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Contents Acknowledgements Editors Erin Stewart Ethan James Anna Adams Designer Carley Elsberry Jeff Sunderland Contributing writers Anna Adams Kevin Bloye Elliott Coward Mallory Garrett Michelle Licht Kurt Mosley Seslee Smith Erin Stewart Jeff Sunderland Contact us: Georgia Hospital Association 1675 Terrell Mill Rd Marietta, GA 30067 Phone: (770) 249-4500 Fax: (770) 955-5801 Email: estewart@gha.org www.gha.org All rights reserved. No part of this publication may be reproduced, stored in, or introduced into a retrieval system, or transmitted in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise) without prior written permission. For permission requests, please contact estewart@gha.org.

3 Executive Corner Letter from the President

4 Cover Story

Better Tomorrow than Today

10 Our Hospitals 12 14 16

Names in the News Innovations that Advance Care Keeping Teens Safe on the Road Remembering 1977 GHA Chair J. William Pinkston

18 Features 20 22 24 28 34

Drive for Perfection Physician Profile: Hospitalist Health Care Superheroes The History, Development and Growing Popularity of Hospitalist Programs Telemedicine Opportunities for Georgia Hosptials Physician Profile: Rural Family Doctor

36 GHA Now 42 49 50 52

2017 Legislative Summary 2017 Hospital Heroes WellStar CEO and Grady Health System CEO Elected to AHA Board of Trustees Economic Impact Report Georgia Hospital Health Services


Executive Corner The health care field is never dull, as we have seen with the recent news of many lawmakers’ anticipated sweeping federal changes to the health care law. Hospitals are constantly navigating the waves of change from year-to-year, month-to-month and even day-to-day. In this issue, you will see how the featured hospitals anticipate the changes and work to stay ahead of any challenges brought on by our complicated health care system. No matter the obstacles, patients and communities can count on hospitals to provide constant, dependable care. Our cover story features Northeast Georgia Health System, an organization that has made positive headlines in the past couple of years with the building of an entirely new hospital in Braselton and the system’s recent acquisition of Barrow Regional Medical Center in Winder. We also have a section on trends in health care, namely, telemedicine opportunities for Georgia hospitals as well as the growth of hospitalists. Featured is a profile of an employed physician from Meadows Regional Medical Center. Each year we are proud to honor outstanding individuals in the health care field through our Hospital Hero Awards program. You can read about this year’s Heroes and their amazing stories. Pictures from a special awards ceremony will be featured in an upcoming issue of twentyfourseven. We are also pleased to recognize two members from our Board who were appointed to the American Hospital Association Board of Trustees for three-year terms beginning in January. You can read more about these outstanding health system leaders in this issue. As you may know, some of the most important work done by GHA and its members is done early in the year at the Georgia State Capitol. Our lobbying team works to educate policymakers on hospital and health care issues and advocate for legislation that is in the best interest of hospitals. GHA and our hospital members also focus efforts on educating our lawmakers in Washington, D.C. In this issue, we’ll provide a brief overview of the 2017 legislative session, as well as a link to our legislative summary with a recap of what bills passed and which ones did not, as well as the status of bills resting in committees. Thank you for your support of Georgia hospitals and the work they do. Earl V. Rogers President and Chief Executive Officer Georgia Hospital Association

Working together is the best way to achieve our goals. Please don’t hesitate to reach out to us at twentyfourseven@gha.org. twentyfourseven Summer 2017

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Cover Story

Northeast Georgia Health System’s flagship campus Northeast Georgia Medical Center in Gainesville.

Better Tomorrow than Today:

How a Gainesville health system is handling dynamic growth in today’s health care environment By Erin Stewart

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“How can we be better tomorrow than we are today in everything that we do? We are on a constant quest for excellence. That’s how we aim to constantly improve.” These words, spoken by Northeast Georgia Health System (NGHS) CEO Carol Burrell, succinctly describe the driving force behind the health system’s goals, objectives and purpose. With a service area of 19 counties with a population of more than 800,000, NGHS’s reach encompasses the large area that is the northeast corner of the state. The number of individuals in the service area is expected to grow to 1 million in just the next few years, but NGHS has been preparing and is ready for the increase in volume with the changing health care landscape. For one, in April 2015, the system opened the state’s first net-new (meaning not a relocation


