The Next Generation of Healthcare in Georgia

After recent years of healthcare priorities being placed on the backburner in Georgia— because of “pure politics,” say sources at the Capitol— the issue came roaring to the forefront this year. The COVID-19 health crisis seeped into every nook and cranny of weakness across the system and wreaked havoc. Rural hospitals that have limited coverage, an onerous insurance process and gaps of coverage for at-risk groups all had been simmering issues. But this year they were exposed as critical problems.

In response, Gov. Brian Kemp and the General Assembly passed various bills aimed at solving some of them. Surprise billing was one of the big items. Sponsored by Rep. Lee Hawkins, R-Gainesville, and with the biparti- san support of Rep. Calvin Smyre, D-Columbus, House Bill 888 is a reform bill to improve the billing process and prevent surprise increases and expensive costs. It is insurance-based, with mechanisms included to resolve payment disputes between insurers and out-of-network providers. It also requires the Commissioner of Insurance to provide for the maintenance of an all-payer health claims data base and to establish an arbitration process.

Sen. Kay Kirkpatrick, R-Marietta— well known as a Republican health guru in the Senate— calls H.B. 888 one of the most important healthcare bills. Kirkpatrick noted that even after a bill passes, there is likely to be follow-up to make sure it is being implemented as envi- sioned and that it is working properly. “HB 888 is ex- ample of where there’s lots of work to be done with the Department of Insurance to be sure that it goes smoothly and does what it’s supposed to do,” she says. “It’s not like getting your car fixed. And so it’s very difficult for people to understand what is going on in terms of how much things are going to cost them.”

The legislature passed several transparency bills for consumers to get more information about what they are actually getting because healthcare is, as Kirkpatrick put it, “a black box” with the lack of awareness about the product. In economics, the term “information asymmetry” refers to decisions in transactions where one side has much better knowledge about the product than the other. Healthcare is one of the prime examples.

By the way, the long-time surgeon and member of the Health and Human Services committee actually caught COVID-19 earlier this year. “The good news is that I re- covered fully, I’ve got antibodies, and I have given plasma twice— so I’m pretty happy about that aspect of things.”

H.B. 1114, another important healthcare bill, was carried in the House by Kirkpatrick’s health expert House counterpart Rep. Sharon Cooper, R-Marietta. It extends postpartum Medicaid benefits to six months. Maternal mortality is a big concern in Georgia and this legislation takes aim at part of that problem.

“We have faced sobering moments together, but to- day is a bright spot as we continue to streamline bureau- cracy, increase access to care, insist on transparency and fairness, improve health outcomes, and put Georgia families first,” Kemp says. “I am grateful for the hard work of the General Assembly along with our partners
in the medical field, frontline heroes, and local leaders
to champion these much-needed reforms as we work to build a safer, stronger Georgia.”

NEEDED TRAUMA CENTER COMES ABOARD

Kemp had traveled to Wellstar for the ribbon-cutting of the new emergency department at the hospital. The new Level II trauma center is part of the state’s largest trau- ma network and the 263,000 square-foot facility will be one of the top two largest emergency departments in the country, serving some 600 patients per day and 220,000 patients per year. This doubles the existing trauma and emergency capacity.

“Being a not-for-profit health system enables Well- star to offer care when and where it matters most,” says Mary Chatman, executive vice president, Wellstar Health System, and president of Wellstar Kennestone and Well- star Windy Hill Hospitals. “In 2019, Wellstar provided more than $784 million in charity care, unreimbursed care, and community programs to help enhance the health and well-being of the people and communities we serve. Our new, state-of-the-art emergency department at Wellstar Kennestone Hospital is a great example of how Wellstar is investing in people and technologies to improve healthcare quality and access for all Georgians, with world-class facilities and the best caregivers you will ever meet.”

At a time when many hospital systems are strug- gling, the enhanced coverage from Wellstar may make a big difference in the lives of many north Georgians. And the tight budgets of many hospitals are likely to get more attention from the legislature over the next few years.

One thing that could not wait until next year was a COVID-19 liability immunity bill. Senate Bill 359 protects businesses and, in particular, healthcare providers that are following Centers for Disease Control guidelines. If you are negligent and not cleaning things or providing for social distancing you can still certainly be sued. It can be difficult for people to figure out where they got the virus so lawsuit challenges could present a big headache to small business.

This year the legislature passed 23 health care bills and last year they passed 22— much different compared to previous years. By the way, the hard-charging Kirkpatrick was able to get 12 bills passed in the Senate and seven all the way across the finish line to signing by the governor.

There were several bills about pharmacy benefit man- agers (PBMs). “They are the middle people that are like the Wizard of Oz,” said Kirkpatrick. “They operate behind a curtain and nobody knows what they do.” PBMs are often the link between pharmacies and drug companies and concerns about prescription drug prices often fall to the unclear nature of their work. Senate Bill 313 revised the regulation and licensure of PBMs with the goal of im- proved transparency.

With the odd legislative calendar this year thanks to the coronavirus, several bills just ran out of time— something that can happen any year but was particularly troublesome this year. Kirkpatrick had a bill regarding regulation of outpatient sedation surgery that she feels is straightforward and is not aware of opposition, but it requires some explaining. That was hard to do in a short time frame.

Prior authorization is another issue likely to see reform over the next few years. Prior authorization is when doctors must call for permission to basically do anything and they waste hours and hours of time, thus causing delays in care. “There is federal legislation to rein that in, but
the feds can’t seem to get anything done. And so just like with surprise billing we probably have a better shot at dealing with prior authorization at the state level than at the federal level,” Kirkpatrick notes.

A SILVER LINING DUE TO COVID-19?

If there is a silver lining to be found in the COVID-19, it is innovation and collaboration. With such a drastic hit to budgets and the normal way of doing things, the slow development of telemedicine and digital connections took a great leap forward.

In this context, Kirkpatrick points to her work on veterans’ issues and, in particular, veteran homelessness. “I work a lot in this space because I’m on the veterans committee and veteran homelessness is just a disgrace and should not happen. Some communities have done really great things to try to end veteran homelessness and in Cobb (County) for example, there’s a group of people talking about how to pull together all the different non- profits and agencies that are working on this into some- thing that is cohesive. I didn’t understand this when I first got to the Capitol, but agencies are very siloed and nonprofits are too.”

Yet COVID-19 forced the issue and these disparate groups are connecting dots on things like access to resources in ways they did not occur before. This is happening not just around homelessness but also addiction and recovery resources, mental health and telemedicine.

Whenever the COVID-19 crisis has ultimately passed, these new methods and tools may have helped to streamline services from civic groups and nonprofits— not to mention state and local government. And that ultimately leads to better outcomes.

By: Baker Owens

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