”

“I’m working at a retail store in the mall.”

“Out of the seemingly hundreds of applications I’ve put in, I’ve had only two interviews, neither of which worked out. At this point, I’m feeling pretty hopeless and really just need a job.”

“Help!!! I’ve tried hospitals, nursing homes, and doctors’ offices. I’ve stayed up all night crying about this for months, and I feel like by the time I do finally get a job I’ll practically [have forgotten] everything I’ve learned!”

The weak economy is the main reason for the disconnect between expectations and reality, says David Auerbach, a health economist at RAND Corporation. Many hospitals need more nurses but can’t afford to pay them. Retirement-age nurses are staying on as long as they can because they need the pay. And many nurses who used to take a hiatus in their 30s to raise children are no longer doing so because their spouses have lost jobs.

The situation is not completely hopeless, though, says Peter Buerhaus, an RN and health economist at Vanderbilt University School of Nursing. As the economy gets better, he says, there will again be a nursing shortage, and hiring will resume.

While studying to be a nurse at NGTC, Tench works at a supermarket, a job that helps her pay the bills that go with a college education.

And a job as a nurse, she hopes, will help cover any bills that are left over after graduation.

Alyssa Sellers is a graduate student at the University of Georgia. She is currently pursuing a master’s degree in journalism and mass communication with a concentration in telecommunications.

By Alyssa Sellers for Georgia Health News, 2013. | Permalink | 6 comments |

A unique collaboration between the Georgia Association of Physician Assistants (GAPA) and Georgia State Parks seeks to promote physical fitness in a fresh-air way.

For a day trip to one of Georgia’s state parks, there’s normally a $5 parking fee. But nowadays, physician assistants in the state can hand out “Rx For Fitness” prescriptions that allow that charge to be waived.

Will park visitors find a canyon trail more exhilarating than a stationary treadmill? “That’s the hope,” says Kim Hatcher, a spokeswoman for the Georgia State Parks and Historic Sites. “The state park is a perfect diversion from a neighborhood sidewalk.”

Physician assistants are licensed and authorized by the state to practice medicine with the supervision of a licensed physician. Georgia PAs, like other health care providers, are concerned about the statewide obesity rate and fitness levels.

Overall, almost 30 percent of adult Georgians were obese in 2010, according to CDC.

Barbara Burk, a PA from North Georgia, says she’s written more than 200 prescriptions for hiking over the past 12 months. “It’s a good way to get people out, and we all have to start somewhere,” she says. “Your age or ability doesn’t matter — almost everyone can enjoy walking.”

A staircase in the great outdoors

Amicalola Falls. Photo from Georgia State Parks & Historic Sites

“The most enthusiastic participant for walking in our parks has to be Jack Fussell,” Burk says.

Fussell, 62, of Talking Rock, says he chose the park stairs at Amicalola Falls State Park to lose more than 100 pounds, which he now credits with saving his life. Amicalola Falls is the highest waterfall in Georgia, and the park, near Dawsonville, has 1,208 stairs (round trip).

Mary Vacala, GAPA’s past president, was determined to help make a difference in patients’ fitness. “GAPA was in good shape,” she said, “but I couldn’t say the same for many orthopedic patients I see in Savannah.”

She started thinking about a “Commit to Get Fit” campaign slogan that she and her board members were planning. Ironically, they were contacted by the state park people about the same time. An orthopedic PA for more than 25 years, Vacala knew the state park Rx For Fitness program was an opportunity to start a conversation with her patients about the importance of weight and wellness.

“People often come into our office with knee and hip problems,” she says, but in many cases they are not thinking about being overweight as the root of their pain.

Major problems brought on by excess weight include diabetes, heart disease and high blood pressure. “Those can kill you,” notes Vacala. “But the orthopedic troubles tend to make those problems even worse. People who are too heavy don’t enjoy any type of movement, and every pound adds more stress to their painful joints.”

As one of 11 children, Vacala learned to eat quickly, and not too much, at a young age. “I’m known for my ‘push-away’ exercise rule,” she says. “Push away from the table is the best advice I can give someone who’s too heavy.”

Vacala has always enjoyed exercise in the form of walking, running and experiencing the great outdoors. When exercise is fun, studies suggest that people tend to stick with a plan. She can attest to that from her own experience.

And outdoor exercise is not just for lone fitness buffs. “Another benefit to this walking program,” says Georgia State Parks Director Becky Kelley, “is being able to take your friends and family along.”

There’s even a program for exercising your dog. The Georgia Veterinarian Medical Association and Georgia State Parks collaborated on the Pet Rxercise program.

Like people, dogs that begin a regular exercise program should go slowly at first, gradually trying to increase their walking time, speed and distance.

Georgia State Parks and Historic Sites cover more than 77,500 acres of natural beauty, with more than 500 miles of trails. In April, the Georgia Department of Natural Resources announced an award of $1.66 million in new grants for Georgia trails. These projects will provide the public added places for walking, running, riding and paddling.

“Our state’s enthusiasm for hitting the trails and paddling the rivers is growing,” says Kelley.

Fussell, meanwhile, has taken exercise a step further. He’s now running from Savannah to Monterey, Calif., to raise awareness and funds for Alzheimer’s disease.

Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.