or replacement) hospital in almost 20 years, Northeast Georgia Medical Center (NGMC) Braselton. The 10-year process of building the new facility gave a unique opportunity, not only to build a hospital from the ground up, but also to construct it while taking into consideration feedback from the community. From early discussions of where the hospital would be to its development and the people it serves, NGMC Braselton was seen as the community’s hospital, “and that’s what it is,” said NGMC Braselton President “How can we be better tomorrow than we and Southern Market Leader Anthony are today in everything that we do? We are Williamson. Even before the design of the on a constant quest for excellence. That’s hospital began, he said, “We held a lot of how we aim to constantly improve.” community forums where we gave regular updates. Once the design process began, we Carol Burrell, President and CEO gathered people’s input and incorporated Northeast Georgia Health System that into the design.” The community has welcomed the new hospital with open arms. An impressive 5,000 people showed up for its grand opening and tour. And if there is any further indication needed that building the new hospital was the right move, one need only look at the use of its emergency department (ED): The hospital projects about 42,000 ED visits for Fiscal Year 2017. “We knew there was a natural need for this hospital,” said Burrell. “We’re already almost at capacity and are looking to add more beds, which is pretty amazing.” Additionally, the ED of the flagship NGMC Gainesville campus “has certainly not been less busy since the opening of the Braselton campus, which I think speaks to the demand in terms of how much [NGMC Braselton] was needed in its community,” said Williamson. With the Gainesville campus being more than 65 years old, it’s safe to say that many community members were not around or living in the area when it was built in 1951. Although they were not there from the beginning, they have still embraced it as “their” hospital. In the same way that the Braselton community has welcomed the NGMC Braselton campus, so have the Gainesville and surrounding areas supported the flagship hospital. This acceptance is evident in Burrell’s description of an open house of a new patient tower prior to its opening in 2009. Only 300 people were expected to show up. The 100-bed Northeast Georgia Medical Center Braselton Campus opened in April 2015. Much to their astonishment, Burrell recalls, about 3,000 people attended.

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“It’s definitely the community’s hospital,” said Burrell. “You could see just how many people in the community the hospital impacts. For several months after [the new tower open house], I would run into different people in the community and I could see their sense of ownership and pride regarding that new patient tower.” The hospital has a huge impact on the community, and not just on the patients it serves. In addition to being the number one employer in the region, many community members are directly involved with the health system as board members or volunteers. The board is comprised of about 75 medical and community staff members and there are at least 800 volunteers supporting the health system.

Carol Burrell and surgical oncologist Ken Dixon, M.D., in NGMC Gainesville’s North Patient Tower.

“We’re a huge economic engine for the service area, and that comes with a responsibility to the community,” said Burrell. “We’re fortunate that the leaders who came before me had a vision to really engage the community, and we love seeing the sense of ownership.”

Burrell, her team, and health system members take the community’s feelings very seriously and continuously work to ensure that the health system is one of which the community can be proud. A constant strive for improvement is a foundation of the health system’s philosophy. The drive for excellence is evident in the fact that the health system has established Lean process improvements. “Lean,” modeled after the Toyota production system from the 1990s, refers to a systematic elimination of waste in an effort to streamline production processes. Lean principles are practiced throughout every part of the entire health system, including its physician group practices, long-term care, hospice, and in-patient facilities. Lean was a significant part of the design of the Braselton campus and is seen in its daily operations. For example, consider a 24-bed patient tower. Rather than having one or two nursing stations for the entire tower, there are six collaboration “hubs” that are located throughout the unit so nurses can be closer to their patients without having to walk a long way to attend to them. A daily management system, also based on Lean principles, helps essential messages travel rapidly from frontline staff all the way up to executive management. This process ensures that Burrell is aware of any issues or potential issues early in the day. “By 9:45 in the morning, I know what the hot-button and major issues are,” said Burrell, “whether it’s that we’re short on staffing, we’re above capacity, or if there have been any kind of safety concerns expressed.” This method of communication is also beneficial in that not only does it help make management staff aware of what is happening with frontline staff, but it also shows frontline staff that their concerns and messages are being heard at a senior level. They can see a connection, showing that the sense of community is felt throughout the health system as well as outside it.

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“It helps everyone at all levels of the organization understand the decisions we make and the directions we set. It helps those frontline staff members be empowered and know that they can make a difference for improvement,” said Burrell.

LEED Gold Certification

The drive for outstanding patient care is only part of NGHS’s mission to keep its community healthy. In addition to treating patients’ illnesses and injuries, the health system puts a large amount of time and resources into keeping individuals out of the hospital by working to improve population health. A community health needs assessment revealed key health focus areas, such as obesity, mental health needs, and diabetes. Part of the health system’s efforts to combat these health disparities includes collaborating with the community to improve every day health.

