Friday, October 29, 2010

GSACS Daily Briefing 10-29-10

Grady CEO apologizes for ‘shine my shoes' remark
The Atlanta Journal-Constitution  October 28, 2010

Grady's chief executive apologized Wednesday for saying Fulton County residents "should want to shine my shoes" for engineering the hospital's financial turnaround, according to Channel 2 Action News.

The TV station obtained a letter that CEO Michael Young sent to Grady Memorial Hospital's board of directors and the Fulton-DeKalb Hospital Authority. In it, he apologized for the comment he made to Buckhead business leaders.

"My statement was terribly [insensitive] to Fulton County taxpayers and does not reflect my true feelings," the letter states. "Please accept my heartfelt apology for this mistake and please keep in mind that it came from an innocent place. I often get excited about the changes we've made at Grady and the impact the health system is having on the community, and sometimes my words get ahead of my brain."

At a breakfast meeting with the Buckhead Business Association, Young said the people of Fulton County "should want to shine my shoes. In 2007, Fulton County gave Grady $76 million. This year Fulton County is going to give $50 million. So I have reduced your tax exposure by $26 million."

Young was hired in 2008 as part of a restructuring of Grady's leadership, which included replacing the old politically appointed board with one comprised of business and community leaders. A Grady spokesman credited Young with taking the hospital from a $51 million operating deficit in 2008 to a $34 million surplus last year, not including more than $300 million raised in a fund-raising drive for capital improvements.

Young improved bill collections and patient care, and workers received merit raises for the first time in about three years, according to the spokesman.

Young also laid off 141 employees and closed the outpatient dialysis unit.

In June, Young received a $290,800 bonus in addition to his base salary of $615,000. The bonus drew criticism from some elected officials, but it was unananimously approved by the hospital's board.

"We now have a hospital not in danger of closing," board chairman Pete Correll said then.

New Imaging Technique Reveals If Breast Cancer Treatments Are Working
Medical News Today 28 Oct 2010

Cancer Research UK scientists have developed a new imaging technique that can show when breast cancer treatment is working, weeks before current methods. The research is published in the British Journal of Cancer1 .

By using two specially labelled chemical markers the researchers were able to see the very early changes in cancer cells that show treatment is working, such as DNA damage and cell death.

Current approaches only show that treatment is effective if the tumour starts shrinking, but it can take several weeks before this becomes visible.

Looking at breast cancer cells in the lab and then in mice, the researchers were able to detect the early signs that tumours were responding to treatment with the chemotherapy drug doxorubicin2.

They were able to see this by developing two labelled markers that are involved in cellular processes that are targeted by doxorubicin, highlighting the early effects that the drug is having on cancer cells.

The first marker - [1-13C]pyruvate - shows that doxorubicin is damaging cancer cells DNA - in cancer cells this molecule is converted into other products but this conversion is reduced in cells whose DNA has been damaged by doxorubicin treatment.

The second marker - [1,4-13C2]fumarate - shows that doxorubicin is killing cancer cells as it is only converted into another molecule called malate in cells that are dying due to cancer treatment.

Lead researcher Professor Kevin Brindle, of Cancer Research UK's Cambridge Research Institute, said: "There has been a need to develop imaging methods that can detect treatment response more accurately and before tumours change size. Our new imaging method not only shows early evidence that treatment is working but could also help predict the long term outcome. We expect that these techniques will have an impact for patients in the near future."

Treatment for cancer is becoming increasingly personalised - where treatments are chosen according to a patient's individual cancer - and doctors need to know early on that the treatment is having an effect. While current approaches, including CT scanning and MRI, are relatively simple and readily available it can take several weeks before they detect changes and they can often overestimate tumour shrinkage.

This imaging technique was developed in conjunction with GE Healthcare. Jonathan A. Murray, general manager for Cross Business Programs, at GE Healthcare, said: "The potential for this technology is very exciting and we are delighted to collaborate with Cancer Research UK."

Dr Lesley Walker, director of cancer information at Cancer Research UK, said: "We need fast and accurate ways of knowing that the treatment is working. This research could help us tailor treatment to each patient by giving doctors a useful tool to check treatments are working after a short time, rather than waiting several weeks to see if the tumour is shrinking, reducing unnecessary treatment for women."

1. Witney TH, Kettunen MI, Hu DE, Gallagher FA, Bohndiek SE, Napolitano R, & Brindle KM (2010). Detecting treatment response in a model of human breast adenocarcinoma using hyperpolarised [1-(13)C]pyruvate and [1,4-(13)C(2)]fumarate. British journal of cancer PMID: 20924379


2. Doxorubicin is used to treat many types of cancer, including breast cancer. One of the ways it works is by binding to the cancer cells' DNA and blocking an important enzyme called topo-isomerase II. This makes the DNA get tangled up and cancer cells cannot divide and grow.

Cancer Research UK

Physician Panel Prescribes the Fees Paid by Medicare

Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars.

The group, convened by the American Medical Association, has no official government standing. Members are mostly selected by medical-specialty trade groups. Anyone who attends its meetings must sign a confidentiality agreement.

Pricing Medicare's Codes

View Interactive

Sortable Table: Top Procedures Billed to Medicare

Yet the influence of the secretive panel, known as the Relative Value Scale Update Committee, is enormous. The Centers for Medicare and Medicaid Services, which oversee Medicare, typically follow at least 90% of its recommendations in figuring out how much to pay doctors for their work. Medicare spends over $60 billion a year on doctors and other practitioners. Many private insurers and Medicaid programs also use the federal system in creating their own fee schedules.

The RUC, as it is known, has stoked a debate over whether doctors have too much control over the flow of taxpayer dollars in the $500 billion Medicare program. Its critics fault the committee for contributing to a system that spends too much money on sophisticated procedures, while shorting the type of nuts-and-bolts primary care that could keep patients healthier from the start—and save money.

"It's indefensible," says Tom Scully, a former administrator of the Medicare and Medicaid agency who is now a lawyer in private practice. "It's not healthy to have the interested party essentially driving the decision-making process."

Plenty of factors contribute to the spiraling costs of Medicare, which rose nearly 9% in 2009. Sheer demographics will add millions of new beneficiaries each year as the baby boomers begin turning 65. Other areas of Medicare—including the prescription-drug benefit and nursing-home expenses—are growing faster than payments to doctors.

Secrets of the System
Dividing the Medicare Pie Pits Doctor Against Doctor
In Medicare's Data Trove, Clues to Curing Cost Crisis (10/25/2010)

Moreover, the RUC's recommendations in theory affect only how doctors' piece of the Medicare pie is divided, not how big it is. RUC chairwoman Barbara Levy says the panel is moving aggressively to correct evaluations that lead to higher-than-appropriate payments for some services. By the start of November, the Medicare agency is due to come out with its doctor fees for next year, likely incorporating the RUC's most recent recommendations.

"We've made tremendous change in the last few years," says Dr. Levy, a Seattle-area gynecologist. "The RUC is not a perfect process, it's just the best that's out there."
Still, the impact of the decisions made by the doctors on the RUC goes well beyond physician fees for cardiac surgery or back procedures. When Medicare pays more for something, doctors have an incentive to do more of that something—with all the associated costs for hospitals, lab tests and drugs.

"Overvalued codes can lead to spending growth," says Jonathan Blum, deputy administrator for the Centers for Medicare and Medicaid Services.

A Wall Street Journal analysis of Medicare and RUC data suggests that services were paid too generously in some cases because the fees were based on out-of-date assumptions about how the work is done. The analysis found more than 550 doctor services that, despite being mostly performed outpatient or in doctors' offices in 2008, still automatically include significant payments for hospital visits after the day of the procedure, which would typically be part of an inpatient stay.

For instance, one operation to treat male urinary incontinence wraps in payment for 118 minutes of hospital visit time after the day of surgery, though 2008 Medicare data show it is done around 80% of the time outpatient or in a doctor's office. Stephanie Stinchcomb, manager of reimbursement for the American Urological Association, says the surgery used to be largely inpatient; its payment was last updated based on a RUC evaluation in 2003. It's not clear if a new analysis will find doctors should now be paid less for it, she says.

The RUC's Dr. Levy says the committee is already recommending changes for services that have moved to an outpatient setting.