By Judi Kanne for Georgia Health News, 2013. | Permalink | 3 comments | Public Health

The Centers for Medicare and Medicaid Services has pushed for a decrease in the use of antipsychotics in managing dementia patients in nursing homes.

Prescribing these drugs for behavior problems is considered “off-label’’ use, meaning they are being employed in a way that’s different from their FDA-approved purposes. Off-label prescribing is a legal and very common practice.

Yet antipsychotics increase the risk of death, falls with fractures, hospitalizations and other complications for nursing home residents, leading to high medical high costs. Roughly half of Georgia’s nursing home patients have dementia, industry officials say.

Georgia had one of the highest rates of use of antipsychotics in 2011. Only Louisiana and Tennessee exceeded Georgia’s rate of 28.9 percent of patients. The state’s current rate of 24.2 percent is still above the national average of 22.2, according to the nursing home industry, citing CMS statistics.

Over the course of 2012, Georgia nursing homes reduced the off-label use of these drugs by 16.3 percent. During the same period, the industry reduced the use of these medications nationally by 5.9 percent.

“We’re extremely encouraged to see Georgia facilities stepping up to the challenge,’’  Jon Howell, president and CEO of the Georgia Health Care Association, which represents nursing homes, told GHN on Tuesday.  “We’re proud of the results.’’

Howell noted Georgia’s high rate, saying, “Georgia had some work to do. We really wanted to address this.’’

He added that nursing homes would continue to seek reductions in this medication use, along with pursuing other initiatives to reduce hospital readmission rates; decrease staff turnover; and boost patient satisfaction.

Howell said the Georgia Health Care Association partnered with Alliant GMCF, the Medicare Quality Improvement Organization for the state, on training for those facilities that had a higher percentage of antipsychotic usage.

Kathryn Fowler of the Georgia Council on Aging told GHN on Tuesday that such drugs have been used too frequently for behavior control in nursing homes.

Research has revealed that more than one in five nursing home patients nationally receive an antipsychotic drug, generally off-label.

“The prescribing of antipsychotic medications persists at high levels in U.S. nursing homes despite extensive data demonstrating marginal clinical benefits and serious adverse effects, including death,” Becky Briesacher and colleagues at the University of Massachusetts in Worcester wrote in a research letter in the Feb. 6 issue of the Journal of the American Medical Association.

Drugs used were often from the atypical class of antipsychotics, which are primarily intended for the treatment of schizophrenia and bipolar disorder, such as Seroquel, Risperdal and Zyprexa, the Massachusetts researchers said.

In addition to dangers associated with antipsychotic medications for the elderly, use of these drugs can also be expensive to consumers and Medicare. Atypical antipsychotic medications cost more than $13 billion in 2007, nearly 5 percent of all U.S. drug expenditures, CMS has reported.

By Andy Miller for Georgia Health News, 2013. | Permalink | 2 comments | Health Costs, Long-Term Care

The Albany system, among other revisions, has reduced the “look-back’’ period for financial documents to three years from seven years requested in the subpoenas it recently sent to all hospitals in the state.

But the reduction of documents requested may not be enough to satisfy hospital officials around the state.

The Phoebe Putney subpoenas have forced a flurry of legal work for hospitals and created widespread concern about the scope and cost of such an effort.

Health care attorneys say the breadth of the request, and the fact that it includes all Georgia hospitals, is unprecedented in the state. “In my 43 years of experience, I’ve never seen anything like it,’’ Marc Peterzell, an attorney for Arnall Golden Gregory in Atlanta, said Monday.

The Georgia Hospital Association, in a May 2 memo to hospital CEOs, obtained by GHN, said that hospitals say their burden in responding to the Phoebe Putney subpoenas “is unreasonable and will be time consuming and costly.’’

The Phoebe Putney subpoenas were the latest tactic in a two-year-old court battle with the FTC over the local hospital authority’s 2011 acquisition of Palmyra Medical Center.

The federal agency, which has opposed the Albany consolidation as anti-competitive, recently won a favorable ruling in the case from the U.S. Supreme Court. The justices unanimously set aside two previous court decisions upholding the Phoebe-Palmyra merger and ruled that the legal challenges to it can continue.

The same May 2 GHA memo includes a copy of a Phoebe Putney attorney’s email that says it would reduce its request for hospitals’ financial documents from 2010 onward instead of 2006. Other changes recounted by Phoebe attorney Tommy Chambless in his email include deleting requests for information about hospitals’ insurance contracts and services provided, demanded in the longer of the two forms of subpoenas sent by Phoebe.

The email from Chambless to a GHA official continued, “The incredible and unreasonable timeline imposed upon us by the Federal Trade Commission gave our attorneys no choice but to throw the broad net out . . . We are not happy bringing problems to our friends, and we want to continue to work toward [a] resolution everyone can live with.”

Chambless, in the email to GHA attorney Temple Sellers, also said that any confidential information requested would not be viewed by Phoebe officials, but only by the outside legal team and consultants working for the hospital system.

“Understand Phoebe will never see documents and data that is hospital specific and submitted as confidential and under seal. Only outside counsel and consultants will see that information, not us.’’

The May 2 memo from GHA’s president, Joe Parker, said the association’s board has requested that Phoebe Putney reduce its document request still further, by, among other things, withdrawing the subpoenas sent to small rural “critical access” hospitals and to hospitals outside Phoebe’s service area “if statewide information is not required.”