The health of the environment and sustainability was also of interest and the opportunity to build NGMC Braselton from scratch, “which doesn’t come around very often,” said NGMC Braselton President Anthony Williamson. “It provided the perfect opportunity for us to take advantage of the chance to integrate sustainability into the design.”

“We think about what issues we can embrace with other community partners to better educate the community,” said Burrell. “Our mission is to improve the health of the community in all that we do.”

Thanks to its many environmentally friendly characteristics, NGMC Braselton is the first hospital in the state to be awarded the Leadership and Energy in Environmental Design (LEED) for Healthcare Gold Certification. Local plants provided all concrete used in the building. Most of the construction waste generated at the site, 92 percent, was recycled. Perhaps the most impressive and beneficial step was that hospital planners installed a geothermal field behind the hospital, where 156 wells, each 500 feet deep, were drilled. They provide all the heating and cooling for the building, and in addition to eliminating the burning of fossil fuels, will save the health system some $25 million over 30 years on the cost of power. Low-flow water fixtures and the use of reclaimed water for irrigation help save water. The landscaping includes only plant life native to the area so there are no high water requirements. An electric vehicle charging station is a great resource for those environmentally conscious community residents.

With NGMC Braselton, for example, community residents were interested in the hospital having a focus on wellness. They wanted to know how to make the hospital part of their daily wellness regimes. Hence, the hospital strategically incorporated walking trails, yoga classes, and even a health care library with a full-time health care librarian into the building plan. “We do have a focus on population health and keeping people out of the hospital,” reiterated Williamson. “It’s not only about treating acute illness or doing surgeries, but it’s also about having that focus on keeping the whole individual healthy.” Another way to keep individuals healthy is ensuring they have access to care close to home. NGMC Braselton saves many community residents from long trips to Gainesville, Athens, Lawrenceville and Atlanta for care. The health system’s recent acquisition of Barrow Regional Medical Center in Winder and its proposed acquisition of Habersham Medical Center in Demorest further support its mission to provide proper access to care for communities. These acquisitions are not just about a large health system providing support to a struggling smaller community hospital. In fact, “they also support us,” said Burrell. “We look at how we can best coordinate care throughout the region. When we are aligned in a more structured fashion, we are better able to coordinate care and provide it in the lowest cost setting.”

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“We do have a focus on population health and keeping people out of the hospital. It’s not only about treating acute illness or doing surgeries, but it’s also about having that focus on keeping the whole individual healthy.” Anthony Williamson, NGMC President and Southern Market Leader A focus on keeping health care costs low is of broad interest, especially in recent years with the underinsured and uninsured crisis facing the nation. NGHS, like many hospitals and health systems, is dealing with increased rates of these patients, and they have various strategies to tackle the problem. The health system helps fund the local health department as well as a free clinic for primary care needs. To deal with the high numbers of ER visitors (many of whom use the ER as their primary care), the health system has ensured that there are urgent care locations close to where people need them so they do not default to the ER for their care and cause overuse and crowding problems. These approaches are, according to Williamson, what helped the Braselton campus educate the community on proper places of care. In addition to having primary care offices “in every community that surrounds Braselton,” he said, the hospital had urgent care centers up and running before the hospital itself opened. “I think the community got into the pattern of going to urgent care for the things that can be treated there, so it’s helped us strategically,” he said. Another important factor in combating high rates of uninsured patients is legislative efforts. In order to be able to provide necessary services to the community, the health care field must educate state and federal legislators. While the Georgia Hospital Association has dedicated government relations staff to advocate on behalf of all Georgia hospitals at the Georgia General Assembly, many hospitals also have their own lobbyists and NGHS is no exception. Deb Bailey, executive director for governmental affairs for NGHS, leads efforts to inform Georgia legislators on health care issues to help ensure the community is able to receive the care it needs from the health system. “The complexity of health care and the unknown make government relations efforts more important now than ever,” said Bailey. “We have to have legislators understanding the implications of their decisions.” Funding for health care and hospitals and the ever-present Certificate of Need (CON) issue are examples of matters on which Bailey and her team work to educate Georgia legislators. Especially important is CON, a program established in Georgia and 34 other states to regulate and facilitate

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Rallying the Troops A strong team culture is emphasized at Northeast Georgia Health System. President and CEO Carol Burrell is known for constantly offering encouragement to staff members.

the planning of new services and facility construction. Several attempts to weaken the state’s CON program have popped up over the years. “We feel like maintaining CON is one of the single most important legislative issues to maintain access for indigent and charity patients,” said Bailey. “If we allow that to deteriorate, it will have a significant impact on access to care because we wouldn’t be able to provide the care we’re currently providing.” Attracting top-notch caregivers is an additional priority in NGHS’s efforts to provide the best care it can to its community. In an age of workforce shortages and high competition for physicians and nursing staff, NGHS has a simple way of thinking. Attract bees with honey, not vinegar. “If you have a culture that is focused on quality and safety where staff members feel like they are part of the team and contributing to the success of the health system, people want to be a part of that,” said Burrell. “It doesn’t matter if you’re an environmental services worker or a cardiac surgeon. You want to know you’re a part of an organization that cares.”

