A subcomittee of the House Judiciary – Non Civil Committee amended and advanced a bill that would require insurers providing services to the State Health Benefit Plan to treat all level 1 trauma centers as in network. The amendment added the state’s critical access hospitals to the list that must be in the provider’s network.
House Bill 354 is sponsored by Rep. Barry Fleming of Harlem, and came about after Blue Cross – Blue Shield, which is the provider for the State Health Benefit Plan, decided not to cover treatment at Atlanta’s Grady Hospital as in-network. Grady is one of the state’s five trauma centers–the rest are in Augusta, Savannah and Macon–which are extensively staffed in order to provide any type of care needed when a person suffers a serious injury.
Grady Hospital CEO John Haupert testified before the subcommitee that state employees were having to pay significant costs they can’t afford because Grady is out of network. For example, he cited a woman suffering from gynocological issues who received at $25,000 bill, and an individual with respiratory issues whose bill came to $14,600 out of pocket. Noting that Grady is part of the Medicaid provider network and that the State Health Benefit Plan is self insured, he argued that the state owed its employees the ability to go to where they could get the best care.
If passed, the bill would require a provider of benefits to the SHBP to include Level 1 trauma centers in its network, and would prohibit a provider from contracting with the SHBP if it does not include all Level 1 centers within its service area. The bill also provides for a method of dispute resolution involving binding arbitration if a service provider can’t resolve contract terms within 30 days. If the bill passes, Grady hopes to use that provision to be able to return to being in-network for the SHBP.
At present, Grady is the only trauma center that is is not in Blue Cross’s network, but Fleming is concerned that others could be next. During the hearing, Rep. Mary Margaret Oliver expressed concerns that while coverage by the Level 1 Centers will benefit those who live near them, it doesn’t help those who are further away. Georgia has 34 hospitals that are considered critical access hospitals by the Department of Community Health for Medicaid purposes, and while they don’t have the complete capabilities that a trauma center would provice, they are better able to provide emergency care than smaller hospitals. Read more
The New York Times on Saturday published a page A-1 story about how uninsured Georgians will have more difficulty getting healthcare after the Affordable Care Act (AKA Obamacare) kicks in in January. The article specifically focuses on two of the state’s largest safety net hospitals: Grady in Atlanta and Memorial Health in Savannah.
The issue arises because the authors of Obamacare assumed that most of the poor uninsured would receive treatment after they became eligible for an expanded Medicaid program. To help pay for that, they reduced funding for the Disproportionate Share Hospital Fund (DSH), which provides grants to states that are used to help hospitals that treat large numbers of indigent patients. Grady alone is expected to lose about $50 million in annual payments from the fund.
Following the Supreme Court decision that states could not be forced to expand Medicaid as contemplated in the ACA, Governor Deal announced Georgia would opt out, claiming the expansion would cost the state between $2.5 and $4.5 billion–money it doesn’t have. Without the additional revenue from treating the additional Medicaid patients, and facing the loss of most DSH funds, the hospitals are left with nowhere to go.
The issue that may ultimately doom the statewide T-SPLOST is the clash between the need for regional planning and the ultimate self-interest of rational voters. An economically-rational voter might consider the benefits he or she will derive from their extra penny sales tax and decide it’s not worth the cost.
I think this is part of what underlies the widespread opposition of commenters on this blog, where any post mentioning TSPLOST becomes an opportunity for MARTA-bashing by OTPers, and for “we’ve been paying for it for 40 years now it’s your ” by the smarter and better-looking denizens of intown neighborhoods. I’ve been guilty of that last part myself, not just in regards to MARTA but also Grady Hospital.
In the 1990s, this dynamic played out along Johnson Ferry Road, where Cobb County residents pushed for widening in order to ameliorate rush-hour traffic but Fulton homeowners opposed the widening that threatened their front yards and homes.
With respect to the Atlanta metro area, we should understand that the benefits of a project are not necessarily constrained to its immediate area, but ramify outwards as bottlenecks are relieved, or demand sated elsewhere. OTPers who travel intown or across 285 benefit from the cars taken off the roads by MARTA, regardless of whether they ever step foot on bus or train. However, this type of benefit does not translate across larger regions, such as northwest Georgia where traffic hotspots tend to be local, population density lighter and the areas where transportation improvements receive more money are farther away.
Per the request of several commenters, we’ll open a discussion of Amendment 2. This amendment would allow the state to tax an extra $10 every year for every car tag you buy. Notice the word tax. That is what this is. You can try to call it a “fee” all day long, but it is revenue collected by state government to fund a somewhat nebulous concept of “trauma care” that is not directly related to the users who pay. It’s a tax.
But, because most of the legislators have drank from Grover Norquist’s Kool-aid at some point, they can never vote for anything that is a tax. Thus, the history of this legislature has been to try to make the voters tax themselves via referendums and constitutional amendments. And, they very much prefer the term “fee” to “tax”. Amendment two allows Georgians to tax themselves an additional $10 per year, per car. It doesn’t sound like much, but when was the last time you left the tag office saying “Dang, that was cheap. I just wish my tax on that car was even more! What will I ever do with this money left over here on my birthday?”
A couple of years ago, when Grady Hospital’s financial troubles could no longer be ignored even by suburban Republicans, a series of compromises was made on all sides to place Grady on tenable financial footing. The major concession by Grady was a complete reconstitution of its board of directors.
Marta stands next in line for the Grady treatment, according to the AJC, with an amendment to SB 22 poised to remake the Marta board. Again.
