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Health Costs

Settlement ends long fight over Phoebe merger

The Federal Trade Commission and a South Georgia health system have reached a settlement in a four-year hospital antitrust case that drew national attention and was the subject of a U.S. Supreme Court ruling.

sealUnder the agreement, Phoebe Putney Health System will not have to jettison the former Palmyra Medical Center, which it acquired in 2011 for $195 million. Palmyra was Phoebe’s sole hospital competitor in the Albany market. It now operates as Phoebe North.

The agreement is similar to one that the two sides reached in 2013. The FTC backed away from that deal last year, but this one is final.

The federal agency has contended throughout the legal tangle that Phoebe’s acquisition of Palmyra violated antitrust laws, reducing competition and potentially raising prices for consumers in southwest Georgia.

But FTC officials, in a statement Tuesday, cited restrictions under Georgia’s certificate-of-need (CON) laws as the reason they’re giving up their effort to force a divestiture of Palmyra. CON laws in Georgia regulate the construction and expansion of health care facilities. full story

Autism bill appears stalled in Georgia House

The fight over autism treatment coverage continued in a House committee hearing Monday, pitting organizations concerned about costs against those advocating for the most effective services for children.

Sen. Charlie Bethel

Sen. Charlie Bethel

Senate Bill 1 would require many health insurance plans to cover applied behavior analysis (ABA), a treatment designed to help young children with autism reach their full potential in learning ability.

The issue is contentious. A similar bill was unable to win approval last year, stymied in a standoff between the Senate and the House. And the House Insurance Committee hearing concluded Monday with no vote taken on the bill.

The General Assembly session is expected to end next week.

One in 68 children has been diagnosed with autism nationally, with a Georgia rate of 1 in 64.

Sen. Charlie Bethel (R-Dalton), the legislation’s main sponsor, told the House panel that autism “is a public health crisis in all of our communities.”  full story

Health IT is big, and Georgia is its epicenter

Chris Hooper and his startup firm, Emergence, are betting on the boom in health information technology.

Chris Hooper

Chris Hooper

Launched last year as an “accelerator,’’ Emergence will take fledgling health IT companies and get them ready to pitch investors for funding. It will also help medical device companies get their new products established.

“One of the only good things’’ about the Affordable Care Act, CEO Hooper says, is its push for cost savings in health care, and for data derived from electronic medical records. “Health IT is a high-growth area,” he says.

Emergence, located in Alpharetta, could not have picked a better place to operate. Industry leaders say Georgia is the nation’s health IT capital. The boom is statewide, but particularly strong in metro Atlanta.

More than 250 health IT companies are located in the state, employing more than 30,000 workers, according to the Technology Association of Georgia. full story

Devil’s in the budget details for state workers

The budget issue that has most rattled the General Assembly this year involves the proposed elimination of health insurance for 11,500 part-time school employees, mainly bus drivers and cafeteria workers.

Gov. Nathan Deal, defending the insurance cut for these “non-certificate” school workers, argued that it’s a matter of fairness to other state employees who work part time but don’t qualify for benefits.

The Georgia House, feeling the heat from the public over the unpopular proposal, put the benefits for the non-certificate workers back into the budget. But the legislators shifted that cost – more than $100 million – to the local school districts. That sparked a new outcry.

1280px-ICCE_Fist_Student_Wallkill_busAnd as the debate continues about who should pay these costs, a state document circulated by a Georgia blogger has raised eyebrows about what the State Health Benefit Plan (SHBP) is saving under its current insurance setup.

The document was generated in 2013 by the Department of Community Health, which runs the SHBP. According to the document, the projected savings of the switch to a single health insurer was to be $1.8 billion over three years – for 2014, this year and next.

“Some folks seeing [the savings document] for the first time are starting to question it,’’ says John Palmer, a leader of the group Teachers Rally to Advocate for Georgia Insurance Changes. The group, known by the acronym TRAGIC, helped push for changes in the state health plan last year.

“People want some answers,” Palmer says, adding that state leaders “keep saying the sky is falling with the budget.”  full story

Key legislator blasts Blue Cross as arrogant

The chairwoman of a key House health panel has gone on record as saying that Georgia’s largest health insurer is acting as a “bully’’ in its dealings with medical providers.

State Rep. Sharon Cooper (R-Marietta) also said Blue Cross and Blue Shield of Georgia “disrespected” the House Health and Human Services Committee by failing to send a representative to the panel’s meeting Monday, which discussed complaints against the insurer.

Rep. Sharon Cooper

Rep. Sharon Cooper

The comments were part of an intense hearing at the state Capitol on the insurer’s actions in the Georgia market. Blue Cross is by far the biggest health insurer in Georgia.

“I have never heard this many complaints [from medical providers] in terms of getting contracts,’’ Cooper said at the panel meeting.

The health committee also passed a bill that would establish safety requirements when a patient is switched to a special “interchangeable biological” drug. These medications are not yet on the market, but could provide cost savings to consumers in the future.

But Cooper and other lawmakers focused most of their energy on Blue Cross. full story

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