The AMA, along with groups representing doctor specialties, formed the RUC in 1991. That's when Medicare was moving to its current system of setting doctor fees, which bases estimates of the cost of a service on the physician work and related expenses involved, as well as a small amount for liability. The panel's main focus is to estimate how much work it takes a physician to perform a given task.

In sessions that can stretch 12 hours or longer each day, the committee walks through dozens of services. The discussions can be mind-numbing—a subcommittee once debated whether to factor tissues into the payment for a psychoanalysis session.

Committee leaders like Dr. Levy have long emphasized that members need to look beyond the interests of their specialties, and she distributed red baseball caps with "RUC" printed on them at the beginning of her term last year. Past efforts at bonding activities include a bowling night where the physicians were randomly assigned to teams. The breakdown of votes is kept secret, and it takes two-thirds of the 26 voting panelists to endorse a value for a service.

The stakes are heightened by Medicare law that says if services get a boost in their values, the money is supposed to come out of existing services' reimbursement. The Medicare agency makes such tweaks to attain so-called "budget neutrality" and also aims to hit overall spending goals set by law. However, its projections are often exceeded due largely to increases in the number of services performed. Congress has stepped in to authorize higher-than-targeted spending.

Matt Lutton for The Wall Street Journal

Dr. Barbara Levy, a Seattle-area gynecologist who heads the RUC.

"This system pitted specialty against specialty, surgeons against primary care," says Frank Opelka, a surgeon and former RUC alternate member who is vice chancellor at Louisiana State University Health Sciences Center in New Orleans.

Primary-care groups have pushed for more representation on the committee, and their leaders have argued its results are weighted against their interests. (Please see accompanying article on

Dr. Levy says the committee is an expert panel, not meant to be representative, adding: "The outcomes are independent of who's sitting at the table from one specialty or another."

A recent analysis for the Medicare Payment Advisory Commission, or MedPAC, a Congressional watchdog, calculated how much American doctors would make if all their work was paid at Medicare rates. It found that the primary-care category did the worst, at around $101 an hour. Surgeons did better, at $161. Specialists who did nonsurgical procedures, such as dermatologists, did the best, averaging $214, and $193 for radiologists.

The imbalance has stoked fears of a shortage of primary-care doctors, as well as a relative shortfall in the amount of primary-care services patients receive, compared to specialist procedures. "The fee schedule we use to pay physicians in Medicare leads to the wrong mix of services and the wrong mix of doctors," says Robert Berenson, vice chair of MedPAC and a researcher at the Urban Institute. "It produces increased spending for Medicare and for the rest of the system."

Out-of-whack Medicare doctor payments are supposed to be corrected in a required review every five years. MedPAC says in the three previous reviews, the RUC endorsed boosts for 1,050 services, and decreases for just 167. Many recommendations on which services to examine came from doctor societies. The upshot may be that payments don't keep up with medical realities when procedures become easier or faster, MedPAC said.

The Medicare payment for placing cardiac stents in a single blood vessel stems from a 1994 RUC analysis. Medicare paid doctors for 326,000 of those procedures in 2008, at a cost of around $205 million. Compared to the mid-1990s, cardiologists say, stenting today is more routine and may often be less stressful.

The example used to set the code's value is "way out of date," says David L. Brown, a cardiologist at SUNY-Stony Brook School of Medicine. "In those days, stents were used when you were having a catastrophic event or thought you might have a catastrophic event." Stents and the catheters used to thread them into arteries are now smaller and easier to use, he says. The time varies by patient, but Dr. Brown says he required around 45 minutes on average to perform a single-vessel stenting. The RUC's valuation suggests a two-hour procedure.

The American College of Cardiology feels the service is "fairly valued," says James Blankenship, who represents the society on the RUC and is director of cardiology at Geisinger Medical Center. He concedes that two hours is "probably a little bit too long," but argues that the procedure may be harder because cardiologists now take on challenging patients who might once have gotten bypass surgeries.

The RUC's Dr. Levy says that the RUC has reduced values for nearly 400 services in the past and it is now reviewing hundreds more.

Where the Money Goes

Medicare Spending, in billions 2009

In 2006, Medicare phased in a payment for applying a skin substitute that used a new RUC evaluation. The estimate of doctor work was built around an example of treating a teenager with an extensive burn, who's seen in an operating room. The procedure was estimated to take 25 minutes, and payment wrapped in the cost of four doctor visits, including one for hospital discharge.

By 2008, according to Medicare data, the code was being billed by podiatrists 74% of the time, and they were applying the skin substitute to ulcers, not burns. Moreover, 53% of the procedures were outpatient and 44% done in doctors' offices. Some podiatrists suggest 25 minutes is longer than the procedure typically takes, though this can vary. Lee Rogers, associate medical director of the amputation-prevention center at Valley Presbyterian Hospital in Los Angeles, says he requires seven minutes on average.

"I can't believe that's the vignette they based this code off of," he says.

At a national podiatric meeting in July, podiatrist James Stavosky showed slides highlighting that doctors who treated a stubborn foot ulcer with Dermagraft, a skin substitute used when billing that code, could make $3,137.54—substantially more than with rival products paid for under different codes. Dr. Stavosky says the slides were his idea and he wasn't paid for the talk by Advanced BioHealing Inc., the maker of Dermagraft. The company confirms that.

The Medicare agency has proposed lopping its reimbursement for the Dermagraft procedure, and the RUC has suggested that the AMA committee that creates billing codes review the matter. Medicare's Mr. Blum says the agency is becoming "much more prescriptive" in working with the committee, prodding the panel to detect, and suggest fixes for, payments based on out-of-date assumptions. He adds that the agency has already made payment changes to "correct historical biases against primary-care professionals" and plans more such moves.

The RUC relies heavily on surveys performed by doctor specialty groups, requiring as few as 30 responses. The surveyed doctors estimate the time, stress, skill and other factors based on a hypothetical case that's supposed to represent a typical patient. They compare services to other, similar ones to help figure out relative difficulty. A blank example provided to The Wall Street Journal noted that the survey "is important to you and other physicians because these values determine the rate at which Medicare and other payers reimburse for procedures."

William Hsiao, the Harvard professor who led the original physician-work research used to set Medicare fees, argues the approach is almost guaranteed to inflate the values used to calculate fees.

"You do not turn this over to the people who have a strong interest in the outcome," he says. "Every society only wants its specialty's value to go up…. You cannot avoid the potential conflict."

A study published this June in the journal Medical Care Research and Review found the procedure times used by the RUC to calculate values may sometimes be exaggerated. The mean times for several types of surgeries were substantially shorter in a database drawn from hospital surgical records.

For instance, the time used by the RUC for carpal tunnel surgery—which was performed 106,000 times on Medicare patients in 2008, at a cost of around $44 million in doctor fees—is 25 minutes. According to Sullivan Healthcare Consulting Inc., which maintains the hospital database, the median time among teaching hospitals in recent years, based on 2,602 cases, was about one-third shorter, at 17 minutes. The figure for community hospitals, with 4,093 cases, was 18 minutes.

According to documents provided by the RUC, the 25-minute figure is based on 39 surveys of surgeons, out of 150 sent out by groups representing hand surgeons, orthopedic surgeons and plastic surgeons.

Robert H. Haralson III, former medical director for the American Academy of Orthopaedic Surgeons, says Medicare's payment isn't too high, because the surgery is a more intense procedure than the current value implies.

In a letter to the medical journal, RUC leaders said the article was "outdated" and questioned use of the surgical database, which classifies procedures in a different way than the RUC. Dr. Levy says the doctor surveys serve as "a beginning point" for the committee's experts.

Mr. Blum of the Medicare agency says that for now, "we are comfortable" with the RUC process. The federal health-care overhaul requires the government to insure that the doctor-fee values adopted by Medicare are accurate. "We're not going to rubber-stamp recommendations," he says.

Write to Anna Wilde Mathews at and Tom McGinty at

Governor's race could be headed for post-Thanksgiving finish  Aaron Gould Sheinin The Atlanta Journal-Constitution

The race for governor could end up being a holiday affair.

If no candidate gets the required majority of votes in Tuesday's general election, then the top two finishers will face off in a last-gasp runoff election Nov. 30. Leftover turkey and a return trip to the polls, anyone?

Depending on which candidate you're supporting, however, that's either an appetizing prospect or something akin to a grandma's hated boiled turkey surprise.

