HHS announces a major new investment in community health centers

Valley Healthcare System, Inc. of Columbus and Community Health Care Systems, Inc of Wrightsville receive over $8 million in grants.

HHS Secretary Kathleen Sebelius today announced awards of $727 million to 143 community health centers across the country to address pressing construction and renovation needs and expand access to quality health care. The funds are the first in a series of awards that will be made available to community health centers under the Affordable Care Act.

Community health centers serve nearly 19 million patients, about 40 percent of whom have no health insurance. Community health centers deliver preventive and primary care services at more than 7,900 service delivery sites around the country to patients regardless of their ability to pay; charges for services are set according to income.

"There is no question that the economic downturn has made it harder for some Americans to get health care and important preventive services. Community Health Centers provide quality healthcare services to Americans across the country but are a life line for those who have lost coverage or are between jobs. These funds from the Affordable Care Act will help get more people care in some communities where there have not been many options in the past," said Secretary Sebelius. "The newly constructed or expanded community health centers will provide care to an additional 745,000 patients and much needed employment opportunities in both rural and urban underserved communities."

The Capital Development (CD) program grants, administered by HHS' Health Resources and Services Administration (HRSA), will support major construction and renovation at 143 community health centers nationwide. This builds on the more than $2 billion investment in community health centers in the American Recovery and Reinvestment Act. A state by state list of Recovery Act investments in community health centers is available at http://www.hhs.gov/recovery/programs/hrsa/index.html .

"Many of these community health centers need more modern space to meet the increasing patient demand for services. These funds will help community health centers build new facilities and modernize their current sites in their continuing effort to provide the best care possible to more and more people in need," said HRSA Administrator Mary K. Wakefield, Ph.D., R.N.

Over the next five years, the Affordable Care Act provides $11 billion in funding for the operation, expansion and construction of community health centers across the country. This expansion of sites and services will help community health centers to serve nearly double the number of patients receiving care, regardless of their insurance status or ability to pay.

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Oklahoma, Georgia Send Health Care Freedom Act to Governor's Desk

/PRNewswire/ -- Yesterday, the Republican-controlled Oklahoma legislature sent House Joint Resolution 1054, the Freedom of Healthcare Choice Act, to Democrat Governor Brad Henry's desk. The statutory measure--which prohibits a federal requirement to purchase health insurance and allows the legislature to hire outside counsel in a lawsuit against federal health reform--was also supported by nine Oklahoma House Democrats. And last week, Georgia's legislature sent similar legislation, Senate Bill 411, to the governor's desk. Both measures are modeled after the American Legislative Exchange Council's (ALEC) Freedom of Choice in Health Care Act now introduced or announced in 42 states.

"The fallout from ObamaCare continues to fuel rebellion in the states," said ALEC health task force director Christie Herrera, who is coordinating the nationwide effort.

"ALEC applauds Oklahoma and Georgia's lawmakers for protecting their citizens from abusive federal power when other state officials will not," Herrera added. Last month, Georgia Governor Sonny Perdue also appointed special counsel to represent Georgia in the multi-state challenge of the federal health reform law.

ALEC's Freedom of Choice in Health Care Act has already been enacted in statute form by the Virginia, Idaho, and Arizona legislatures, and constitutional amendments in Oklahoma, Arizona, and Florida will appear before voters on the November ballot.

In addition to the Georgia and Oklahoma statutes on the governor's desk, Freedom of Choice in Health Care Act statutes have also been passed by one chamber in the Missouri and Tennessee legislatures. And active citizen initiatives are underway in Colorado, Michigan, and Mississippi.

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CBO: Dem's Health Care Plan Costs $1 Trillion, Leaves 36 Million Uninsured, Forces 23 Million Out of Their Current Plans

Yesterday’s Congressional Budget Office (CBO) report on a Democratic health care “reform” bill has sent shockwaves through Washington – and middle-class families, small businesses, and all taxpayers are right to take notice. Here’s what CBO has uncovered:

The Democratic plan will cost taxpayers at least $1 trillion;
The legislation will leave at least 36 million Americans uninsured; and
The proposal will force at least 23 million Americans to give up the health coverage they currently enjoy.

This is reform?

House Republicans are working on a better solution to ensure that every American has access to affordable health care. To that end, tomorrow, the House GOP’s Health Care Reform Solutions Group will outline a common-sense plan to reduce costs, expand access, and increase the quality of care in a way that Americans can afford. The GOP plan will:

Expand access to affordable, quality care regardless of pre-existing conditions;
Protect Americans from being forced into a government-run plan, making certain that medical decisions are made by patients and their doctors, not Washington bureaucrats; and
Let Americans who like their health care coverage keep it, while giving all Americans the freedom to choose the plan that best meets their needs.

With the Democratic and GOP plans now coming into clearer focus, middle-class families and small businesses across the country are beginning to ask: is a $1 trillion government takeover of health care really worth it if it leaves at least 36 million Americans uninsured and forces at least 23 million Americans off their current plans? Or, is the better solution a proposal that will expand access to affordable care while protecting Americans’ relationships with their doctors? That choice will become increasingly evident in the weeks to come, as Democrats in charge of Washington continue pushing their costly plan onto Americans who just don’t support it.

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Health Care Reform May Force U.S. Pharmaceutical Companies to Overhaul Sales Strategies, Says New Report From ZS Associates and eyeforpharma

/PRNewswire/ -- While President Obama's push for a larger government role in health care and the prospect of a European-style health care model developing in the United States may worry some pharmaceutical companies, all should share a more immediate concern: the growing influence of payers over physician prescription decisions in the United States.

According to a new report by global management consulting firm ZS Associates and eyeforpharma, a leading provider of pharmaceutical business intelligence, this changing payer landscape will force companies in the United States to change their sales models much like pharmaceutical companies in Europe who must adapt today to serve the needs of the various decision-makers and influencers driving their local health economies. Still, this change won't happen in the U.S. as quickly as in Europe.

