state of health care in georgia marcus downs director of government relations/gampac director of the...
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State of Health Care in Georgia
Marcus DownsDirector of Government Relations/GAMPAC
Directorof the
Medical Association of Georgia
Building a Better State of Health Since 1849
Medical Association of Georgia
Founded in 1849 Leading voice for medical profession in Georgia Nearly 7,000 members MAG creates value for every physician in Georgia
because MAG represents every physician in Georgia Leader in state legal and legislative arenas Members include solo physicians, small group
physicians, multispecialty physicians, health system physicians, as well as academic institutions
Discussion Topics
State of Health Care in Georgia Medicaid Expansion Questions
Building a Better State of Health Since 1849
State of Health Care in Georgia
Physicians and Health Care Providers Rapid consolidation of the marketplace More employment under systems or multispecialty groups Loss of private practice Rapid growth of Accountable Care Organizations Emphasis on physician and provider shortages
Health Insurance Industry Wellstar/Piedmont Insurance Plan Aetna purchases Coventry Wellpoint purchases Amerigroup Interest in MEWA/Association Plans on the rise
Building a Better State of Health Since 1849
State of Health Care in Georgia
Budget/Medicaid $19.8 billion dollar budget Hospital management fee to fill $700 million hole Physician and provider cuts of .74% recommended but
restored Primary care being Medicare rates in Medicaid through
2014 15% drop in physician participation since 2009
Building a Better State of Health Since 1849
Building a Better State of Health Since 1849
State of Health Care in Georgia
Tort Reform 2005 tort reform (SB 3) improved environment in GA New medical malpractice claims opened decreased from 2004
(1128) to 2011 (837) Indemnity and defense costs decreased from $94.5 million (2004)
to $74.9 million (2011) 47% increase in market competition among professional liability
carriers Total statewide premium decrease 24% since tort reform MagMutual premiums decreased 40% since tort reform
More solutions Provider Shield Act – HB 499
Challenges to Tort Reform SB 141 – Jackson Healthcare
State of Health Care in Georgia
Pain Clinics Documented problem in GA with surrounding states having tough
laws Georgia Composite Medical Board addressed with initial Pain
Management Rules and Unprofessional Conduct Rep. Tom Weldon introduced a bill aimed at Pain Clinics (HB 178)
Must be owned by physician 50% patient population requirement
Telemedicine Georgia seen as leader with the Partnership for Telehealth – Paula
Guy Georgia Composite Medical Board addressing rules for
telemedicine Goal to increase more access More input from big businessBuilding a Better State of Health Since 1849
Building a Better State of Health Since 1849
State of Health Care in Georgia
Implementation of PPACA/Federal Requirements in Georgia Medicaid expansion – No Health insurance exchanges – federal Medical loss ratio – initial waiver Children on parent’s policy up to age 26 No more annual and life time limits on health insurance policies Primary care being paid Medicare rates in Medicaid EMR satisfaction/”meaningful use” a problem
Medicaid Expansion
Will cover those who earn less than 133 percent FPL ($14,403 for single)
600,000 new enrollees expected in Georgia in 2014 Federal government will cover 100 percent of costs for first two years,
90 percent thereafter Represents additional costs for states, and health care already
accounts for 18 percent of Georgia’s budget Governor Nathan Deal said NO to expansion MAG Position:
Support innovations and modifications in the Medicaid program, balancing the needs of GA uninsured patients with the need to achieve a sustainable solution to the budget shortfalls and expected financial challenges in the years to come
Medicaid Expansion
Pros Healthier population Assist physician and provider bottom lines Studies cite approximately 3500 lives saved over 10 years Tax money going to other states Disproportionate Share Hospital allotment going away State can expand Medicaid at anytime and get out Bill Custer, economist at Georgia State University
Generate 70,000 new jobs Georgia economy would boost $8.2 billion per year State and local tax revenue by more than $275 million
annually
Medicaid Expansion
Cons Cost to state is approximately $4.5 billion State will continue to fund if federal government defaults
on obligation Expanding a broken system does not solve problem Just because have insurance card does not insure access Oregon report – no significant improvement in health Woodwork effect – 159,000 individuals already eligible but
not participating Increased Scope of Practice Battles
Medicaid Expansion in Georgia
New money translates into well-compensated health professionals, which stimulates the overall economy
Georgia cost of care for uninsured is <$2 billion per year Care provided in most expensive places (ER visits) at most expensive
time (late in an episode of illness) Cost to employers- $71m to $107m if Georgia does not expand
Mediciad Need for statistics on physicians and uncompensated care
2007 Study funded by the Kaiser Family Foundation- from 0% to $3.2billion nationally
Georgia physicians receive .69 per $1. Every $20 hair cut= $13.80 Every $2,000 speaking engagement= $1,380 Every $20,000 vehicle sold= $13,800 Every $200,000 home sold= $138,000 Every $2,000,000 legal settlement= $1,380,000
Doctors accepting Medicaid has decreased by 15.9% over the past 3 years
Medicaid ExpansionSource: www.advisory.com, Updated June 14, 2013
Building a Better State of Health Since 1849
State Decisions
Not Participating (13) Affordability North Carolina- Officials conducted a comprehensive analysis to determine the
advantages and disadvantages of expanding Medicaid and the right type of exchange option. It concluded that it is “abundantly clear that North Carolina is not ready to expand the Medicaid system and that we should use the federal exchange.”
Leaning toward Not Participating (6) Wyoming- Officials will recommend that Wyoming not participate but the position could
change in the future and has asked for others to keep an open mind about this issue.
Participating (26) “Participate but will re-evaluate” (Fl), “Forced to accept reality” (Nv), “Will reverse
decision” (Oh) Arizona, Florida, Michigan, Nevada, New Jersey, Ohio
Leaning toward Participating (1) Participating through Alternatives (4)
Use Medicaid dollars to purchase private insurance plans Arkansas
Building a Better State of Health Since 1849
For more information…
www.mag.org
404-797-0488 (Cell Phone)
Look for the “Medical Association of Georgia” on Facebook
Marcus Downs, Director of Government Relations [email protected]