Those who back Democrat Roy Barnes see a runoff as their best, and perhaps only, chance of regaining the governor's office. Republican Nathan Deal's supporters see that their man has consistently led every poll in a Republican state in what's shaping up to be a Republican year and want to claim victory on Tuesday -- or at least end the madness that is campaign season.

"Please, no runoff," said Mark Glidewell, 39, of Savannah, who describes himself as a "soft" Deal supporter. "I cannot imagine [four] more weeks of these horrible ads being run by both Barnes and Deal."

But Emily Schunior, 39, of Ormewood Park is rooting hard for a chance to vote for Barnes twice in November.

"I definitely think [a runoff] is our best chance," she said.

But is it likely? Again, it depends on who is asked.

"My contention is I don't think there will be a runoff," said Brian Rell, a former state GOP executive director and campaign strategist.

Recent polls all have shown Deal with anywhere from a 5- to a 10-point lead over Barnes, with Libertarian John Monds in the low- to mid-single digits. While the polls have not yet shown Deal getting the magic 50-percent-plus-one vote needed to win, Rell believes the race is already trending that way.

Besides, he said, "I don't think the voters want [a runoff]."

Jack Staver sure doesn't.

The 57-year-old Atlanta resident said the race "needs to be over Tuesday."

"Nathan Deal will be the next governor," he said.

But Democratic political consultant Jim Coonan isn't so sure.

Georgia's electorate is less partisan than many believe, with a "very large pool of swing voters."

"The big question is whether the swing vote is being rung out of the Georgia electorate," Coonan, of Atlanta, said.

If those voters who split tickets still exist -- meaning if they haven't been swept up in the Republican wave -- "it boosts the chances of the gubernatorial race going to a runoff."

The campaigns, however, remain steadfast that there will be no runoff.

“We feel really good going into the final days and hours of this campaign," Deal spokesman Brian Robinson said.

Barnes' spokesman Emil Runge indicated similar optimism.

"Roy is gathering momentum from across Georgia, including from Republicans, independents and women," he said.

If there is a runoff, the outcome will be determined by several factors, Coonan said. Who has the volunteers and the campaign organization to keep voters interested and get them to return to the polls is a big factor. Another is which candidate does the best to make the runoff matter.

This year, Coonan said, Democrats could get swept in every other statewide election, lose one or two congressional seats in Georgia and see Republicans retake Congress. If that happens, the party faithful might see a Barnes runoff victory as one last strand of hope.

"We've got to save one," he said. "This is one we've got to save. We can make a difference."

But Rell believes a runoff "just delays the inevitable."

"There's no incentive for a Barnes vote coalition to turn out in greater numbers this time in a runoff than in the general election," he said.

Finally, there's the question of which candidate has the money to wage four more weeks of a campaign. Through Sept. 30, Barnes had raised more than $122,000 specifically for a general election runoff, while Deal had not taken a single contribution geared toward an extra election. Both candidates can spend whatever is left in their general election fund, but how much that will be won't be known for some time.

Eric Teusink, 29, of Grant Park is simply hoping Barnes gets the chance to spend that money.

"If there's not a runoff, that means Nathan Deal has won," he said. "As a Barnes supporter, that's a terrible thing."

There have been two statewide general election runoffs in modern Georgia history: in the 1992 U.S. Senate race when Republican Paul Coverdell ultimately beat Democrat Wyche Fowler and in 2008 when Republican Saxby Chambliss topped Democrat Jim Martin.

If there is a runoff, the pattern then obviously favors Deal. But, Coonan said, that's a myopic view.

"Patterns don't vote, people do," he said. "I think it's illusory to say there's some observable pattern you can talk about in a chat show that means anything."

Looking to save more lives in Georgia
Macon Telegragh October 28, 2010  By JAMES M. CUNNINGHAM M.D., F.A.C.S.

The Viewpoints letter titled “’No’ to Amendment 2” which was published in The Telegraph on Oct. 17, demands a reply. The writer stressed the “cons” of Amendment 2; but, in my opinion, your readers should also be exposed to the “pros” of the amendment.

Currently, the only four Level I Trauma Centers in Georgia are located in Atlanta, Augusta, Macon and Savannah. Ideally, all victims of major trauma would be in close proximity to one of these centers.

Unfortunately, the ideal situation is not always realized. The transfer of acutely injured patients may be delayed for hours due to difficulties with extrication from badly damaged vehicles or rough terrain which limits the use of rapid air evacuation via helicopter. These patients often require resuscitation and preliminary stabilization of their injuries if they are to survive.

The State Trauma Commission, which is composed of physicians, nurses, EMTs and trauma center administrators, has formulated a statewide plan to improve trauma care throughout Georgia. The Commission has received input from both regional and national organizations including the American College of Surgeons. As a result, a well thought out, strategic decision has been made to provide additional, much needed resources to a select group of existing facilities which are currently unable to participate in trauma care. With appropriate funding, the number of trauma centers in the state will increase to an acceptable level.

Those of us who actually treat victims suffering major traumatic injuries are not concerned with “diluting the effectiveness of major trauma centers” as the letter writer suggested. Additional resources strategically scattered throughout the state would, in fact, improve the effectiveness of the major centers because we would receive patients who have been locally resuscitated and are not in shock on arrival.

Once the detrimental physiologic changes associated with prolonged shock have continued unabated, resuscitative efforts, no matter how intense, are often futile. Additional Level I, Level II, and Level III centers in the state will allow more of these severely injured patients to be stabilized during the critical “golden hour” after major trauma. As a result, more victims will survive and fewer family members will be visiting the gravesites of their loved ones.

Importantly, for all Georgians who will vote in the upcoming election, the amount of money added to the annual tag purchase is limited to $10 by virtue of a constitutional amendment. Only another amendment can raise the fee. Additionally, all monies collected must go only to fund the trauma system. The State Trauma Commission will then determine the appropriate disbursement and distribution of the fees which are collected.

I encourage you to vote “yes” on Amendment 2 on November 2nd.

James M. Cunningham, MD, FACS, is the Chief Medical Officer for the Medical Center of Central Georgia.

Thursday, October 28, 2010

Doctor-owned hospitals race to beat Medicare deadline -

Doctor-owned hospitals race to beat Medicare deadline -

Is this the right answer? Is there an answer? Republican’s Controversial Proposal To Mend Medicare - Kaiser Health News

With mid term elections next week and the SGR cut still looming, what Medicare changes will Congress address? In this article from Kaiser Health News, privatization is discussed. Do you agree? Disagree? Why?

Republican’s Controversial Proposal To Mend Medicare - Kaiser Health News

Small-Practice Update: Three Key Steps to Survive and Thrive

GSACS has a Private Practice Committee chaired by Dr. John Harvey.  Have you got ideas or issues you want this committee to tackle?  Let us know.  Comment below.

Small-Practice Update: Three Key Steps to Survive and Thrive: Introduction:

HealthGrades: Lower Mortality Seen at High-Ranked Hospitals

How does your hospital stack up?

HealthGrades: Lower Mortality Seen at High-Ranked Hospitals --Doctors Lounge

Wednesday, October 27, 2010

Colorectal Cancer Rates Could Drop 23% With Lifestyle Changes Alone

Colorectal Cancer Rates Could Drop 23% With Lifestyle Changes Alone: "Colorectal Cancer Rates Could Drop 23% With Lifestyle Changes Alone"

AMA Patients' Action Network

AMA Patients' Action Network

Forward this link to the AMA's Patients' Action Network. This is an easy way to send Congress and the Senate a letter concening the need to permanently fix the SGR!

GSACS Daily Briefing 10-27-10

Docs Unhappy With Medicare, But Can't Agree on a Fix
MedPage Today October 26, 2010

Most physicians believe current Medicare payments are unfair, but there is little consensus among doctors on how to make payments more equitable, according to a new study.

While physicians generally support changing how Medicare reimburses doctors, most don't support payment reforms that would reduce their own incomes, according to survey results published in the Oct. 25 issue of Archives of Internal Medicine.

Physician spending accounts for about one-fifth of all healthcare spending, but the clinical decisions of doctors are a "major factor" in rising healthcare costs, and many have looked to physician reimbursements as "potential targets to promote cost savings and establish incentives to improve care," wrote the study authors, who were led by Alex Federman, MD, MPH, of Mount Sinai School of Medicine.