GHA also asks for an agreement “to pay the reasonable costs for hospitals to produce the requested documents’’ and an extension of the deadline to deliver the documents, now set at May 21.

Health care experts say Phoebe Putney’s strategy in issuing the subpoenas may be to prove that its own market is competitive in terms of pricing of services and access, or to prove that other hospital systems have similar control over their own markets.

Putney Putney acknowledged the breadth of its request in an interview with GHN last week. “We understand it’s going to be a burden to other hospitals,’’ said Phoebe spokesman Rick Smith. “It’s unfortunate that all this information has to be sought.’’

The $195 million deal, which consolidated operations of Phoebe Putney and Palmyra, was completed in December 2011. Phoebe officials have noted that the integration has proceeded to the point where it would be very difficult to unravel.

An administrative trial on the merits of the acquisition is scheduled to begin Aug. 5. The hearing is expected to explore whether the merger has an anti-competitive effect on the Albany marketplace.

By Andy Miller for Georgia Health News, 2013. | Permalink | 3 comments | Hospitals

Mohammed K. Ali, professor of Global Health at Emory University’s Rollins School of Public Health, led a CDC team that analyzed the health data of people with diabetes from 1999 to 2010. Their findings were published recently in the New England Journal of Medicine.

Diabetes takes a heavy toll in Georgia and across the South. From 1995 to 2010, Georgia experienced a 145 percent increase in its rate of diabetes. Proper care of the disease is a big factor in the state’s overall health statistics and even its economy.

In this video interview, courtesy of Emory University, Ali discusses with GHN the central findings of the study and how the data could help in assessment of reforms created by the Affordable Care Act.

Click here to view the embedded video.

By Andy Miller for Georgia Health News, 2013. | Permalink | Comment | Health Costs, Public Health

One in five Georgia adults meets the aerobic and muscle-strengthening guidelines for physical activity, equaling the national average, according to a CDC report released Thursday.

Georgia’s 20.7 percent of physically fit made it third in the Southeast. Only Virginia, at 22.7 percent, and Florida, at 21.4 percent, did better among states in the region. Tennessee was at the bottom regionally, with 12.7 percent.

The guidelines recommend that adults get at least 2½ hours a week of moderate-intensity aerobic activity such as walking, or one hour and 15 minutes a week of vigorous-intensity aerobic activity, such as jogging, or a combination of both.

The federal recommendations also say adults should do muscle-strengthening activities, such as push-ups, sit-ups, or exercises using resistance bands or weights. The muscle work should involve all major muscle groups and be done two or more days per week, according to the guidelines.

Strength training helps build muscle tissue and fiber, and increases an adult’s metabolism, said Jennifer Gay, a physical activity expert at the University of Georgia College of Public Health who commented on the report’s findings to Georgia Health News.

With muscle strengthening, “when you eat foods with a lot of sugar in them, your body is better able to handle the sugar and turn it into energy,’’ Gay said Thursday.  The emphasis on strength training has increased over the past two decades, she added.

The West (24 percent) and the Northeast (21 percent) had the highest proportion of adults meeting the aerobic and muscle activity guidelines. Women, Hispanics, older adults and obese adults were all less likely to meet the standards.

The report finds that nationwide, nearly 50 percent of adults are getting the recommended amount of aerobic activity and about 30 percent are engaging in the recommended muscle-strengthening exercise. Georgia’s averages in those categories are right at the national marks.

“Although only 20 percent of adults are meeting the overall physical activity recommendations, it is encouraging that half the adults in the United States are meeting the aerobic guidelines and a third are meeting the muscle-strengthening recommendations,” said Carmen Harris, epidemiologist in CDC’s physical activity and health branch, in a statement.

“This is a great foundation to build upon, but there is still much work to do,” Harris said. “Improving access to safe and convenient places where people can be physically active can help make the active choice the easy choice.”

(Here’s an Athens Banner-Herald article on the importance of walkability in cities.)

Georgia has been working hard to reduce its child obesity rates. CDC statistics, though, also show that two-thirds of adults in the state are overweight, and roughly 30 percent are obese.

More than two-thirds of adults in the United States are overweight or obese, and the rate has increased since the 1980s. It’s an expensive condition: Obesity-related health care costs reach $150 billion annually.

Regionally speaking, obesity rates are highest in the Southeast.

Georgians are becoming more aware of the issue of weight and obesity, as are Americans in general, UGA’s Gay said. The attention on child obesity in Georgia, she added, helps get adults “to think of their own bodies.’’

The physical activity data released Thursday are based on self-reported information from the Behavioral Risk Factor Surveillance System, an annual phone survey of adults aged 18 and over conducted by state health departments. The data are from the 2011 survey.

By Andy Miller for Georgia Health News, 2013. | Permalink | One comment | Public Health

The subpoenas were sent by attorneys representing Phoebe Putney Health System, which is locked in a long-running, contentious fight with the Federal Trade Commission over the 2011 Albany hospital merger.

A spokesman for Phoebe Putney told GHN on Wednesday that every Georgia hospital has been sent the requests, and so have some facilities in neighboring states if they treat Georgia patients.

There are two forms of requests. A subpoena to at least one hospital asks for financial statements from 2006 onward as well as medical quality reports, including those by the Joint Commission.