"Though U.S. health care has plenty of problems of its own, the lack of central decision-makers, as are common in much of Europe, allows the traditional practice of pharmaceutical representatives calling on physicians to remain effective and largely intact -- for now," said Chris Wright, principal and leader of the pharmaceutical practice at ZS Associates and co-author of the "Drivers of Change to Pharmaceutical Commercial Models" report. "Over the next several years, however, U.S. pharmaceutical companies should trim another 15-20 percent of their sales forces and prepare to do what many in Europe are doing today. They must modify their direct-selling strategies and prepare to sell to an increasingly diverse group of health insurance companies, government payers like Medicare and Medicaid and other opinion leaders who will increasingly influence prescription decisions."

Payer Restrictions in the U.S. versus EU

The fragmented nature of managed care organizations and government-led health care initiatives limits their influence over physician prescription decisions in the United States. So even if a pharmaceutical company fails to obtain a favored spot -- and the concomitant smaller co-pay -- for its drug on a payer's formulary in the United States, physicians and patients still can opt for the drug.

This contrasts with Europe, where government-funded payers such as the Primary Care Trusts (PCTs) in the United Kingdom administer most health care budgets. During the last five years, many of these payers have increased their influence over physician behavior by penalizing those who prescribe drugs that fall outside of increasingly restrictive formularies. They often use a combination of financial rewards and penalties to control prescribing.

"Unlike in the United States, pharmaceutical executives in Europe must immediately change the way they market and sell to increasingly powerful public health care payers who strive to provide their constituents the best drugs at the lowest possible cost," said Rohan Fernando, managing principal for ZS Associates Europe and co-author of the report. "Pharmaceutical companies in the United States should watch carefully the changes taking place in Europe to prepare for a future when they face similar challenges."

Lessons from Europe

Several companies in Europe, primarily in the United Kingdom, the Netherlands, Italy, Spain and Germany, have begun to make meaningful changes to their selling strategies to meet the needs of public payers. While there is no blueprint for strategies that will work for every European country, the "Drivers of Change to Pharmaceutical Commercial Models" report identifies some common features of effective changes to the sales model -- changes that could be relevant for companies in the United States in the near future:

1. Acquire the skills to manage "new" stakeholders effectively, and
integrate sales strategies that previously functioned separately. This
includes blending account management with regional health care payers,
stakeholder management with key opinion leaders and continuing
traditional promotion with physicians.
2. Design flexible, regional strategies that address the differences
between local health economies. This can be a complex undertaking since
many pharmaceutical companies are set up to implement national-level
strategies. Many companies that seek this flexibility will make a move
towards contract sales forces.
3. Create stronger, mutually beneficial relationships with regional health
care payers. Focus not just on product features and benefits, but also
on product value by explicitly tying outcomes to costs.


The Pharmaceutical Sales Rep is Safe -- for Now

Despite frequent news stories about the imminent demise of pharmaceutical sales people, the report suggests that while the rep function will not disappear in the near future, sales representatives will need to adapt.

The report also addresses select, long-term trends that are likely to have a dramatic influence on the future of the sales representative position. Among them: the development of personalized medicine, which would lead to multiple "versions" of a branded product and allow doctors to prescribe drugs that best align with a given patient's genetic makeup. Such a fundamental shift in the branding and marketing of pharmaceutical products could render the pharmaceutical sales representative irrelevant in the future. The report stresses, however, that the impact of personalized medicine won't likely be felt in the next decade.

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Vidalia Makes the Cut as Reuters Announces Top 100 Hospitals

Meadows Regional Medical Center in Vidalia is the only Georgia hospital to make the list in the small community hospital winners.


/PRNewswire/ -- The Healthcare business of Thomson Reuters today released its annual study identifying the 100 top U.S. hospitals based on their overall organizational performance.

The Thomson Reuters 100 Top Hospitals(R): National Benchmarks study is based on the 100 Top Hospitals National Balanced Scorecard that evaluates performance in nine areas: mortality, medical complications, patient safety, average length of stay, expenses, profitability, cash-to-debt ratio, patient satisfaction, and adherence to clinical standards of care. The study has been conducted annually since 1993.

"The 100 Top Hospitals winners raised the bar again this year, delivering a higher level of reliable care and greater value for their communities and payers," said Jean Chenoweth, senior vice president for performance improvement and 100 Top Hospitals programs at Thomson Reuters.

Thomson Reuters also is launching the 100 Top Hospitals: Everest Award for National Benchmarks to recognize those hospitals among the 100 winners that delivered the greatest rate of improvement over a five-year period. This marks the first time the 100 Top Hospitals national benchmarks have been integrated with data reflecting long-term performance trends to identify the top-performing hospitals that are improving at the fastest rate. This year, there are 23 Everest award winners.

"Integration of national benchmarks for improvement and top performance is an innovation that enables Thomson Reuters to identify those hospitals with a mature culture of performance improvement," Chenoweth said. "The ability to objectively gauge where a hospital stands in its journey to excellence is a breakthrough in the measurement of leadership effectiveness, the success of organizational improvement strategies, and the impact of executive decisions."

"The boards, executives and physician leaders of the Everest award-winning hospitals developed long-term strategies and executed them with extraordinary skill and extraordinary results," she said. "The Everest award winners have reached the point at which innovation is a must to improve further."

To conduct the 100 Top Hospitals study, Thomson Reuters researchers evaluated 3,000 short-term, acute care, non-federal hospitals. They used public information -- Medicare cost reports, Medicare Provider Analysis and Review (MedPAR) data, and core measures and patient satisfaction data from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare data set.

If all Medicare inpatients received the same level of care as patients treated in the winning hospitals:

-- More than 107,500 additional patients would survive each year.
-- Nearly 132,000 patient complications would be avoided annually.
-- Expenses would decline by $5.9 billion a year.

-- The average patient stay would decrease by nearly half a day.

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Governor Proposes Investments in Georgia's Future, Encourages Long-Term Perspective

Governor Sonny Perdue today delivered his annual State of the State address before a joint session of the General Assembly detailing how the state continues to fulfill its core mission through challenging economic times. The Governor’s Amended FY 2009 and FY 2010 budgets and policy initiatives continue his commitment to education, economic development and government transformation to deliver better value for the taxpayer’s dollar.