In order to assess physicians' opinions on reimbursement reform proposals, researchers conducted a national mail survey of 6,000 randomly selected doctors from the American Medical Association Masterfile between June 25 and Oct. 31, 2009, which was several months before the Affordable Care Act (ACA) was signed into law. In all, 1,222 physicians responded, most of whom reported accepting Medicare.

Physicians were asked about their support for several new payment options, including: rewarding quality with financial incentives; bundling payments; shifting payments from procedures to managment and counseling services; increasing pay to generalists; and offsetting the pay increase for generalists with a reduction in pay to specialists.

The survey found that 78% of doctors surveyed felt that some procedures are compensated too highly and others are not compensated enough to cover costs.

Offering incentives was the most frequently supported payment reform option, with nearly half of surveyed doctors saying they support a model in which doctors would be paid bonuses for meeting certain quality standards, such as preventing rehospitalization. Doctors would be penalized for providing "suboptimal" care as well.

Overall, 46% of physicians opposed shifting payments away from procedures and toward counseling services, while 42% of physicians supported the option. Not surprisingly, doctors who make their living performing procedures, such as surgeons, were much less likely to support moving payments away from procedures, while most generalists (67%) supported the proposal.

Bundling payments -- defined as paying for a specific episode of care with one fixed amount -- was supported by just 17% of doctors.

"Physicians generally showed the least support for proposals that carried the risk of reduced reimbursement, such as payments for bundled care," the authors wrote.

Bundled payments are cited frequently by health policy experts as a viable payment reform option, and the ACA also promotes bundled payments.

"Because bundled payments are likely to be implemented in one form or another, this mechanism ought to be carefully explained to physicians to promote broad acceptance and smooth implementation," the authors wrote.

Nearly 80% of physicians surveyed supported increasing pay for generalists. Even among surgeons, more than three-quarters supported boosting pay for generalists.

However, offsetting the higher payments by decreasing payments to specialists was supported by just 39% of doctors.

The ACA did include a payment bonus for primary care physicians, but no reduction in payment for services provided by specialists.

The study authors conclude that doctors are not satisfied with current Medicare reimbursement, but don't agree on how best to reform the payment system.

"The successful adoption of payment reform proposals may require a better understanding of physicians' concerns and their willingness to make trade-offs," the authors conclude. "In addition, maximizing physicians' approval of reforms would facilitate implementation."

The researchers said their study is limited by a slightly-lower-than-average response rate, and also limited because the opinions were collected as proposals for healthcare reform were in flux in Congress.

This study was supported by a grant from the Robert Wood Johnson Foundation and also by grants from the National Institute on Aging; the National Heart, Lung, and Blood Institute; and the Veterans Administration Health Services Research and Development Service.

The authors reported no financial conflicts of interest.
Primary source: Archives of Internal Medicine
Source reference:
Federman A, et al "Physicians' opinions about reforming reimbursement" Arch Intern Med 2010; 170(19): 1735-1742.
The information presented in this activity is that of the authors and does not necessarily represent the views of the University of Pennsylvania School of Medicine, MedPage Today, and the commercial supporter. Specific medicines discussed in this activity may not yet be approved by the FDA for the use as indicated by the writer or reviewer. Before prescribing any medication, we advise you to review the complete prescribing information, including indications, contraindications, warnings, precautions, and adverse effects. Specific patient care decisions are the responsibility of the healthcare professional caring for the patient. Please review our Terms of Use.

Mark Murphy: 'Yes' to life-saving Amendment 2Savannah Morning news By mark e. murphy
Created 2010-10-26 00:18

I will remember Feb. 7, 2008 for the rest of my life.

I was eating dinner with my wife in Spanky's that evening when my cell phone rang. It was my partner, Dr. Steve Carpenter, the head of Memorial's Internal Medicine residency program.

"Murph, the sugar refinery blew up," Steve said. "We're calling everyone in."

A wave of nausea washed over me. I flicked my eyes up at my wife, who was finishing off a chicken finger. Her brother Larry had worked at that plant.

"Larry's not at the sugar refinery, is he?" I asked.

He was not; he'd been ill, and had in fact changed to a different plant a few years earlier. Our family had been spared that night. Others were not so fortunate.

In the end, 14 people died as a result of the Imperial Sugar disaster. Another 42 were injured. Many more might have died had it not been for the rapid, coordinated response of Savannah's medical community - and, particularly, of the physicians, nurses and support personnel at Memorial Health University Medical Center, the area's only Level One Trauma Center.

Not all emergency rooms are trauma centers. Trauma centers are designated facilities which are required to meet certain standards to achieve that designation.

Level One Trauma Centers, like Memorial's, must have multiple medical specialties available 24/7 so that they can be responsive to any disaster which might arise. Georgia currently has only four Level One Trauma Centers. Besides Memorial's, the others are in Atlanta (Grady), Macon (Medical Center of Central Georgia) and Augusta (MCG Hospital). There are 12 other lower-level trauma centers in the state, which is not enough.

It's estimated that Georgia should have at least 30 trauma centers to be adequately staffed. In many cases, if a victim of major trauma is not at a trauma center within 30-60 minutes of an injury, that person will die when they might have otherwise been saved. Approximately 700 people die unnecessarily each year in our state as a result of trauma because our state is medically underserved in this area..

This is a tragedy. But it is a correctable tragedy.

The state has an opportunity to shore up its statewide trauma network in the upcoming election. It is a vote that has more potential impact of the everyday lives of Georgians than any political election this year.

Trauma care is an often thankless job. Many victims of trauma - be they the victims of gunshot wounds, automobile wrecks, drownings - are uninsured. Moreover, medical reimbursement overall is declining and will continue to decline.

Without a dedicated source of trauma funding support, many hospitals which currently maintain trauma centers will not be able to keep those centers open, to the detriment of all Georgians. Memorial Health, for example, lost $6 million dollars providing ER care for uninsured patients in 2007 alone. This is not sustainable without outside assistance.

A "yes" vote on Amendment 2, which is on the Nov. 2 ballot, will afford Georgians the opportunity to maintain the state's trauma network by using a $10 car tag fee to provide dedicated trauma network support. It provides funding that cannot be diverted by legislators for less noble purposes.

For less than the price of a few gallons of gasoline per year, Georgians can build a trauma network that can be broadened in scope and strengthened in depth.

Our area has seen its share of disasters. In addition to the Imperial Sugar explosion, one might recall the 1959 Meldrim train derailment (23 dead), the 1972 Sidney Lanier Bridge collapse (11 dead), the 1949 crash of a B-50 bomber (11 dead), the 1948 crash of a chartered airplane (17 dead; nine injured), the 1953 B-29 crash (11 dead), and the 1929 boiler explosion in a Glennville factory which killed five and injured five more.

This does not take into account the numerous Savannah disasters of the latter part of the 19th century, including two large downtown fires and the devastating hurricanes of 1893 and 1898. A healthy trauma network can be the difference between life and death in these situations - in addition to the less dramatic, but no less significant, impact that such a network can have on people involved in more routine automobile accidents and gunshot injuries.

A healthy trauma network benefits all of us. It does not discriminate and is not political. Voting to support it is, quite simply, the right thing to do - for all Georgians.

Mark E. Murphy, M.D., is a Savannah physician and writer.

Supporters of Ga. trauma-care amendment rallyMorris News Service Tuesday, Oct. 26, 2010 4:17 PM

ATLANTA -- Rarely do political gatherings on the Capitol steps stir partisans to tears, but Charlotte Laverty’s story Tuesday of her son’s fatal car wreck did during a rally in support of a constitutional amendment for trauma care.

She told of how her dinner out with her husband was interrupted with news of the accident, of rushing to the scene less than a mile from home, and of arriving at the hospital moments after an ambulance delivered her 17-year-old.

“We were fortunate that we live in a town that has a trauma center,” she said, listing the many specialists who were on call the night of the wreck who tended to her son.

Although he died two days later, she was thankful for the chance his out-of-town family had to say their good-byes.

“If I lived in a rural area and thought, ‘had I only paid 10 extra bucks for my car tag I might have gotten the care that Grant Laverty got.’ How can you forgive yourself?” she asked.

Some of 100 or so nurses, doctors, rescue personnel and business executives attending the rally choked up as she spoke. Her comments were punctuated by the siren of an ambulance on an emergency call a few streets over.