A subpoena to another Georgia hospital, however, asks for much more information, including documents on contracts, compensation, competition, services, pricing, and even the effect of the Affordable Care Act on the hospital if the state does not expand its Medicaid program.

“We understand it’s going to be a burden to other hospitals,’’ said Phoebe spokesman Rick Smith. “It’s unfortunate that all this information has to be sought.’’

The broad nature of the requests appears to have stunned the hospital industry in the state.

Health care experts say Phoebe Putney’s strategy may be to prove that its own market is competitive in terms of pricing of services and access, or to prove that other hospital systems have similar control over their own markets.

Tobin Watt, an attorney for Smith Moore Leatherwood in Atlanta, told GHN on Wednesday that several of the law firm’s clients have received subpoenas.

“I’m not sure where [Phoebe Putney] is heading with this,’’ Watt said. “You kind of assume they’re trying to build an economic picture of the hospital industry in Georgia and trying to demonstrate that their costs and charges are in the mainstream.’’

He said the request for information is especially burdensome for small rural hospitals.

The FTC recently won a favorable ruling in the Phoebe Putney case from the U.S. Supreme Court. The justices, in a unanimous ruling, set aside two previous court decisions upholding the merger, which combined Phoebe Putney Memorial Hospital and Palmyra Medical Center.

The high court ruled that the acquisition by the local hospital authority of Palmyra was not immune from antitrust scrutiny. The decision did not kill the merger, but left it on shaky ground, with legal challenges to continue.

The $195 million deal, which consolidated operations of Phoebe Putney and Palmyra, was completed in December 2011. Phoebe officials have noted that the integration has proceeded to the point where it would be very difficult to unravel.

Lower courts originally ruled that the Georgia General Assembly had already granted antitrust immunity to such deals through a hospital authorities law. The high court rejected that reasoning.

The FTC, which has been fighting the deal for two years, recently filed motions in federal district court seeking a temporary restraining order and preliminary injunction to stop the further integration of the only two hospitals in the Albany area.

An administrative trial on the merits of the acquisition is scheduled to begin Aug. 5. The hearing is expected to explore whether the merger has an anti-competitive effect on the Albany marketplace.

Smith cited the “compact space of time’’ that the Phoebe Putney legal team has before the next hearing.

“I’m not privy to the legal strategy,’’ Smith said. “These are all numbers relevant to the case – how it’s relevant, I couldn’t tell you.’’

An attorney in Washington, D.C., is available to Georgia hospitals if they have any questions, Smith said.

Phoebe Putney officials previously have said the FTC’s requests for a restraining order and injunction would prevent any improvements or renovations to enhance patient care at the facility.

“We will proceed to protect the organization and community interests in court,’’ said Tommy Chambless, Phoebe senior vice president and general counsel, in a statement at the time of the recent FTC court filings. “It’s unfortunate that so many resources must be committed by Phoebe, interfering with the Phoebe mission to deliver the best possible care and exceed the expectations of all we serve.”

During the 2013 Georgia General Assembly session, Phoebe supporters sought to blunt the FTC action against the deal by changing state law.

Legislation was proposed to buttress antitrust immunity for hospital authorities in Georgia – and make those protections retroactive. Theoretically that might have addressed the problem the Supreme Court found with the merger.  But the legislation failed.

By Andy Miller for Georgia Health News, 2013. | Permalink | 3 comments | Health Costs, Hospitals

The Georgia Hospital Association is an exception, however.

GHA, in a recent email to Georgia Health News, says it is studying the expansion issue. “We are still in the process of collecting data on the issue,’’ said Kevin Bloye, a GHA vice president. “Hopefully, we’ll be able to offer more on this in the near future.”

A state’s decision to reject Medicaid expansion would hurt a local hospital industry financially, experts say. The 2010 health reform law is expected to cost hospitals billions of dollars by reducing Medicare reimbursements and phasing out federal payments that compensate hospitals for providing free care to the indigent.

Georgia hospitals, for example, are projected to lose $400 million in federal indigent care funds under the Affordable Care Act.

The ACA assumed that most of these uninsured patients would get coverage through an expansion of Medicaid. The U.S. Supreme Court ruled last year, however, that states don’t have to expand Medicaid to cover such people.

And without expansion turning millions of uninsured people into paying patients, hospitals could come out as losers under the law, known colloquially as Obamacare.

About half the states plan to expand their Medicaid programs. If Georgia were to expand Medicaid – which the state’s current Republican leadership says it won’t do – more than 650,000 people would be added to the program’s rolls.

Privately, hospital officials in Georgia say they favor expansion, and two other hospital associations in the state are voicing support as well. But most of the talk about it is behind the scenes. Industry leaders appear to be leery of getting into a political battle right now over expansion.

A recent Stateline report, meanwhile, said hospital associations in other states have paid for television and newspaper ads, organized rallies, and choreographed legislative testimony in support of Medicaid expansion.

Uphill battle in Georgia

The roadblock to Medicaid expansion in Georgia is formidable. Gov. Nathan Deal has remained steadfast in his opposition to it, citing an estimated $4.5 billion cost to the state over 10 years. And his fellow Republicans in the state’s political establishment are not pushing for it.

Deal, who has expressed skepticism about the law’s federal funding guarantees, says Medicaid expansion would prove too costly to the state in any event, adding to the expense of a financially strapped program. He is running for re-election next year.