“We must not allow ourselves to be trapped in a short-term mindset where rash decisions result in dire long-term consequences,” said Governor Perdue. “Our perspective must be one of optimism even in the face of difficult economic cycles.”

Governor Perdue used his State of the State address to formally submit his Amended FY 2009 and FY 2010 budget recommendations to the General Assembly. Governor Perdue’s recommended Amended 2009 budget totals $19.2 billion and the 2010 budget stands at $20.2 billion.

The Governor thanked the legislature for working with his administration to help replenish the Rainy Day Fund, which now stands at $1.2 billion. In these budgets, Governor Perdue recommended using the maximum amount available for appropriation from the reserves, appropriating $187 million for the education midyear adjustment, $50 million in 2009 and $408 million in 2010. In 2009, a number of one-time strategies unavailable in 2010 will be implemented to balance the budget. Therefore, Governor Perdue recommended the largest portion of available reserve funds be committed to the 2010 budget.

The Governor’s 2010 budget includes a $1.2 billion bond package that will create an estimated 20,000 jobs and features projects in which both design and construction are funded in the same year.

“These projects touch every corner of the state and include new construction at our universities, technical schools, local school systems and libraries; harbor deepening at the Savannah port and needed improvements at state facilities.,” said Governor Perdue.

Governor Perdue also outlined a proposal to restructure the Department of Human Resources. Currently, $3.8 billion is spent within DHR every year. The plan calls for the creation of a new Department of Behavioral Health which will include all mental health and addictive disease programs. The bill also establishes a Department of Health, a combination of the public health and oversight programs in DHR and the current functions of DHR. Remaining social services, such as Developmental Disabilities, Aging, DFCS and Child Support, will come together under a reconstituted Department of Human Services.

Governor Perdue will also introduce legislation to ask those who receive Medicaid payments to help fund the system. This proposal takes advantage of the fact that every dollar used toward Medicaid purposes draws down almost two additional dollars from the federal government. The budget will reflect, and an accompanying bill will propose, a 1.6 percent fee on hospitals and health insurance plans to, not only fill the hole in Medicaid, but also to do what the healthcare community has asked of Governor Perdue’s administration. This proposal will significantly raise Medicaid rates, particularly for hospitals; and in conjunction with the SuperSpeeder legislation, provide $60 million for trauma to sustain and expand the state’s trauma hospitals, EMS and trauma physician infrastructure.

The Governor asked the General Assembly to carefully consider the consequences of cutting healthcare coverage.

“I implore you, do not rush into a short-sighted cut that would have long-term consequences for Georgia’s most needy,” the Governor said.

Governor Perdue highlighted the efforts by Gwinnett County schools to increase student achievement. Last week, the State Board of Education approved an IE2 contract and committed to be held accountable for increased student achievement above and beyond state and federal requirements.

For the 2009 session, Governor Perdue is proposing merit pay legislation that will award teachers who show evidence that their classroom instruction leads to increased student achievement. Governor Perdue is also proposing differentiated pay for math and science teachers. Additional legislation will ensure every student in Georgia has the benefit of responsible leadership at the school system level. This legislation will clearly define what citizens expect from Georgia’s school board members, and it will give the state the ability to replace board members who aren’t serving in the best interests of their students.

“Education means opportunity,” said Governor Perdue. “We spend more than half of our state budget on education because we know that opportunity is discovered in Georgia’s classrooms.”

Governor Perdue’s encouraged legislators and all Georgians to remember the resiliency of our great state, and while we confront the short-term challenges of today we will continue to prepare to take advantage of future opportunities.

“As I think about the American promise of freedom and economic opportunity, I know that rich promise will mean great things for Georgians in the years to come. The soil has proven too rich to dare believe anything else,” the Governor said. “As I look within, I find something within the human constitution that bounces back, something within this collective American spirit that rebuilds. This is the time to continue building our state, to prepare for the future, to plant the seeds that will enrich our children’s inheritance. Together, we will do just that.”



The text of the Governor’s State of the State speech is below…

Mr. President, Mr. Speaker, President Pro Tem Williams, Speaker Pro Tem Burkhalter … Members of the General Assembly. Constitutional officers and members of the judiciary. The Consular Corps and other distinguished guests. And, most of all, my fellow Georgians.

I want to begin this morning with the story of a young Georgian who embodies the resiliency of our state.

Just three years ago, Jeremy Lee was a 14-year old student from Clayton County on his way to the Ireland Youth Development Campus in Milledgeville because he and some friends made a bad decision.

He could have seen this as an indictment not only of his crime, but of his potential. He could have settled for a life marked by disappointment.

But Jeremy made a life altering decision, one that will benefit the lives of others for years to come. He chose to focus on what he could be, not wallowing in the self-pity of tough times, and invested his time and energy in preparing himself to emerge from that campus a better person.

Last summer, Jeremy walked out of those gates with a high school diploma and is now enrolled at Morehouse College.

Jeremy is now pursuing his goal to be a doctor, and that pursuit is a testament to his inner-resilience. I am pleased that he could join us this morning. Jeremy, please rise so we can recognize your efforts.

It’s Jeremy’s resilience and the resilience of thousands like him across our state that gives me confidence that we will emerge from these challenging times stronger.

This is a pivotal moment in our nation’s history. It is a moment in which we are asked to see beyond what George Will calls the “tyranny of the short-term,” beyond the circumstances of the moment, to the big picture – a picture that is informed by our history, bolstered by our character and steeled by our will to succeed.

Despite the stresses of a moment like this, we must not allow ourselves to be trapped in a short-term mindset where rash decisions result in dire long-term consequences. We must remain focused on the big picture … Our perspective must be one of optimism even in the face of difficult economic cycles.

… I look forward to attending President-elect Obama’s inauguration next week and I am confident that he and the new administration will do everything in their power to meet the challenges that face this nation.

However, we cannot plan by relying on the unknown, and the budgets I present to you today are balanced and do not assume money from Washington. Our latest revenue estimate for this fiscal year shows a decline of $2.2 billion, resulting in a $19.2 billion amended budget.