The goal of the rally, and one in Savannah at the same time, was to build support for Amendment 2 on this fall’s ballot. Approval would add a $10 yearly fee to most vehicle tag renewals with the expected $80 million going toward a statewide network of trauma-care centers.

The state’s 189 hospitals only house 17 specialized trauma centers. Experts say the state needs 30 of them, and the specialists on call around the clock to treat the most challenging accident victims.

“When you leave the Bibb County line heading south on Interstate 75, there is not a single neurosurgeon on call until you get to Gainesville, Fla.,” said George Israel, president of the Georgia Chamber of Commerce, one of the backers of the campaign, Yes 2 Save Lives.

The campaign’s internal polls show it has the support of slightly less than what’s needed for passage. The sticking point for opponents: distrust of politicians to use the money as promised.

Israel stressed that by using a constitutional amendment to create the fund, supporters have prevented any other uses.

“Rest assured the $10 is locked in. The politicians are locked out,” he said.

Chad Black, a Hall County paramedic and the face of Yes 2 Save Lives’ campaign commercials, said he’s been pushing for a trauma-care network for a decade because the state has 20 percent less emergency coverage than the national average. That shortage results in about 700 lives lost each year.

“It’s been very difficult watching people die who shouldn’t die,” he said.

Rally For Amendment 2 To Help Build Georgia's Trauma System
WSAV-TV 10-26-10

Georgia voters next Tuesday will decide if they want to add ten dollars to their tag renewals in order to get better trauma care.  A small crowd gathered in Forsyth Park today in support of Amendment 2. The money would help build a better trauma care system throughout the state.  A recent study showed Georgia’s growing population needs 30 trauma care centers throughout the state.  We currently only have about half that number. 

Memorial Health Trauma Surgeon Dr. Gage Oschner says, "We don't have enough trauma centers - this is where we have most of our preventable deaths - are in this area cause people just can't get to us and I see one or two people a month, maybe more - that did shortly after they get to me - had I got 'em 20, 30 minutes earlier - they weren't hard to save - any good surgeon could do it - but they didn't get to us in time.”  Proponents say the money raised from the new fee could not be diverted to other things and would be a renewable source of revenue to help fund trauma centers each year.

Physicians and survivors push for YES on Nov. 2
WTOC Savannah 10-26-10

SAVANNAH, GA (WTOC) - When you head to the polls next Tuesday, you'll be voting on more than who takes over in various offices.

Voters in both Georgia and South Carolina will decide the fate of a number of proposed constitutional amendments.

In Georgia, there are five amendment questions on the ballot.

One of the most widely discussed is whether or not to add a $10 fee on private passenger vehicle tags to establish and fund a statewide trauma care system.

The annual $10 trauma charge would be on passenger vehicles designed to carry 10 or fewer passengers. Passenger vehicles include cars, SUVs, pickup trucks, and motorcycles, but does not include large transfer trucks or government-owned vehicles.

The annual charge will be collected at the same time as other license tag and registration fees required by law prior to the issuance of a license plate or revalidation decal and will be deposited in the Georgia Trauma Trust Fund.

It is estimated that the $10 charge will raise $78 million a year in revenue that will be dedicated to trauma.

That $10 goes to training first responders and helping fund trauma care centers where there are none.

Hospitals and survivors are asking you to say yes to Amendment 2.

"We got to trauma at Memorial within 15 minutes. That saved my life," Shae Cowart McDaniel told WTOC.

McDaniel shared her story with WTOC and everyone at an Amendment 2 rally for trauma care at Forsyth Park Tuesday morning.

In 2007, McDaniel was involved in a near-fatal accident 30 minutes from Savannah.

"We hit a tree. It started spinning and we were both thrown from the car," she said.

McDaniel was flown to Memorial Health, broken bones all over her body, paralyzed from the waist down with a punctured lung and liver.

Jolene Cowart believes her daughter would have died if trauma care was not available.

"If we hadn't had lived as close as we did, she wouldn't have made it because time was crucial," Cowart told WTOC.

"Who knows what would have happened," McDaniel said.

"Where we live, around us, we don't have enough trauma centers. This is where we have the most preventable deaths," Dr. Gage Oschner told WTOC.

Dr. Oschner is a trauma surgeon at Memorial Health and says a trauma network, serving all communities, is a necessity.

"I see one or two people a month, maybe more, that die shortly after they get to the hospital. Had I got to them 20 - 30 minutes earlier, they weren't hard to save," Dr. Oschner said.

Oschner told the Forysth Park audience, $10 extra a year when you register your car tag could raise $80 million to develop trauma care in areas where none exists, giving crash victims and others a better chance to survive.

He says the $10 will go directly to hospitals. "Nobody. No politician can mess with it. Every penny goes to trauma care," he said.

McDaniel is urging everyone on November 2nd to say YES to Amendment 2, ten dollars for trauma care statewide. "That's two happy meals a year and that could save who knows how many lives," she said.

For more information, you can visit Also, visit our 2010 General Election page
for more election information.

Marshall trailing by double digits, says poll from The Hill | Political Insider

The American College of Surgeons Professional Association's Surgeons PAC is supporting Representative Austin Scott in this race.

Your morning jolt: Jim Marshall trailing by double digits, says poll from The Hill Political Insider:

Tuesday, October 26, 2010

GSACS Surgeons Support Yes2SaveLives Atlanta Rally

The Georgia Society of the American College of Surgeons was well represented at the Atlanta rally for Yes2SaveLives on Tuesday, October 26 at the State Capitol. Don't forget to vote for Amendment 2 on November 2!

Watch the video - Dr. Dennis Ashley, tireless advocate for trauma care addresses the Yes2SaveLives Atlanta rally 

Drs. David Feliciano and Jeff Salomone

Representative Sharon Cooper, Chair of House Health

Dr. Dennis Ashley & GSACS Executive Director Kathy Browning

GSACS Daily Briefing 10-26-10

Health Care Overhaul Depends on States’ Insurance ExchangesNew York Times 10-23-10

WASHINGTON — In Massachusetts, which has had a government-run health insurance marketplace for four years, people typically file paper applications for subsidized coverage offered by one of five state-approved insurers. In Utah, employees of small businesses can go to a state Web site and sign up for insurance over the Internet, almost as easily as they download music from iTunes.

The success of President Obama’s health care overhaul, with its promise of affordable coverage for all, depends on the creation of such retail shopping malls, known as health insurance exchanges.

Massachusetts and Utah provide a glimpse of the future, and they offer radically different models for other states. The battle over health care is shifting to the states, and the design of insurance exchanges will be one of the most pressing issues for state legislators when they convene early next year.

“Utah and Massachusetts may well serve as bookends for other states,” said Norman K. Thurston, the policy coordinator at the Utah Health Department.

The Congressional Budget Office predicts that by 2019, about 24 million people will have insurance through exchanges, with four-fifths of them getting federal subsidies that average $6,000 a year per person. People with incomes up to four times the poverty level (about $88,000 a year for a family of four) will be eligible for subsidies.

The Utah Health Exchange organizes the market, allowing consumers to compare a wide variety of health plans sold by any insurers that want to participate.

In the Massachusetts exchange, known as the Connector, the state serves as an active purchaser, soliciting bids from insurance companies and negotiating prices and benefits in an effort to secure the best value for state residents. Health plans cannot be sold through the Connector unless they receive its seal of approval.

“Massachusetts has been more selective and aggressive in contracting,” said Jon M. Kingsdale, who was executive director of the Massachusetts exchange from its creation in 2006 until June of this year.

Matthew A. Spencer, manager of the Utah exchange, said: “We are on the other end of the spectrum from Massachusetts. Our exchange is wide open for any carrier that wants to participate. We define the minimum benefits that plans need to offer. But we step back and allow carriers to compete within the exchange, setting their own prices.”

The idea of an insurance exchange has bipartisan appeal.

Liberals and conservatives alike see it as a way to concentrate the purchasing power of individuals and small businesses.

The federal law was shaped, to a large degree, by the experience of Massachusetts. But Senator Orrin G. Hatch, Republican of Utah, said: “Utah is not Massachusetts. Nor does it want to be.”

Other states will probably fall somewhere along the continuum from Boston to Salt Lake City as they try to figure out the right mix of regulation and competition.

State legislators are asking: Can we get a better deal by limiting competition in the exchange or by accepting all qualified health plans? Should states negotiate premiums or rely on market forces to set rates?