The Cover Georgia campaign, which pushes for Medicaid expansion, has just one hospital as a member – Grady, the big Atlanta safety net provider.

Expansion would cover people upfront with insurance, rather than the current system of hospitals seeking uncompensated care funds at the end of the process, said Cindy Zeldin, a leader of Cover Georgia and executive director of Georgians for a Healthy Future.

When asked why she thinks the state’s hospital industry isn’t working hard for expansion, Zeldin said, “I don’t know. It doesn’t make a lot of sense to me. We’ve seen hospital associations all across the country engage on this issue.’’

Part of the industry’s reluctance to push expansion may be linked to its huge legislative victory on the provider fee in the recently concluded General Assembly session.

Lawmakers passed a bill that paved the way for renewal of the hospital provider fee mechanism, which is expected to fill a hole of nearly $500 million in the financially squeezed Medicaid budget. In passing the measure, most Republican legislators had to tread carefully to avoid riling the anti-tax movement, a key GOP constituency that wanted the fee killed.

Industry experts say that in the aftermath of the legislation, the hospital industry may be lying low, waiting for federal approval of Georgia’s provider fee plan.

Still, officials with two other hospital organizations, HomeTown Health and the Georgia Alliance of Community Hospitals, each told GHN they support Medicaid expansion.

“We cannot afford not to do this, even knowing that there are so many uncertainties associated with Medicaid expansion,’’ said Jimmy Lewis, CEO of HomeTown Health, an organization of rural hospitals in Georgia.

If the state does not expand Medicaid, Lewis said, “Georgia taxpayers will be subsidizing other states’ expansions.’’

And Julie Windom of the Alliance of Community Hospitals said, “We certainly support expansion, especially given the elimination of [uncompensated care] funds in the ACA.

“We are just cautious about pushing too hard given the stance that state leaders have taken on the issue,’’ she said in an email. “We certainly understand that there are future financial obligations the state will encounter if they do expand.”

Outspokenness in other states

Elsewhere, the Florida hospital industry has aired commercials across the Sunshine State, saying the expansion would improve the health of residents as well as help hospitals, and would create thousands of new jobs. South Carolina’s hospital association trumpets expansion on its website.

Craig Becker, president of the Tennessee Hospital Association, noted that hospitals in his state stand to lose $5.6 billion at a time when 58 facilities, mostly rural, are already losing money every year.

“I can’t wrap my head around those numbers,” he told Modern Healthcare. “This is a tax on hospitals. Why should we send those tax dollars to California, New York or Vermont, or even New Jersey?”

Mississippi hospitals recently backed away  from their call for full Medicaid expansion. But according to Mississippi Public Broadcasting, hospitals there still insist they need something like Medicaid expansion or they will have to cut services or lay off staff.

The projected benefits of Medicaid expansion would include an economic boost for Georgia, a recent report found.

An estimated 70,000 new jobs would be gained if Deal approved expansion of the state’s Medicaid program, according to the report, from Georgia State University’s Bill Custer.

The study also said expansion would produce an economic impact statewide of $8 billion annually.

And a recent article from the progressive-leaning Center for American Progress, citing a  New England Journal of Medicine study on higher mortality rates for the uninsured, said Medicaid expansion could save more than 1,100 lives per year in Georgia.

By Andy Miller for Georgia Health News, 2013. | Permalink | 4 comments | Hospitals, Medicaid, Safety Net

Now that decision apparently will cost the state a shot at federal money for HIV/STD prevention.

In an April 4 letter from a Department of Education official to the CDC, the state said it would not apply for a round of federal funding for HIV/STD education because “it will not be able to comply with the new requirements.’’

Those new rules from the CDC require a state to include sex questions in the Youth Risk Behavior Survey in order to qualify for the extra funds.

Those questions include: Have you ever had sexual intercourse? The last time you had intercourse, did you or your partner use a condom?

For years, Georgia students have answered survey questions on other types of behavioral issues, such as carrying a weapon, wearing a seat belt, being bullied, using tobacco, having symptoms of depression, drinking alcohol, and using illegal drugs.

But not on sex. “There were some sensitive questions that many districts have not felt comfortable answering in the past, and we wanted reliable results,’’ Department of Education spokesman Matt Cardoza said in an email to GHN.

The agency has been receiving roughly $200,000 a year in federal funds to fight HIV. That money will go away under the new requirements. The state also receives money for monitoring the disease, albeit a lesser amount, and that funding does not require the sex questions to be asked.

HIV takes a heavy toll in Georgia. The state is ranked sixth-highest in the nation for its cumulative reported number of AIDS cases through December 2009.

Jeff Graham of advocacy group Georgia Equality says that in 2011, there were 156 new diagnoses of HIV among Georgia teenagers, following 161 the prior year.

Also in 2011, almost 1,200 young people between ages 20 and 29 in Georgia received HIV diagnoses, he added.

“The CDC has revamped its HIV prevention strategies and is focused on high-epidemic states, such as Georgia,’’ Graham said Monday. “It’s discouraging that the state doesn’t want to apply for this funding.’’

By the time young people graduate from high school, almost two-thirds have had sex, the CDC says. Nearly 40 percent of sexually active students did not use a condom the last time they had sex.

Such risky sexual behavior can have serious health consequences: About 18 percent of all new HIV diagnoses are among people ages 13 to 24. Teenagers and young adults have the highest rates of sexually transmitted diseases (STDs) of any age group.