Political mantras aside, cutting more than 10 percent from a budget cannot be achieved by simply cutting waste. While we have worked for six years to do more with less, at some point, in business or in government, it becomes less with less.

The job of budgeting is hard right now, but it’s not because the directions are complicated. Like families sitting around their kitchen tables all over Georgia, we are doing what is necessary to balance our checkbook.

… I want to thank the legislature for working with us to replenish the Rainy Day Fund, which now stands at $1.2 billion. As you all know, at my request, you wisely passed legislation requiring us to retain at least four percent of previous year’s revenue in the reserve fund for balancing the budget at the end of the year if needed.

So I have recommended using the maximum amount available for appropriation from the reserves, appropriating $50 million this year and $408 million next year, as well as $187 million for the midyear education adjustment. We are using some one-time strategies to help balance this year’s budget that won’t be available next year. Therefore, I have recommended that the largest portion of available reserve funds be committed to next year’s budget, which stands at $20.2 billion.

I want to applaud our department leaders -- men and women who are on the ground, who know their mission, their people and their customers. This past spring, agencies willingly responded to my call for restrained spending and returned over $200 million to our state’s Rainy Day Fund at the end of last year.

And then this summer, when I asked them to identify potential budget reductions, their response was thorough and strategic. They were able to find the cuts and maintain the ability to execute their core missions.

That is a testament to those leaders and to the culture change we’ve made in state government!

In six years, we have transformed government making it more efficient and more accountable by instilling a customer-focused culture of public service.

Sometimes this difference isn’t seen in a budget document. But even then, it often impacts thousands of Georgians, who spend less time waiting on government and more time doing what they want to do.

Over the last three years, Joe Doyle and his team at the Office of Customer Service have led this culture change. For example, in Child Support Services, the time between a parent’s initial contact with the agency and meeting with a case worker, has gone from a 30 day wait to same-day service.

A year ago, when a prospective teacher seeking certification called the Professional Standards Commission, they waited nine minutes, on average, to speak with a person … 37 percent just hung up out of frustration. Now, those folks wait eight seconds.

The wait for a new driver’s license has gone from two hours to six minutes and the Medicaid approval process has gone from nine weeks to twelve days, with half of all applicants getting same day approval. And those changes didn’t cost a penny!

This year, we experienced a historic early voter turnout and this same group partnered with the Secretary of State’s to assist 13,000 voters: telling them where and how to voter early. They will continue their work with projects ranging from improving financial aid response times to speeding up DCH’s approval process for children with special needs.

Ladies and gentlemen, I want you to help me recognize Mr. faster, friendlier and easier … Joe Doyle.

We are working in every area of government to ensure that we are getting the best possible value for our investment and that we are providing the best possible service to every Georgian.

To that end, in February, I signed an executive order forming a task force to look at a possible restructuring of the Department of Human Resources. Folks, we spend $3.8 billion within DHR every year – an agency that hasn’t undergone major change since it was formed over three decades ago.

After a thorough review by the Health and Human Services Task Force, we have determined a course of action that will re-orient our approach to healthcare by shifting the focus from inputs to results.

First, we are proposing the creation of a new Department of Behavioral Health which will include all mental health and addictive disease programs. This will improve our responsiveness to mental health needs and will make funding more transparent.

We will continue to improve care by moving towards a community-based delivery system. I know some folks will be concerned with how this might affect jobs in their area, but when it comes to mental health, I believe we have an obligation to provide services to Georgians as close as possible to where they live.

Second, the bill would establish a Department of Health – a combination of the public health and oversight programs in DHR and the current functions of DCH. This agency, which will be led by Dr. Rhonda Medows, will deliver workable solutions on the key healthcare issues we face …

Issues affecting Georgians like how to best facilitate and finance healthcare coverage and how to provide needed access.

Preventative medicine will play a bigger role, inefficiencies and redundancies will be eliminated and every stakeholder in Georgia’s healthcare system – from county boards of public health to Medicaid providers – will work as part of a more coordinated effort.

The remaining social services – Developmental Disabilities, Aging, DFCS and Child Support – will come together under a reconstituted Department of Human Services led by Commissioner B.J. Walker.

We have made progress in the delivery of these safety-net services to our critical populations: we have improved from 50th to 5th in the nation for moving people from state hospitals to community facilities; DFACS has reduced out-of-home placements by 21 percent, and recurring child abuse rates have dropped from 9 percent to 3 percent in the last two years, 2 percent below the national average. I believe a more targeted focus on these programs will lead to even further improvement.

We know that improved lines of communication and enhanced coordination are critical, and I fully expect that these agency heads will meet regularly to coordinate policy and cross-agency service delivery.

I have charged the affected agencies to make this transition within their current budgeted amounts and, in the long term, we believe this reorganization will bring greater efficiency and greater value for the taxpayer dollar.

I want to thank all those who have helped make this happen, particularly the legislative members of the task force: Senators Jack Hill and Renee Unterman, and Representatives Ben Harbin and Mark Butler.

I look forward to working with the legislature and health and human service leaders and providers throughout this state to improve healthcare delivery for every Georgian.

When I came into office, Medicaid was growing annually at rates as high as 17 percent. Over the last four years, growth averaged just 3.4 percent, saving the state a staggering $4.7 billion. Those are numbers that any business would envy.

Even though we have controlled the growth of our Medicaid budget, we faced some very difficult choices this year. The federal government has told states that we can no longer fund Medicaid as we have since 2006. That decision could not have come at a worse time. Washington, in its infinite wisdom, has decided that if we assess a fee against our Care Management Organizations as we currently do, we must impose it on all commercial health plans.

We had to choose: everyone or no one. If we said “no one,” it would have cost Georgia $96 million in state Medicaid funds.

While I’m recommending cuts to many agencies and programs above ten percent, even a five percent cut to the state Medicaid budget would mean an additional $112 million reduction.

That one-two punch of federal mandates and declining revenues means we faced a $208 million hole in the state’s Medicaid budget. To be clear, this $208 million represents the funds paid to providers on behalf of Georgia’s most needy.