David Clark, a Republican who is speaker of the Utah House of Representatives, said: “In our exchange, the government is a market facilitator, not a contracting agent. We believe in the invisible hand of the marketplace rather than the heavy hand of government.”

Utah has no interest in putting its exchange plans out for bid, Mr. Thurston said. “Any attempt to standardize benefit designs tends to discourage competition and entry into the market, and limits choice,” he said.

In Massachusetts, State Senator Richard T. Moore, a Democrat who is president of the National Conference of State Legislatures, said: “We took a much more governmental approach. But both models make sense. Small states might find Utah is a good model. Bigger industrialized states might go the route we went.”

Massachusetts officials point to the state’s near-universal coverage as evidence that their approach is working. The Census Bureau says 95.6 percent of Massachusetts residents were covered by health insurance last year, compared with 83.3 percent for the nation as a whole and 85.2 percent for Utah.

“We have the lowest uninsured rate in the nation, and we are immensely proud of that,” said Glen Shor, executive director of the Massachusetts Connector.

The White House has provided $49 million to states to help them set up exchanges, which are envisioned as a kind of bazaar where insurers will offer their products side by side, so consumers and employers can make intelligent comparisons.

Congress assumed that insurance would also be sold outside the exchange. But federal subsidies, to help pay for insurance, will be available only to people who enroll in health plans through an exchange.

Exchanges will also play a crucial role as gateways to Medicaid and other public health programs. If people are found eligible, the exchange will help them enroll. In Massachusetts, the same application form is used for Medicaid and for subsidized private insurance purchased through the Connector.

California is another pioneer. On Sept. 30, Gov. Arnold Schwarzenegger, a Republican, signed two bills establishing the California Health Benefit Exchange, with broad powers to “negotiate on behalf of the public” and select qualified health plans.

The legislation generated intense lobbying, and the governor’s intentions were unclear until the last minute. Mr. Obama had urged him to sign the bills and was thrilled when he did, aides said.

The fight in Sacramento offers a preview of what other states can expect. In a letter to California lawmakers in August, Natalie Cárdenas, regional director of government relations for Anthem Blue Cross, a unit of WellPoint, complained that the exchange would have the power to pick winners and losers in the insurance market.

“Federal law will already limit the types of products that carriers can offer,” Ms. C├írdenas said. “Beyond that, the marketplace should determine what products consumers and small employers can purchase, not a government bureaucracy.”

The California Chamber of Commerce urged a veto of the bills, saying they “could lead to unnecessary cost increases and limited choice for employers.”

But Betsy M. Imholz, a lobbyist for Consumers Union, said the California laws struck the right balance.

“At first,” Ms. Imholz said, “the exchange may want to have a large number of health plans participating. But then the state needs to winnow down the number so consumers can see where they will get the best value.”

The California law says the exchange should choose health plans that “offer the optimal combination of choice, value, quality and service.”

Massachusetts requires people to have insurance. Utah does not.

Massachusetts provides more generous subsidies. But, Mr. Kingsdale said, the biggest difference is the magnitude of the two state programs.

In Massachusetts, more than 154,000 people receive subsidized coverage through the exchange, and 40,000 receive unsubsidized coverage, which can be bought on the Web. The Utah exchange, created under a 2008 state law, began enrollment this year. About 1,200 people have coverage through the Utah exchange, and the number is expected to grow to 10,000 by July 2011.

“We anticipate exponential growth,” Mr. Spencer said.

Under the new federal law, the exchanges must be in operation by January 2014. Federal officials will assess states’ progress as of Jan. 1, 2013, and will run the exchange in any state that is unable or unwilling to do so.

The exchanges will have a huge number of duties. They must evaluate health insurance plans and publish “standardized comparative information.” They must set up telephone call centers to answer consumers’ questions. They must determine who is eligible for subsidies and who will be exempt from the penalties imposed on people who go without insurance. They must build new computer systems to exchange data with state Medicaid agencies, insurance companies, employers and federal agencies.

While the exchange cannot explicitly control prices, it can exclude health plans that show a pattern of “excessive or unjustified premium increases.”

State officials worry that sick people will gravitate to the exchange, while healthier people who do not need subsidies will buy insurance outside it. However, insurers must agree to charge the same prices inside or outside the exchange.

Moreover, the law stipulates that members of Congress must get their health insurance through an exchange. So lawmakers will presumably be alert to problems.

Trauma centers in critical condition

Fuding measure on ballot would add $10 to car tags
The Atlanta Journal-Constitution October 24, 2010

Plenty of Atlanta drivers speed through the South Georgia segment of I-75 on the way to Florida’s beaches.

But they might slow down if they knew what some health care workers call that portion of the interstate: “the corridor of death.” The stretch of road earned the name because people who get in car crashes in much of South Georgia are at least 50 miles from a trauma center — a hospital equipped to handle serious injuries.

Georgia voters will decide on Nov. 2 whether they want to add $10 to the cost of annual vehicle registrations to improve trauma services statewide. Hospitals, emergency services workers and public health officials say the $80 million that would be raised every year by passage of Amendment 2 is needed to save lives.

Georgia has 17 hospitals designated as trauma centers, short of the 25 to 30 centers that public health officials say the state needs.

Trauma-related injuries — usually the result of car crashes, falls and work accidents — are the leading cause of death among Georgians between the ages of 1 and 44, said William T. Moore, a member of the Georgia Trauma Care Network Commission and president of Atlanta Medical Center.

“Georgia’s trauma death rate is 20 percent higher than the national average — or about 700 deaths greater than what you would expect at the national average,” Moore said.

Atlanta Medical Center is one of the state’s 17 trauma centers.

Everyone wants a fast response when they dial 911 for help, but selling the new $10 fee may be difficult. Some metro Atlanta voters believe they are close to well-staffed trauma centers and don’t want to pay more to staff up services in rural Georgia.

The Libertarian Party of Georgia opposes the amendment, saying it would be just the latest tax on Georgians already struggling in a tough economy. The party also said the plan for spending the $80 million is too vague.

“There are a lot of details that we’re curious about that we don’t have the answer to, but we’re expected to amend the state constitution for a $10 fee in perpetuity without knowing the details of what is planned with the money,” said Brett Bittner, operations director for the Libertarian Party of Georgia.

Between 2004 and 2006, a committee closely studied trauma care in Georgia and concluded the state was significantly underserved, according to Lisa Marie Shekell, a spokeswoman for the Georgia Department of Community Health. That committee estimated the need for up to 30 trauma centers statewide.

The number of Georgia trauma centers rose to 17 last week, when Taylor Regional Hospital in Hawkinsville became a Level IV trauma center.

The state’s trauma centers are rated as Level I through IV, depending on their capabilities. The state’s four Level I centers are the most advanced and must operate 24 hours a day with a full-service surgical suite, an intensive care unit and diagnostic imaging services. Level I facilities must also run a residency program and conduct research. Atlanta’s only Level I trauma center is Grady Memorial Hospital.

Level IV facilities provide initial assessment of trauma patients, but transfer most of the patients to hospitals with more capabilities.

In 2007, the General Assembly created the Georgia Trauma Care Network Commission to help improve Georgia’s trauma services, and the state authorized $58.9 million in 2008 for the commission to distribute to trauma care providers.

The new fee would offer a long-term stream of money that the commission could dole out to create a more organized approach to trauma care, increase the number of trauma centers and help hospitals cover the cost of providing the care, since many trauma patients do not have insurance.

The commission also would help pay for more ambulances, equipment and training for first responders. The commission is made up of doctors, hospital officials and others who work in the trauma field.

Moore said Atlanta Medical Center treats about 2,200 trauma patients a year. Last year, about 300 of its trauma patients were uninsured. The cost of providing care to those patients was about $4.3 million, he said.

Moore said he understands that many voters will be hesitant to approve a new tax. “I’m fiscally conservative,” he said, “but I’m going to support it because I’m familiar with the situation in Georgia and I believe this $10 is going to help save lives.”

The amendment provides that the money can only be used for trauma care, he said.

About one in seven fatal car crashes in Georgia took place at least 50 miles away from the closest trauma center in 2008, according to the Governor’s Office of Highway Safety.

Many South Georgians, as well as people traveling through that area of the state, are outside the 50-mile radius.