In addition, Georgia ranks 13th-highest in births by girls 15 to 19, and is second-highest in repeat teen pregnancies.

Georgia’s teen birth rate is 17 percent higher than the national average, costing Georgia taxpayers $465 million a year, according to a letter that advocacy groups sent to Gov. Nathan Deal last year. The letter urged him to rescind the state’s decision not to let sexual behavior questions be asked. (Here’s a GHN article about the letter to Deal)

The YRBS is sent at random to high schools. The process is anonymous, with no recording of students’ identities. A state Department of Education spokesman said Tuesday that local school systems decide whether to allow students to take the survey.

Though the effort is federally sponsored, each state decides which questions can be asked within its jurisdiction. Besides Georgia, other states prohibiting the sex questions last year included Louisiana, Utah and Virginia. A few states allowed some, but not all, of the sex questions to be asked.

The CDC said the survey data are needed to measure outcomes that contribute to the reduction of HIV infection and other STDs among adolescents.

The 2013 national YRBS is in the field right now, a CDC spokeswoman said. Data collection will be complete at the end of this school year, the official said.

By Andy Miller for Georgia Health News, 2013. | Permalink | 4 comments | Children's Health, Public Health

This is a high-traffic hospital, one of two in a county with nearly 115,000 people, but similar patterns can be seen in any hospital.

“We have a lot of frequent flyers in and out of here,” Blanton says.

Her responsibilities include keeping track of who is hospitalized on any given day, and she says some of the repeat admissions involve people who clog the emergency room as well.

“People do not see their doctor first, they just come into the ER,’’ she says. “This causes an overflow of patients.”

The repeat ER visits interfere with the hospital’s functioning and hurt the bottom line.

The federal government hopes to put an end to this “frequent flyer” problem through the new system of rewarding hospitals for quality care and penalizing them for readmissions.

Hospital readmissions cost Medicare close to $26 billion a year. Almost 25 percent of heart failure patients on Medicare, for example, are readmitted to the hospital within 30 days of discharge.

Overall, one in five Medicare patients returns to the hospital within 30 days of being discharged.

Carrot-and-stick approach

Officials with the Centers for Medicare and Medicaid Services (CMS) say readmissions could often be avoided if hospitals and health care providers altered how they prepare patients who are heading home.

“This is the kind of behavior which really doesn’t cost anything but pays really big,” said Mike Fierberg, a spokesman for CMS.

When the Affordable Care Act is fully implemented in 2014, it will reward not only hospitals – but also physicians – for improving the quality of patient care and for avoiding needless readmissions and other excess costs.

After coming home, some patients develop infections or other complications that make returning to the hospital the safest alternative.

But many other readmissions are not medically justified and could be avoided, Fierberg said. Simple preventive steps include:

* Better, more thorough pre-discharge counseling from health care providers.

* Better coordination between patients and providers they’ll rely on in the community, including their primary care physicians.

* Ensuring that patients have an ample supply of necessary medications and know how to take them.

* Making sure patients understand recovery or rehabilitation instructions.

The U.S. Department of Health and Human Services (HHS) will have to convene expert panels and define what constitutes high-quality, high-value care. These goals will be used to set up a grading scale, enabling CMS to issue an annual report card for hospitals and physicians, said Jordan VanLare in his 2012 article in the Journal of the American Medical Association.

This will be phased in over the next several years, and reducing unnecessary hospital readmissions is one of the goals of the new performance monitoring and reimbursement system.

Efficiency vs. compassion?

A total of 2,217 hospitals, or 71 percent of those eligible, are receiving penalties for having too many patients with heart attacks, heart failure or pneumonia return within 30 days, Kaiser Health News reported in October. They include South Georgia Medical Center.

From her vantage point in the Lowndes County facility, Blanton hopes that the new approach will have the intended effect, but she sometimes worries about unintended consequences.

Even though CMS says the ultimate goal is to improve individual care for everyone, Blanton – speaking as an older adult – worries that people in her age group will lose personalized care as Medicare strives to save money and reduce volume.

“I don’t want to be pushed out to sea on an iceberg” when no longer considered useful, Blanton said. “I just hope the government sticks to its promises.”

VanLare, on the other hand, believes that care will become more individualized, not less.

“I can find the innovative parts that are going to be most effective for my patients in my health system; high quality care is not just about following the process measures that come from a large consensus organization.”

“If measures are created that look at outcomes,” VanLare says, “doctors as well as hospitals can take a step back and ask themselves why their patients are being admitted and readmitted to hospitals when they shouldn’t be.”

The New York Times has reported that increasingly, health policy experts and hospital executives say the readmission penalties unfairly target hospitals that treat the sickest patients or the patients facing the greatest socioeconomic challenges.

Still, a recent study shows that hospitals can indeed improve on readmissions.

Fourteen communities in a national care improvement project — including an area in suburban Atlanta — saw a significant decrease in Medicare patients who were rehospitalized within 30 days of a discharge.

The Medicare readmission rate for an area served by Gwinnett Medical Center in Lawrenceville, Eastside Medical Center in Snellville, Rockdale Medical Center in Conyers and Newton Medical Center in Covington fell by 7.5 percent during the two-year program. This area — designated a community for purposes of the project — is east of the city of Atlanta. (Here’s a GHN story on the improvement project)

Overall, Medicare hospitalizations in that area fell by 7.37 percent.