To ensure these needed services continue, I had to choose between some tough options. The first option was to eliminate discretionary Medicaid programs – the ones that the federal government does not require us to fund.

This would mean eliminating the medically needy category for eligibility, which serves 7,100 Georgians; eliminating the Katie Beckett Program for 3,100 Georgians; eliminating dental benefits for the 60,000 pregnant women that were covered last year; and eliminating Medicaid coverage for foster children over the age of 18.

In PeachCare, we would have had to eliminate dental benefits, freeze enrollment and reduce the enrollment cap, as well as increase premiums and – for the first time – impose premiums on children between the ages of two and five. All of those cuts combined would still have left a gap exceeding $150 million.

A second option, I could have cut reimbursements to our providers by $208 million. Providers have consistently told us – rightly or wrongly – they believe even our present reimbursement rates are already too low.

A third option would have been to impose the same 4.5 percent fee on commercial and Medicaid managed care and preferred provider plans, that we currently impose only on CMOs. While that remains an option, I prefer a broader based approach that spreads the burden.

I chose to ask those who receive Medicaid payments to help fund the system. This proposal takes advantage of the fact that every dollar we send to Washington for Medicaid draws down almost two additional dollars.

So my budget will reflect, and an accompanying bill will propose, a 1.6 percent fee on hospitals and health insurance plans to fill the hole in Medicaid, and to do what the healthcare community has asked of us for so long: one, to significantly raise reimbursement rates for providers, particularly for hospitals; and two, in conjunction with SuperSpeeder legislation, provide $60 million to sustain and expand the state’s trauma network.

Like most things we address here at the Capitol, this plan will not be universally acclaimed, but I have arrived at this solution after thoughtful, careful deliberation. I implore you … Do not rush into a short-sighted cut that would have long-term consequences for Georgia’s most needy.

Finally, for those that would wait for Washington … we have waited before. And while I am hopeful that we may receive additional federal funds, when I put the budget together, I did not have the option to budget for money that may never materialize.

… We all say, whether it’s in a campaign or a State of the State speech like this, that education is our number one priority. But what does that mean? To me, it means providing opportunity. We spend more than half of our state budget on education because we know that opportunity is discovered in Georgia’s classrooms.

In these budget times, there are certain things we can do to help our local school systems. We have already informed schools of our intention to relax expenditure controls, giving them additional flexibility. This move will allow those closest to the students to manage funds in the most efficient way.

… Last year, I proudly signed IE2 legislation. Let me boil it down for you … this is true local control with real accountability! In exchange for this flexibility, systems entering into a contract with the State Board of Education are held accountable for increased student achievement above and beyond state and federal requirements. And they will face serious consequences if they fail to meet those goals.

It’s exactly the kind of clear, straightforward and results-driven program local school districts have asked for since I came into office. And, just last week, the State Board of Education approved the first IE2 contract with Gwinnett County.

This means that ten percent of the students in Georgia will be under a performance contract to increase student achievement. I commend Alvin Wilbanks and the Gwinnett County School Board for continuing to lead by example.

In the weeks and months to come, I believe you’re going to see progressive school systems from all around the state sign on, and if you’re in a parent in Georgia, that’s something to be excited about!

As I outlined yesterday, I am proposing legislation that will ensure that every student in Georgia has the benefit of responsible leadership at the school system level.

Most local school board members in this state are in that position for all the right reasons and they do a great job for our students, but unfortunately, that isn’t universal. And we must take action, because when a school board is failing, every student that depends on them is cheated.

This legislation will clearly define what citizens expect from school board members and it will give the state the ability to replace board members with responsible, local citizens when accreditation is threatened. Never again, do I intend for the state to be handcuffed by our current law and powerless to help students who are being failed by the adults in their community.

Also, I will propose legislation to establish a high school principal incentive pay program for those principals who increase student achievement – raising graduation rates and improving SAT and End of Course Test scores.

I am proposing merit pay legislation that will award teachers who show evidence that their classroom instruction leads to increased student achievement. Currently, extraordinary teachers are locked into a compensation model that fails to reward excellence. This is the next step in moving education from a culture of compliance to one based on performance.

We are also proposing differentiated pay for math and science teachers. It astonishes me that this state produced just three physics teachers last year. We must introduce a market dynamic into the salary schedule to address these critical needs areas. Some may be surprised to hear these ambitious plans in these times, but, this more than any other period, is a time to continue improving education and the basic institutions of government.

We are fortunate to live in a state where people want to be. Last year, Georgia was the fourth fastest growing state in the nation. And in the last eight years, we have added 1.5 million people.

Not only do people move here, they stay here. Georgia ranks third in the nation for keeping our native-born population, with over 69 percent of people who were born in Georgia still living here. I don’t say all this just to share statistics, there is a story there, and it’s a story about Georgia’s competitive advantages and a great quality of life.

This enormous growth brings its own challenges … I call those the “problems of prosperity.”

We continue to work to protect our most precious natural resource … water. Last year, I signed into law Georgia’s first Comprehensive Statewide Water Management Plan to help our state balance water use and growth.

I want to, again, thank all of you for participating in what I consider to be the most inclusive piece of legislation we’ve worked on since I’ve been Governor.

The Lieutenant Governor, Speaker and I will soon announce our appointments to the Regional Water Councils. We are working to ensure that those selected will represent a good cross-section of Georgia talent – both in their personal experiences and geographically. These councils are going to put our Statewide Water Plan in action.

I am confident the rains will come, and I am encouraged by the fact that our new management plan will make us better stewards, both now and over the long term.

Our experience in working together on the water plan will be needed again as we address our transportation needs. A growing Georgia will depend upon a transportation network that supports mobility and commerce. Like most government programs, the money available is short of what our needs are, so we must guard every dollar that is spent to make sure we maximize its value. Reforming DOT has been one of the toughest challenges my administration has faced, and we are not through yet.

Last summer, I commissioned Investing in Tomorrow’s Transportation Today, or IT3, so that we as policymakers could understand the value of additional investment, while we continue to bring our transportation planning, funding and building policies up to date.