“If you’re in a major accident on I-75 and you need immediate care, that’s a problem,” said Kevin Bloye, a spokesman for the Georgia Hospital Association. “You’re in trouble.”

“Our data is very clear — when you’re in excess of 25 miles from a trauma center your chances of surviving that crash go down,” said Bob Dallas, director of the Governor’s Office of Highway Safety.

Dallas said an improved trauma network would save lives, improve the outcome of those who are injured, and make Georgia a more attractive place for retirees and companies.

“It’s less than 3 cents a day,” Dallas said. “That’s a great investment.”

Ga. governor candidates' views on jobs show contrastsMorris News Service 10-25-10

ATLANTA --- Democrat Roy Barnes and Republican Nathan Deal say their final campaign tours in the race for governor are focused on jobs. What they are saying on those tours shows how different their approaches to the issue are.

Barnes is traveling by school bus. It's his way of emphasizing that education is the foundation of a productive work force and that public school funding would strengthen Georgia's long-term economic welfare.

He plans to pay for the schools by boosting taxes on businesses, such as insurance companies and industries that use coal and diesel fuel.

Deal talks instead about tax cuts.

He takes pride in reminding audiences that he unveiled a jobs plan in May after winning the seal of approval from the Tax Foundation, which predicted that it would catapult Georgia's rank of competitiveness from 29th nationally to second in the South.

The plan calls for cutting corporate income taxes by one-third, exempting start-up businesses from corporate income taxes entirely and eliminating the corporate "net worth" tax.

He would also allow local governments to waive the business-inventory tax.

Barnes has his own tax-cut plan.

It includes a two-year suspension of capital-gains taxes and payroll taxes for new hires. Those capital-gains proceeds would have to be reinvested in the business.

He would also give tax incentives to companies that expand broadband Internet in the state.

A $25 million biomedical research park would spur high-tech industry, he says.

One ad shows him telling workers that he will prohibit the state from doing business with vendors that transfer jobs to other countries.

"You outsource jobs away from the United States, then you shouldn't be eligible to bid on state contracts," he said.

Both candidates have pledged to deepen the Savannah River to accommodate bigger ships and preserve the jobs of the warehouse and shipping industry near the Port of Savannah.

Economists are skeptical about all the proposals.

"Quite frankly, Georgia's tax structure is already not that bad," said Jeff Humphreys, of the University of Georgia's Selig Center for Economic Growth. "The marginal benefits of tax reform may not change the economy dramatically."

Atty. Gen. candidates agree on littleMorris News Service 10-25-10

ATLANTA - The three candidates for attorney general only agreed on one issue during Sunday-night's half-hour debate, that the records of the governor's office need be more open to the public.

The trio bickered on seemingly every other issue during the forum sponsored by the Atlanta Press Club and aired statewide by Georgia Public Broadcasting.

A recurring theme was whether the post requires someone who has been a prosecutor. Democrat Ken Hodges, district attorney for 12 years in Albany, described Republican Sam Olens as unprepared for never having been a prosecutor. Hodges dwelt on it so much, that at one point, he misspoke.

"I'm running to be district attorney. Excuse me, I mean, I'm running to be attorney general of the state of Georgia," he said, as he criticized Olens for seeking the attorney general's office as a stepping stone for governor.

Later, Olens turned it around.

"I want to be your attorney general, not your district attorney," he said.

Olens, the former chairman of the Cobb County Commission, said he's tried 150 jury trials in his legal career, giving him the wide background needed to oversee the state's Law Department that deals mostly with civil matters anyway.

But he defended charges his salary rose from $58,000 to $129,000 during his tenure as chairman, saying it was set by the legislative delegation, not him. And he brushed off Hodges' claims that the county's budget and payroll ballooned during that time by noting that the county has been described by others as one of the state's most conservatively managed as he cut tax rates.

Olens attacked Hodges for trying three times to indict two doctors at the local hospital who were questioning the accounting there. Hodges corrected him because it was a special prosecutor who sought the indictments after Hodges removed himself from the case to avoid a conflict of interest.

Libertarian Don Smart, a Savannah attorney, also participated in the debate, but not in the mud slinging. However, he did get Olens to agree that state law should be changed to allow more Libertarians and other political parties greater access on the ballot.

Insurance candidates spar over ethics, lobbyists, health reformMorris News Service 10-25-10

ATLANTA - Ethics, lobbying and federal health reform provided the most clashes Sunday night during a debate between the three candidates for insurance commissioner.

The half-hour forum sponsored by the Atlanta Press Club and aired statewide by Georgia Public Broadcasting didn't provide outgoing Commissioner John Oxendine time for rebuttal since he's not on the ballot, but his name kept coming up.

Democrat Mary Squires said he "has been one of the most corrupt that we've had in a long time in Georgia." She said he wouldn't need the oversight of an independent office of consumer advocacy the way he did when she voted for it as a legislator.

And Republican Ralph Hudgens said just because Oxendine is chairing a fundraiser for him next week doesn't mean the two see eye-to-eye.

He also said he saw nothing wrong with letting insurance lobbyists pick up the tab for meals or in accepting campaign contributions from individuals in the insurance.

"These are the people who have an interest in the insurance-commissioner race. ... I don't have any problem taking any individual's money," he said, noting that the lobbyists encouraged him to run because they viewed him as fair as chairman of the Senate Insurance Committee.

Squires, who is a lobbyist, denied she is trading on her six years as a legislator. She was a lobbyist before her election, she said.

Hudgens asked why she doesn't mention her lobbying in her campaign materials.

"I'm not hiding it," she said, noting her name appears on the public registry.

She blasted Hudgens, however, for accepting $20,000 in gifts, meals and event tickets from insurance lobbyists even though he has an $8 million net worth and could pay his own way.

"I've done well in building up my net worth, but that doesn't have anything to do with whether or not I would be a good insurance commissioner," he said, adding that his experience as a business owner while earning wealth means more because it gives him an understanding of commerce.

But Squires shot back.

"No one begrudges Sen. Hudgens his net worth, but you just have to ask when you take those kinds of gifts, trips and sporting-events tickets and vacations at lobbyists' expense when you don't have to, are you going to work for consumers?" she said.

Both candidates vowed to stand up for Georgia's authority during the implementation of federal health reform. Hudgens admitted he's said the "insurance commissioner can't do squat about health reform," but that he had sponsored legislation that passed, making it optional for Georgians to buy coverage despite the federal requirement.

Squires said his law won't have an impact.

Libertarian Shane Bruce also participated but stayed out of the squabbles.

Wearing a colorful Hawaiian shirt and no tie, Bruce closed by saying, "I can out run, out ride, out shoot, out hunt, out fish anybody standing on this stage. I am a true Son of Liberty."

Then he urged voters to cast a ballot for John Monds, the Libertarian nominee for governor.

Monday, October 25, 2010

3 federal lawsuits against health system reform keep judges busy :: Oct. 25, 2010 ... American Medical News

amednews: 3 federal lawsuits against health system reform keep judges busy :: Oct. 25, 2010 ... American Medical News

AMA Continues Push Against Nurses' Scope of Practice - Part B News Blog

AMA continues push against nurses' scope of practice.

Part B News - latest Medicare rules with guidance, analysis and news coverage : Part B News Blog:

What do you think? Do you employ nurses?

Will this work? Insurers talk quality while targeting physician pay :Amed news

amednews: Insurers, employers talk quality while targeting physician pay :: Oct. 25, 2010 ... American Medical News

Is targeting physician payment the answer? Depends on the question. Weigh in with your comments and thoughts.

Trauma centers in critical condition  |

Don't let trauma funding die! Come out and support amendment 2 at rallies in Atlanta and Savannah, Tuesday October 26.

Trauma centers in critical condition

Mergers between insurers and hospitals expected to accelerate :: Oct. 25, 2010 ... American Medical News

amednews: Mergers between insurers and hospitals expected to accelerate :: Oct. 25, 2010 ... American Medical News

Do you think this is a move in the right direction? Post your comments.

GSACS Daily Briefing 10-25-10

Amendment 2: Piece of mind - Charles E. Richardson -

Amendment 2, trauma funding and Georgia: An interview with HealthSTAT’s Michelle Putnam – The Hospital Accountability Project - Promoting access to affordable care in Georgia: "Amendment 2, trauma funding and Georgia: An interview with HealthSTAT’s Michelle Putnam"

Latest breast cancer research focuses on effective drugs The Augusta Chronicle

Amendment 2 - Albany Herald

Savannah Yes 2 Save Lives Rally - Amendment 2 Trauma Funding

Join us!