The group of 14 communities nationally reduced readmissions by 5.7 percent over a two-year period, versus a 2 percent drop in a control group.

The study was published recently in the Journal of the American Medical Association.

Katie Ball is currently pursuing a master’s degree in health and medical journalism from the University of Georgia. Her reporting interests include research in medical technology and ustainable environmental practices.

By Katie Ball for Georgia Health News, 2013. | Permalink | Comment | Health Costs, Hospitals, Medicare

Saturday is national Drug Take-Back Day.

Georgia is again promoting the effort to prevent prescription pill abuse. Members of the public are encouraged to rid their homes of expired, unused or unwanted drugs.

The CDC has reported that prescription drug abuse is the fastest-growing drug problem in the United States. Unused drugs in the home can contribute to this abuse, and teenagers are especially prone to misuse pills left in medicine cabinets or drawers.

Some young people use such drugs at parties: They pour several different kinds of pills into a bowl and then take them at random.

The number of accidental poisonings and overdoses from these drugs has increased.

The Georgia Bureau of Investigation Medical Examiner’s Office says that  in 2011, 512 deaths were officially attributed to prescription drug abuse in Georgia. This statistic largely excludes metro Atlanta counties, so the real number is actually higher, law enforcement officials say.

“I am proud to partner with the DEA and local law enforcement to urge Georgians to clean out their medicine cabinets and discard old and unwanted prescription drugs,” said state Attorney General Sam Olens in a statement. “Unfortunately, prescription drug abuse is wreaking havoc in communities across Georgia, and many abusers obtain or steal drugs from family and friends.”

Improper drug disposal can also pose a threat to the environment. Flushing pills down the toilet, or throwing them into the trash, presents potential safety and health hazards.

The DEA’s sixth Drug Take-Back event is free and anonymous, and will be held Saturday from 10 a.m. to 2 p.m.

During the last event, held in September 2012, sites registered in Georgia collected 8,233 pounds of prescription drugs. Georgians have turned over more than 25,000 pounds of prescription drugs at Drug Take-Back Days since 2010.

Citizens can locate the nearest collection site by visiting the DEA website  or calling 1-800-882-9539.

Here’s a Carrollton Times-Georgian article about the event Saturday.

By Andy Miller for Georgia Health News, 2013. | Permalink | Comment | Children's Health, Prescription Drugs, Public Health

Georgia received mixed grades for its air quality in a new report released Wednesday.

The Atlanta-Sandy Springs-Gainesville area dropped out of the Top 25 cities in the nation for ozone pollution, ranking No. 28 in the “State of the Air 2013” report from the American Lung Association.

But the same area tied for 18th in annual particle pollution, worse than last year’s ranking of 24th.

Macon-Warner Robbins-Fort Valley, in roughly the center of the state, tied for 14th among the most polluted cities in the nation for annual particle pollution.

Meanwhile, Brunswick and Savannah-Hinesville-Fort Stewart, close to the Atlantic Ocean, were recognized as having no unhealthy days of ozone pollution.

The Lung Association report found that overall, the nation’s air is getting healthier, as a result of reduced emissions from coal-fired power plants and the transition to cleaner diesel fuels and engines. The improvement is especially noticeable in the eastern United States, the report said.

The analysis used pollution data compiled by the EPA in 2009, 2010 and 2011 for ozone, or smog, and for particle pollution, also known as soot.

“The air in Georgia is healthier than when we started the ‘State of the Air’ report 14 years ago,” Martha Bogdan, president of the American Lung Association in Georgia, said in a statement. “We saw some significant improvements, but there are still many areas of the state with unhealthy levels of smog and soot.”

Several of the reporting Georgia counties received an “A” for high ozone days, while others, especially around Atlanta, received an “F.’’

June Deen, state director of the Lung Association, noted that the metro Atlanta area had a slight increase in both ozone and particle pollution in the latest data. “We’ll see if this trend continues,’’ she said.

Ozone and particle pollution, or soot, are the most widespread air pollutants — and among the most dangerous. Ground-level ozone, a main ingredient of smog, has harmful effects, especially on children, older adults and people with respiratory illnesses.

Air pollution, including particulate matter, is linked to respiratory and heart diseases, cancer, premature death, and reduced lung function in children.

Researchers are continuing to find an association between air pollution and a range of health effects, said Jeremy Sarnat, a research professor in the Department of Environmental Health at Emory’s Rollins School of Public Health.

He cited a study that found an association between exposure of pregnant women to pollution and pediatric cancers.

“Atlanta is still an area where a lot of improvements need to be made,’’ Sarnat said.

“I don’t think we’re driving less in Atlanta,’’ he told GHN.

But cutting back on driving, Sarnat said, “is the single greatest thing we can do to improve our air quality.’’

By Andy Miller for Georgia Health News, 2013. | Permalink | Comment | Children's Health, Public Health

Georgia Health News reported earlier this month that data on 11 hospitals showed wildly exaggerated times for ER waits before patients were discharged. Waits for an emergency department patient to see a health care professional were also listed as alarmingly high.

Those figures were grossly inflated – and incorrect – due to the fact that arrival times of the ER patients at the 11 hospitals were wrongly coded when the information was sent to the feds. Georgia Hospital Association has admitted responsibility for the error.