Transportation improvements providing access to markets, reliable and stress-free commutes and speedy freight movements can be the catalyst that propels our economy forward, just as we have seen over our state’s history.

The Lieutenant Governor, Speaker and I share a mutual commitment to address our transportation needs, and we will continue reforming DOT with a goal of standing up a system that can take that funding and provide the value Georgians deserve. Once I feel certain that we can deliver transportation value to Georgia citizens, I will support responsible measures to raise additional revenues.

… As Georgia grows, so do our energy needs and Georgia is meeting this challenge by creating a fertile environment for alternative energy production. Those efforts have been rewarded with $2.4 billion of investment over the last two years. That investment means new jobs for Georgians.

In November, Norcross-based Suniva, birthed right here in one of our research universities, began fabricating the most advanced solar technology in the world.

This summer, we will host more than 15,000 energy innovators for the biggest bio-lifescience conference in the world – BIO 2009. This is an outstanding opportunity to showcase Georgia’s progress in life sciences, and our potential to help heal, fuel and feed the world.

As we continue to attract new investment in biotechnology, we can secure our position as a leader in this industry by enacting laws that respect the role of the federal Food and Drug Administration as the regulator of the safety of drugs and medical devices.

But the best incentive we can offer an employer is a talented workforce that is ready to meet their needs, and our Work Ready program does just that.

We began Work Ready two years ago and Georgia workers have responded. There are now 111 counties – 70 percent of the state – working toward Certified Work Ready Community status.

As Georgia workers compete with peers as far away as China or as close as South Carolina, Work Ready puts them a step ahead. That is certainly the case with Joy Anthony.

Joy’s Work Ready Certificate distinguished her and gave her the edge she needed in her job search. Her employer was impressed by the skills Work Ready identified and they have designated her as a “Rising Star” in their company.

Joy is one over 35,000 Georgians to take control of their future, making themselves more marketable to employers looking for a talented workforce.

Ladies and gentleman, Georgia is ready to take advantage of our workforce and our strong balance sheet. We remain one of seven states with a triple-A bond rating and we will invest in projects that will be of long-term value to Georgians.

This year’s bond package, totaling over $1.2 billion in new investment, will put Georgians to work and build critical infrastructure. In the past, we have often funded the design phase of a project one year and construction at some later date. This year’s package will feature many projects in which both design and construction are funded in the same year, ensuring their timely completion.

In a time that we have trimmed our budget in other areas, we are aggressively increasing our bond package by a full twenty percent over last year. This will take advantage of low construction costs and create an estimated 20,000 new jobs in an industry that is ready to go to work.

These projects touch every corner of the state and include new construction at our universities, technical schools, local school systems and libraries; harbor deepening at the Savannah port and needed improvements at state facilities.

As I said at the outset today, we’re going to maintain a long-term perspective – we are not going to panic and make knee-jerk decisions that will have negative long-term consequences.

We stand at a crossroads, and as a father and a grandfather ten times over, I can say, we all recognize how important it is to the next generation that we get it right … right now.

Don’t hear me dismissing the scope or severity of this downturn. But, more importantly, don’t leave failing to hear the message that we need to look beyond this downturn.

Think about it, you don’t get anywhere in life without a long-term perspective and a long-term plan. You have to weather the turbulence - that’s true in a career, that’s true in the history of every successful marriage. Isn’t that right, Mary?

When the economy takes a downturn, you don’t give up on the economic promise of America that has proven true over the centuries. You don’t discard the promise … you build for the future with that promise in mind.

There is much to do in Georgia in this coming year but it can be summarized in that overarching mission to continue executing on the fundamentals of good government; to improve our competitive advantages, to make Georgia a better place to live and a better place to do business.

As I look back and think about our history, I am certain that this is not the tallest mountain we’ve been asked to climb.

As I think about the American promise of freedom and economic opportunity, I know that rich promise will mean great things for Georgians in the years to come. The soil has proven too rich to dare believe anything else.

As I look within, I find something within the human constitution that bounces back, something within this collective American spirit that rebuilds.

I’ll never claim to be a Nehemiah; but the prophet’s call, “Let us rebuild the walls,” rings true today. This is the time to continue building our state, to prepare for the future, to plant the seeds that will enrich our children’s inheritance. Together, we will do just that!

Thank you! God bless you. God bless America … and may God bless the great state of Georgia!

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Election Finale Good For Global Economy, Says Emory's Rosensweig

The end of the 2008 election season will be good for the global economy, no matter who won, according to international finance expert Jeff Rosensweig of Emory's Goizueta Business School. "Uncertainty is always bad for an economy, and we live in the most volatile and uncertain of times. Removing this element of political uncertainty will certainly help."

Executives in finance and business generally fear an era with both U.S. Congress and presidency controlled by Democrats, says Rosensweig. "Rightly or wrongly, they think this could lead to massive government spending," he says. "In this unique case, such fears may be unfounded.

"First, the outgoing administration was one of the most profligate in U.S. history, to the dismay of many Republican fiscal conservatives," says Rosensweig. "Second, the present time, for the first time since the Great Depression, may call for some direct government spending to stimulate the economy. The job market is fragile at best, and could soon become awful. This is already apparent in the financial services, construction and manufacturing (e.g. auto) industries."

Similar to the jobs created by Franklin Delano Roosevelt in the 1930s, President-elect Barack Obama may work with a Democratic Congress for a second stimulus package. "The first one, tax rebates, had only limited impact because much of it was saved or spent on imports, not on U.S. production," Rosensweig says.

As the economy continues to stall, Rosensweig expects the federal government to implement a temporary spending package aimed at directly creating jobs. "My own proposal is to hire unemployed construction workers, among others, to help rebuild the U.S. infrastructure. Bridges, sewer systems, subways--they are all in disrepair.

Already, key economies such as Germany are enacting fiscal stimulus packages, Rosensweig adds. An effort will be made to globally coordinate such packages, as well as to capitalize the financial system.

Finally, Rosensweig does not look for a President-elect Obama to increase taxes within a few years on wealthier families as he has proposed. "It is one thing to get elected, another to govern," he says.