House Speaker pro Tempore Jan Jones said that the legislation (an amendment to SB 22) would reduce the current MARTA board from 18 to 13 voting members, with three appointed by the state. The governor, lieutenant governor and speaker would each appoint one voting member to make up that three. In addition, the Department of Transportation commissioner and the Georgia Regional Transportation Authority director would have non-voting seats.
Jones said it was to ensure balance on the board and make sure Fulton and DeKalb taxpayers were protected.
According to a copy of the amendment, this is how the 13 voting seats would break down:
State – 3
City of Atlanta – 3
DeKalb County – 4 (at least 1 from north DeKalb, at least 1 from south DeKalb)
Fulton County – 3 (1 from south Fulton, 2 from north Fulton)
Jones pointed out that nearly all of Fulton County’s population lives in municipalities, so it only made sense for mayors to make the appointments. She also said it was about protecting taxpayers.
I recommend clicking the link and reading Ariel Hart’s entire article, to get the true flavor of the points of contention, and the motivation for the change. Read more
Sam Massell, president of the Buckhead Coalition and former Mayor of Atlanta, has decided to weigh in on the proposed split of Milton County from Fulton with a “No” vote.
After Massell was defeated for re-election in 1973, he became the defacto voice of the Buckhead and North Atlanta areas, and is still affectionately known as Buckhead’s mayor.
His position, issued via the following press release, is significant because it represents somewhat of a shift in the coalitions that make up Fulton County Politics. Massell could often be counted on by those who felt their interests were not being represented at City Hall to be their point man, and he could often be counted to raise (and resolve) issues on their behalf.
But with Massell favoring the status quo for Fulton, he now finds himself squarely aligned with those at both City Hall as well as those in the Fulton County Government complex.
Time will allow a proper measure of the seismic nature of this shift, but as of now, Buckhead’s power center is aligned with Fulton, and not the folks North of the Chattahoochee.
Full press release here: Read more
And it is again not for something good.
A package containing confidential medical records sent via UPS to an address on Canterbury Lane in Lawrenceville ended up at the same street address only in Fayetteville.
The package contained the records of more than 40 Grady Memorial Hospital patients including names, Social Security numbers, medical conditions and diagnoses which were meant for a workers’ compensation office in Lawrenceville called MCMC.
“Grady Memorial Hospital officials are investigating a spike in Legionnaires’ disease. Four patients who were recently hospitalized at Grady have contracted the bacterial infection in the past month, according to Grady’s Web site. In a typical year, the hospital might see two or three cases,” reports the AJC.
As a Peach Pundit public service: if you have been hospitalized at Grady in the last month and you think you may be currently ill with Legionella, please call (404) 616-0600.
From this story in the Emory Wheel (admittedly from a few days ago):
Despite tight economic conditions, Emory will forgive $20 million of the $62 million that Grady Memorial Hospital, one of the largest public hospitals in the United States and Atlanta’s only level-1 trauma center, owed to the University since Jan. 1, 2008.
Sarah Goodwin, director of media relations for health sciences communication, wrote in an e-mail to the Wheel that this decision will require Emory to make some sacrifices because the portion of the debt that will not be paid back constitutes nearly one-third of the total and is ultimately “foregone funds” to Emory Healthcare and the School of Medicine.
And I only mean that with half of the sarcasm that the headline may express.
I pretend to be an expert on many things. One area that I do not attempt this is our bizarre and complex system of health care and its funding. While our country still manages to deliver the world standard for medicine, the way we do so, and more specifically, the way we fund it, appears to be overly complex, bureaucratic, and inefficient.
I’ve been warning for years that if Republicans don’t come up with some kind of market based reform of the system, we would ultimately accept the reforms the democrats give us. At the national level, we’re probably on the verge of that.
But at the state level, Republicans are still in charge. And the man most in charge, Governor Perdue, has apparently decided that the best way to generate the additional money hospitals need for a statewide trauma network is to tax the hospitals themselves.
Wait, what? Read more
The money vacuum that is Grady Hospital is about to have another Captain at the helm.
For her part, [Lisa] Borders said she planned to spread the message that Grady is “an incredible resource and asset,” not only for those in need of health care but as an important part of the area’s economy.
“We have an opportunity as a community to lift up this resource, polish it and relish it,” she said.
And she’ll be asking for the money to do it.
Good to see nothing is going to change.
Any Job. Really, it doesn’t matter which one. Marta, Grady, heck, put me in charge of sanitation. I don’t care. Don’t worry about my qualifications, because the person I’m replacing apparently didn’t have any either. Just make sure I get the severence package that Pam Stephenson got from Grady, or Richard J. McCrillis got from Marta.
I promise to do some traveling to conferences around the country, learn why Atlanta’s infrastructure isn’t working, hire a few relatives, plea for state funds that will be totally unaccounted for, and then bail with a nice parachute. I promise to leave things even more messed up for the next guy/gal, so that they can demand and even bigger severance package when they sign on, thus continuing this circle of life.
That should be the new meme! Grady Hospital equals Macon, GA. Both get out negotiated.
Stephenson’s contract, with an annual salary of $600,000, stipulates that should the new hospital board replace her within the first year, she would be paid the remaining amount in the two-year contract. Should she leave in September, that could mean a parting check of about $750,000 or more.
News of the two-year contract has created concerns —- and objections —- among some Grady officials. The agreement was executed by the Fulton-DeKalb Hospital Authority, of which Stephenson is chairwoman, and was signed by Geoffrey Heard, vice chairman. Stephenson also serves as vice chairwoman of the new hospital corporation, the entity that assumed control over the hospital in late May.