Savannah Yes 2 Save Lives RallyYes 2 Save Lives Rally

11:00 AM – 12 Noon

Tuesday, October 26, 2010

Forsyth Park Band Shell

Drayton and Whitaker Streets, Savannah

Help us improve Georgia’s ailing trauma system. Our

supporters include health care providers, safety professionals,

businesses and citizens across the state. Now, we need you.

The Yes 2 Save Lives coalition is working to pass Ballot

Amendment 2, which would establish a dedicated funding source

to improve and expand Georgia’s trauma care system.

This is a chance to make a difference in your community.

*Refreshments will be provided..


supporters include health care providers, safety professionals,

businesses and citizens across the state. Now, we need you.

The Yes 2 Save Lives coalition is working to pass Ballot

Amendment 2, which would establish a dedicated funding source

to improve and expand Georgia’s trauma care system.

This is a chance to make a difference in your community.

*Refreshments will be provided.Yes 2 Save Lives coalition is working to pass Ballot

Amendment 2, which would establish a dedicated funding source

to improve and expand Georgia’s trauma care system.

This is a chance to make a difference in your community.

*Refreshments will be provided.make a difference in your community.

*Refreshments will be provided.

Atlanta Yes 2 Save Lives Campaign Rally

 11:00 AM – 12 Noon
Tuesday, October 26, 2010
Yes 2 Save Lives is a coalition that represents concerned citizens, safety and community advocates, health care providers, local
governments, and the business community in support of passing Ballot
Amendment 2 in the Nov. 2 election.

Hear from emergency physicians, EMS, survivors, families of


The Yes 2 Save Lives campaign is working to pass Ballot Amendment 2,to create a dedicated trust fund to improve and expand Georgia’s trauma
care system. The funds would train 911 professionals, paramedics,
critical care nurses and physicians, increase rapid transport, provide the
latest life-saving equipment, and upgrade more emergency rooms to
trauma centers.

Gather at Georgia Railroad Frieght Depot (65 Martin Luther King, Jr. Drive, Atlanta.)
Grab a sandwich, yard signs, balloons, and march together to the State
Capitol Building, Washington Street side.

A Rally to support Yes 2 Save lives Ballot Amendment 2, which would establish a dedicated funding source for Georgia’s ailing trauma care

Yes 2 Save Lives Campaign Rally Atlanta

Friday, October 22, 2010

AACR Colorectal Cancer Conference To Focus On Screening, New Treatments

AACR Colorectal Cancer Conference To Focus On Screening, New Treatments: "AACR Colorectal Cancer Conference To Focus On Screening, New Treatments"

Medical News: Fentanyl Patches Recalled - in Pain Management, Pain Management from MedPage Today

Medical News: Fentanyl Patches Recalled - in Pain Management, Pain Management from MedPage Today: "Fentanyl Patches Recalled"

Daschle On Health Law: Defunding Is 'A Very Serious Threat' - Kaiser Health News

Daschle On Health Law: Defunding Is 'A Very Serious Threat' - Kaiser Health News: "Daschle On Health Law: Defunding Is 'A Very Serious Threat'"

Diabetes may affect as many as 1 in 3 Americans by 2050 -

Diabetes may affect as many as 1 in 3 Americans by 2050 - "Diabetes may affect as many as 1 in 3 Americans by 2050"

States Back Rule to Use 80% of Health Premiums for Care -

States Back Rule to Use 80% of Health Premiums for Care - "States Affirm Tough Limits on Insurers’ Use of Dollars"

Insurer Agrees to Pay N.J. ASCs $22M to Settle Class-Action Suit > October, 2010 > Insurer Agrees to Pay N.J. ASCs $22M to Settle Class-Action Suit: "Insurer Agrees to Pay N.J. ASCs $22M to Settle Class-Action Suit"

New vitamin E treatment for prostate cancer

New vitamin E treatment for prostate cancer: "New vitamin E treatment for prostate cancer"

Discovery Of A Very Promising Biological Marker For Cancer

Discovery Of A Very Promising Biological Marker For Cancer: "Discovery Of A Very Promising Biological Marker For Cancer"

Low-Dose Aspirin May Cut Risk Of Developing And Dying From Colon Cancer

Low-Dose Aspirin May Cut Risk Of Developing And Dying From Colon Cancer: "Low-Dose Aspirin May Cut Risk Of Developing And Dying From Colon Cancer"

News from the American College of Surgeons: American College of Surgeons Releases New Publication Mapping Distribution of U.S. Surgical Workforce

News from the American College of Surgeons: American College of Surgeons Releases New Publication Mapping Distribution of U.S. Surgical Workforce: "American College of Surgeons Releases New Publication
Mapping Distribution of U.S. Surgical Workforce"

American Trauma Society: Race & Insurance Status Associated With Death From Trauma

American Trauma Society: News: News Detail #1: "Race and insurance status associated with death from trauma"

Yes 2 Save Lives says 48% of voters favor passage

From the Political Insider-Atlanta Journal and Constitution:

"Yes 2 Save Lives, the group behind Amendment 2 and the $10 car tag fee for a statewide trauma network, says its most recent polling shows 48 percent of likely voters in favor of passage, with 45 against. That’s the result of several weeks of TV ads.

In August, polling showed 51 percent against the measure. This most recent survey gauged the opinion of 500 voters, has an MOE of +/- 4.38 percentage points, and was conducted Oct. 19 and 20. "

Governor’s race stealing the show this election

Governor’s race stealing the show this election

Joint Commission-Hospital Collaboration Targets Hand-Offs - Health Blog - WSJ

Joint Commission-Hospital Collaboration Targets Hand-Offs - Health Blog - WSJ: "Joint Commission-Hospital Collaboration Targets Hand-Offs"

Extra tag fee would expand trauma network

Extra tag fee would expand trauma network

Thursday, October 21, 2010

Using the internet for health information is not the exception

Using the internet for health information is not the exception: "Using the internet for health information is not the exception"

AMA makes physician health a priority

AMA makes physician health a priority: "AMA makes physician health a priority"

Buckeye Surgeon: NSQIP Appendicitis Data

Buckeye Surgeon: NSQIP Appendicitis Data: "The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database has yielded some great ammunition to my pref..."

New Finding Suggests Safe Surgical Margins When Removing Breast Cancers --Doctors Lounge

New Finding Suggests Safe Surgical Margins When Removing Breast Cancers --Doctors Lounge

Estrogen May Boost Women’s Recovery From Trauma --Doctors Lounge

Estrogen May Boost Women’s Recovery From Trauma --Doctors Lounge

Infusion Ups Risk of Organ Failure in Trauma Patients --Doctors Lounge

Infusion Ups Risk of Organ Failure in Trauma Patients --Doctors Lounge

Why California hospitals can charge so much

Why California hospitals can charge so much

Representative Introduces Bill to Relax Physician Supervision Requirements - October 19, 2010

Representative Introduces Bill to Relax Physician Supervision Requirements - October 19, 2010

New Anti-Clotting Drug Jumps Into Giant Market

New Anti-Clotting Drug Jumps Into Giant Market

amednews: California counties get 2nd chance to challenge Medicare payments :: Oct. 18, 2010 ... American Medical News

amednews: California counties get 2nd chance to challenge Medicare payments :: Oct. 18, 2010 ... American Medical News

Read Dr. Dennis Ashley's article in the Oct Issue of the ACS Bulletin

The Quest for Sustainable Trauma Funding:The Georgia Story

amednews: Treading awkward waters when reporting colleagues :: Oct. 18, 2010 ... American Medical News

amednews: Treading awkward waters when reporting colleagues :: Oct. 18, 2010 ... American Medical News

amednews: Medicare payment -- past, present, future: Prelude to a crisis :: Sept. 25, 2006 ... American Medical News

amednews: Medicare payment -- past, present, future: Prelude to a crisis :: Sept. 25, 2006 ... American Medical News

Georgia voters must decide Nov. 2 to pay $10 a year for upgraded trauma care statewide - News -

Georgia voters must decide Nov. 2 to pay $10 a year for upgraded trauma care statewide - News -