Given the backdrop of looming recession, Rosensweig expects the new president will realize this is no time to raise taxes in general, and despite his social goals, will have to delay such tax increases. "The U.S. goverrnment will clearly incur the largest budget deficit in history, leading also to a delay in Obama's proposals to boost healthcare coverage."

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New Trauma Center Locator Map Shows If Georgia Counties Are Within the “Golden Hour”

A new interactive trauma center locator map shows whether you, your family and your friends can get to a Georgia trauma center within the “golden hour.”

A trauma patient's chances of survival increase dramatically if he or she receives care within the "golden hour" immediately following injury. Rapid response by emergency medical technicians in ground and air ambulances is critical. So is the distance to the nearest trauma center - a special hospital facility with the resources and medical specialists to handle the most severe injuries.

The trauma center locator map, which is part of the http://www.georgiaitsabouttime.com/ trauma awareness Web site, shows how far each county is from the nearest Georgia trauma center. You simply click on a county to see if it is within an hour of a trauma center.

The map shows that all or parts of more than 50 counties in South Georgia are not within the golden hour.

The golden hour is defined as within 50 miles of a trauma center. Distances are estimates and do not account for traffic delays.

Georgia is served by only 15 trauma centers – about half the number needed, according to state health officials – and many areas of the state currently lack access to adequate emergency transportation. As a result, trauma death rates are significantly higher than the national average. If Georgia’s death rate improved to the national average, it would mean a difference of as many as 700 more lives saved every year.

The trauma center locator map is part of the Georgia It’s About Time trauma awareness campaign which is funded through a grant from Healthcare Georgia Foundation. The campaign is aimed at helping to establish a statewide trauma system that will serve all Georgians, including many in rural areas of the state that are currently lacking access to adequate emergency transportation and trauma care.

About the Trauma Awareness Campaign and the Georgia Statewide Trauma Action Team
(GSTAT): The trauma awareness campaign is designed to educate Georgians about the need for a statewide trauma system. It is funded through a grant by Healthcare Georgia Foundation (www.healthcaregeorgia.org.) The Georgia Statewide Trauma Action Team (GSTAT) is a coalition of hospitals, EMS providers, physicians, nurses, local government officials, business leaders and others interested in creating a statewide trauma system. For more information, please visit www.georgiaitsabouttime.com.
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Medicaid Spending Projected to Rise Much Faster Than the Economy

Cumulative Spending on Medicaid Benefits Projected to Reach $4.9
Trillion Over 10 Years

Under current law, spending on Medicaid is expected to substantially
outpace the rate of growth in the U.S. economy over the next decade,
according to a new annual report released today by the Centers for
Medicare & Medicaid Services (CMS).

The report projects that Medicaid benefits spending will increase 7.3
percent from 2007 to 2008, reaching $339 billion and will grow at an
annual average rate of 7.9 percent over the next 10 years, reaching $674
billion by 2017. That compares to a projected rate of growth of 4.8
percent in the general economy.

HHS Secretary Mike Leavitt presented the report today at the fall
meeting of the National Association of State Budget Officers (NASBO).

"This report should serve as an urgent reminder that the current path of
Medicaid spending is unsustainable for both federal and state
governments. We must act quickly to keep state Medicaid programs
fiscally sound," Secretary Leavitt said. "If nothing is done to rein in
these costs, access to health care for the nation's most vulnerable
citizens could be threatened."

Although the CMS Office of the Actuary regularly produces 75-year
projections of Medicare expenditures for the annual report of the
Medicare Board of Trustees, the report released today is the first
annual fiscal report on Medicaid.

The Medicare Trustees Report provides detailed information on the past
and estimated future financial operations of the Hospital Insurance and
Supplementary Medical Insurance Trust Funds. This new annual report on
Medicaid contains analysis of past program trends and projections of
Medicaid expenditures and enrollment for the next 10 years only. Future
reports will expand on content to include longer-range projections and
more extensive analysis.

Medicaid is a federal/state partnership program that provides health
care to certain low-income people and is one of the largest payers for
health care in the United States. For both federal and state
governments, Medicaid is the largest source of general revenue spending
on health services. Notably, Medicaid is the largest source of general
revenue spending for health care for both the Federal government and the
states.

This growth rate compares to spending projections for Medicare of 7.4
percent per year through 2017. Medicaid benefits spending over the next
10 years is projected to be $4.9 trillion. These amounts are in
addition to that spent by federal and state governments on the State
Children's Health Insurance Program (SCHIP).


At this rate, Medicaid growth is projected to slightly exceed growth in
overall health care expenditures, which is projected by CMS actuaries
and economists to increase by 6.7 percent per year over the next 10
years, or over twice the rate of general inflation. Additionally,
Medicaid's share of the Gross Domestic Product (GDP) is projected to
reach about three percent in 2017. The combined share of GDP spending
for Medicare and Medicaid is projected to be 6.9 percent by 2017.

As a partnership program, both states and the federal government pay for
services to Medicaid beneficiaries. The federal government matches
state expenditures based on a formula that yields subsidies ranging from
50 percent to as high as 83 percent. The average federal medical
assistance percentage is 57 percent.

However, even with federal support, states report they are struggling to
meet their share of expanding Medicaid costs. State spending on
Medicaid has remained relatively stable as a share of states' budgets,
averaging about 20 percent from 1995-2007. However, some states such
as Maine are already spending as much as 31 percent of their budgets on
Medicaid, according to NASBO.

NASBO is projecting that state spending on Medicaid will increase by 4.4
percent from 2008 to 2009. NASBO says such an increase would be more
than four times the rate of growth in the average state general fund.

"High and increasing Medicaid spending clearly leaves states less able
to fund other state priorities," said Acting CMS Administrator Kerry
Weems. "This new financial report confirms that America's health care
system faces significant fiscal challenges.

"As a nation we must tackle the difficult job of bringing health care
costs under control and assuring that our health care dollars are buying
the highest quality, most efficient health care services."