Centers for Medicare and Medicaid Services (CMS) officials told Georgia Health News when the error was uncovered that they were not changing the numbers.

But with newly updated figures, which are mixed in with the older, inaccurate numbers, Archbold Medical Center in Thomasville now is listed as 684 minutes as an average waiting time for a patient before being sent home. That’s down from 1,115 minutes, which was Archbold’s listed wait time last week.

And its average wait time for an emergency department patient to see a health care professional dropped to 569 minutes from 1,022 minutes.

“The effect you see is from the second quarter data we submitted being included with the first quarter data,’’ said Mark Lowe, an Archbold official, in an email to GHN.

The other Georgia hospitals with wildly exaggerated wait times listed were Memorial Hospital of Adel; North Georgia Medical Center in Ellijay; Berrien County Hospital in Nashville; Southeast Georgia Health System’s Brunswick and Camden hospitals; McDuffie Regional Medical Center in Thomson; Burke Medical Center in Waynesboro; Chatuge Regional Hospital in Hiawassee; Newton Medical Center in Covington; and Jeff Davis Hospital in Hazlehurst.

Some, but not all, of these hospitals’ wait times have shrunk similarly to Archbold’s drop.

A CMS spokesman told GHN that the quarterly update of the Hospital Compare website was done last week, and newly submitted data had been included.

A GHA vice president, Kevin Bloye, said Tuesday that “three months of good data is now being averaged with three months of bad data to make the data better than before, but still skewed unfavorably and inaccurately.’’

As part of the range of statistics on hospital quality, federal officials recently started reporting emergency room waiting times.

Long waiting times in hospital emergency departments can increase risks for patients, especially those who have serious illnesses, CMS’s website says.

Waiting times at different hospitals can vary widely, depending on the number of patients seen, ED staffing, efficiency, admission procedures, or the availability of inpatient beds, the federal site adds.

By Andy Miller for Georgia Health News, 2013. | Permalink | 2 comments | Hospitals

Meanwhile, the Atlanta health system received 5,000 calls to its hotline fielding queries about possible concussions.

Dr. David Marshall, medical director for sports medicine at Children’s Healthcare, told GHN on Tuesday that he does not believe the incidence of concussions has jumped, but that public awareness of them “has exploded.’’

Marshall, CEO Donna Hyland and other Children’s Healthcare officials spoke of the importance of proper concussion treatment at a ceremony Tuesday at the health system’s Scottish Rite campus that featured Gov. Nathan Deal signing the Return to Play Act into law. The measure was passed by the General Assembly during its recently concluded session.

The main provisions of the act include informing parents or guardians of school athletes of the consequences of concussions, and educating coaches and school training staff on how to recognize symptoms.

And under the bill, any player with a concussion must be removed from a game until a health care provider clears the athlete to return.

A concussion that goes untreated can have serious medical effects, Deal told a crowd of health officials, legislators, NFL officials and health advocates at the bill-signing ceremony.

“I am proud to sign this bill that serves to protect Georgia’s young athletes from sustaining very serious injuries if the condition goes unnoticed or untreated,”  Deal said.

More than 40 states have passed similar concussion legislation.

Gov. Nathan Deal signs the Return to Play Act into law as state lawmakers, Children’s Healthcare of Atlanta officials, Falcons president Rich McKay and team mascot Freddie the Falcon look on, along with Children’s mascots

The Georgia law also applies to cheerleaders, who are often at risk of head injury but do not wear any protective headgear.

Recreation sports leagues must provide the parents with the information sheet on concussions. The leagues are also encouraged, but not required, to take the other steps.

Marshall of Children’s Healthcare told GHN that the Georgia legislation is “a tremendous first step’’ in educating young athletes, schools, medical personnel and parents about the possible serious medical effects of concussions.

The CDC estimates that up to 3.8 million concussions related to sports or recreation occur every year in the U.S. (Here’s a Children’s Healthcare concussion toolkit  about signs, symptoms and treatment.)

Former football players, hockey players and other athletes have reported having serious neurological issues in retirement. Hundreds of former pro football players are suing the NFL over concussion-related health problems.

The NFL, while it denies the claims, has gotten tough against helmet-to-helmet hits by players, as well as instituting a league-wide sideline testing protocol for concussions.

In March, the league passed a rules change that will ban players from delivering forceful blows with the crown of the helmet.

The NFL supported the Georgia legislation, noted Rich McKay, the Atlanta Falcons president, who spoke at the bill ceremony.

Too often in the past, players have suffered concussions but have been put immediately back into games or simply continued playing, experts say. (Here’s a GHN article from last year on this issue.)

During Tuesday’s signing, Deal was joined by a 12-year-old lacrosse player who suffered a concussion when she was hit in the head by a ball during a lacrosse clinic.

“I saw black flashes, like you were in a different world for a couple of minutes,” she told 11Alive News.

Also attending the ceremony was state Rep. Demetrius Douglas (D-Stockbridge), a former UGA linebacker, who told GHN recently that he probably had concussions as an athlete, though he wasn’t aware of it.

The goal of the legislation is to prevent long-term injury, Douglas told GHN.

“Kids want to play the game but don’t understand [the impact] on the brain,’’ he said.

By Andy Miller for Georgia Health News, 2013. | Permalink | 2 comments | Children's Health