Other findings from the report include:

* Average Medicaid enrollment is projected to increase 1.8 percent
to 50 million people in 2008.
* During the next 10 years, average enrollment is projected to
increase at an average annual rate of 1.2 percent and to reach 55.1
million by 2017.
* The estimated average cost of a person covered by Medicaid in
2007 is $6,120; however, per-enrollee spending for non-disabled children
($2,435) and adults ($3,586) was much lower than that for aged ($14,058)
and disabled beneficiaries ($14,858), reflecting the differing health
status of these groups.
* Medicaid represented 14.8 percent of all health care spending in
the United States in 2006.
* Medicaid is projected to grow as a share of the federal budget
from 7.0 percent in 2007 to 8.4 percent by 2013.

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80 Georgia Lawmakers to Meet with Trauma Care Specialists September 29

80 Georgia lawmakers to meet with trauma care specialists Statewide briefing on trauma care on Monday, September 29 is free and open to health care providers, business and community leaders, educators, and the media at the Georgia Railroad Freight Depot in downtown Atlanta.

More than 80 Georgia legislators will meet next Monday, September 29, with dozens of trauma care professionals, other health care providers, and active stakeholders to brief government and the public on the status of the Georgia statewide trauma care system. Some 118 state lawmakers have signed on as hosts and supporters of this project, and they are working to develop a permanent funding source.

The Trauma Care in Crisis statewide briefing is expected to draw several hundred participants to the Georgia Railroad Freight Depot in downtown Atlanta for the luncheon forum from 10 AM till 1 PM.

The event is free and open to health care professionals and others interested in trauma care.

Topics covered by speakers and panelists will include an overview of the statewide trauma system, legislation, preparedness, the regional approach, communication, business, funding, and prevention.

Speakers representing major hospitals, emergency medical services (EMS), universities, the Governor's Office of Highway Safety, and business organizations will present a variety of perspectives on how to establish and fund a comprehensive statewide trauma care system to serve all the people of Georgia.

The briefing is sponsored by Healthcare Georgia Foundation, a non-profit grantmaking institution that has funded a series of roundtables and forums facilitated by Atlanta-based Reece & Associates, a group that specializes in public policy and government relations.

Register online now > or call Christine Jordan at (404) 586-2100.

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Emory Board Authorizes Enhancements to Clifton, Midtown Campuses

With a special focus on fighting cancer, heart disease, pediatric ailments and neurodegenerative conditions such as Alzheimer's and Parkinson's, Emory University trustees have authorized the next stage of program definition and design work for redevelopment and innovation of Emory Healthcare, the state’s largest and most comprehensive health care system.

The board agreed to spend $73 million for programming and schematic design for the clinic, hospital and research facilities on Emory’s Clifton Road and Midtown (Crawford Long) campuses. In addition, money was approved for utility relocations, preliminary infrastructure modifications and site preparation for the Clifton Road clinic facility.

"We are pleased to move ahead with state-of-the-art programs in patient care and research that will address the most acute health needs of our population in this new century," says James W. Wagner, president of Emory University.

"We look forward to working with our surrounding communities and government leaders to give DeKalb County and metro Atlanta a destination health care system that will be an unsurpassed source of civic pride and competitiveness, high-quality patient care and job growth well into the 21st century."

Perennially ranked among America’s Best Hospitals by U.S. News & World Report, Emory has eight specialties rated among the nation’s top 50, the most in Georgia.

Emory previously announced plans, in 2006, to construct a new Emory Clinic complex, along with a replacement for Emory University Hospital (EUH), to be located and built in phases across Clifton Road from the hospital’s current site. The 2006 plans also called for construction on the replacement hospital not to begin until 2014 at the earliest.

The new proposal – which will now move into a design phase contingent on final program definition and the availability of funding – envisions the first phase of hospital redevelopment to be completed in 2013. The new proposal also contemplates investment at Emory Crawford Long Hospital in Midtown, which was not in the 2006 plan.

Key components for the Clifton Road site:

• A 250-bed hospital (100 beds will replace beds currently in EUH, for a net gain of 150 beds on Clifton Road)
• A new 395,000 square foot Emory Clinic to be built next to the current Emory Clinic
• A new emergency department in the new hospital to replace the current facility in EUH
• A new 100,000 square foot research facility located on Haygood Drive across from Emory Children’s Center

Key components for Emory Crawford Long Hospital site in Midtown:
• Approximately 125 new beds
• A new 137,000 square foot Emory Clinic building
• Approximately 75,000 square feet of new research space

"These new facilities will be designed to support top-tier patient care, research and medical training in a new and more nimble way that sets the standard for academic medicine and teaching hospitals everywhere," says Fred Sanfilippo, MD, PhD, Emory’s executive vice president for health affairs. "Emory's growth in programs and facilities will enable us to create the ideal patient and family experience, now and for the future, as we pursue our vision of transforming health and healing in the 21st century."

"As we continue to develop the ideal integrated model for health care delivery, the dedication to quality is at the heart of all of our facilities planning," says John T. Fox, CEO of Emory Healthcare. "Dedication to quality will drive everything we do now and in the coming years."

In concert with the Clifton Community Partnership, Emory has pledged to continue its dedication to sustainable buildings, a pedestrian friendly environment, a landscaped public realm, the aesthetic transformation of Clifton and North Decatur roads, and alternative transportation and improved traffic flow.

The new plans are founded on several years of planning, culminating in eight months of concentrated study involving more than 100 Emory faculty and administrators, along with professional consultants and community input. Emory’s new approach is predicated on building smaller-scale projects that can be executed more nimbly and economically in response to many variables including patient demand, the success of fundraising, national business cycles, and the healthcare policy and financing environment.

Research – particularly research that can translate discoveries from the laboratory directly into patient care – is a central component of the vision of Emory's Woodruff Health Sciences Center. Emory University received nearly $384 million in external research funding last year. Over the past decade, Emory's research funding has increased nearly two-and-a-half fold.

Emory's new plan will support and enhance its partnerships with the Georgia Institute of Technology, Morehouse School of Medicine, Children's Healthcare of Atlanta, the Grady Health System, and the Atlanta Veterans Affairs Medical Center, as well as with the Centers for Disease Control and Prevention, Georgia Research Alliance and the Georgia Cancer Coalition.