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Our Hospitals

Names in the News January

March

Leslie Thompson, charge nurse at Piedmont Atlanta Hospital, was awarded the Unit/ Departmental Nursing Leader Award by Modern Healthcare magazine.

For the second year in a row, St. Mary’s Good Samaritan Hospital was named Georgia’s Coverdell Champion Hospital of the Year for stroke care in the very small hospital category.

South Georgia Medical Center was ranked third in Georgia in the Large Hospital category for 2016 by Georgia Trend magazine.

The Pearlman Cancer Center at South Georgia Medical Center received the Commission on Cancer’s Outstanding Achievement award.

Northeast Georgia Health System President and CEO Carol Burrell, Children’s Healthcare of Atlanta President and CEO Donna Hyland, Augusta University Health CEO Brooks Keel, WellStar Health System President and CEO Candice Saunders, and Phoebe Putney Health System CEO Joel Wernick were named to Georgia Trend magazine’s Most Influential List.

WellStar West Georgia Medical Center was named one of the nation’s 100 Top Hospitals® by Truven Health Analytics™ for the second year in a row.

St. Francis Hospital became the first hospital in Georgia to receive the Perinatal Care Certification from The Joint Commission.

February Gov. Nathan deal visited The Medical Center, Navicent Health to tour the hospital’s nationally verified Level I Trauma Center. Emory St. Joseph’s Hospital became the first hospital in Georgia to offer advanced brain radiosurgery. St. Francis Hospital was named one of America’s Best Hospitals for Heart Care and one of America’s Best Stroke Centers by Women’s Choice Award. The ALS Association recognized the Emory ALS Center as a Certified Treatment Center of Excellence.

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April The cardiac program at WellStar Kennestone Hospital became one of only two programs in the country to receive The Joint Commission Gold Seal Disease-Specific Certification for Heart Valve, Coronary Artery Bypass Surgery and Congestive Heart Failure. JAMES magazine named WellStar Health System President and CEO Candice Saunders and Shepherd Center Co-Founder Alana Shepherd to its Most Influential list. South Georgia Medical Center received the American Heart Association/American Stroke Association’s Get with the Guidelines – Target: Stroke Honor Roll-Elite Plus Quality Achievement Award.

May Northside Hospital-Cherokee opened its replacement hospital in Canton.


Memorial University Medical Center and St. Francis Hospital received the American Heart Association/American Stroke Association Get With The Guidelines® Stroke Gold Plus Quality Achievement Award. Northeast Georgia Health System President and CEO Carol Burrell was named the 2017 Most Respected Business Leader by Georgia Trend magazine and was honored as the Greater Hall Chamber of Commerce’s Distinguished Citizen. Columbus Regional announced its intent to pursue a strategic affiliation with Piedmont Healthcare. South Georgia Medical Center’s Rehabilitation Program became the first in the state to offer patients Kickstart, a neurorehabilitation device designed to accelerate recovery following a neurological injury. (See page 12) The Winship Cancer Institute of Emory University earned the prestigious comprehensive cancer center designation from the National Cancer Institute (NCI), placing it in the top one percent of all cancer centers in the United States. Shepherd Center Chief Nursing Officer Tammy King, RN, MSN, won the AJC Executive Nursing Leadership Excellence Award. St. Mary’s Hospital received the American Heart Association Get With The Guidelines®Resuscitation Gold Award.

June St. Mary’s Hospital received its eighth consecutive Gold Plus Award for stroke care. The Medical Center, Navicent Health became one of the first hospitals in the Southeast to offer the world’s smallest pacemaker for patients with bradycardia, or an abnormally slow heart rate. St. Francis Hospital acquired new surgical technologies to benefit breast cancer patients, the SPY Elite® and the Faxitron BioVision Breast Specimen X-ray System.

July University Health Care System welcomed Trinity Hospital of Augusta into University Health Care System as University Hospital Summerville. Emory Johns Creek Hospital and Emory University Hospital Midtown were selected as Georgia Safe to Sleep Hospitals by the Georgia Department of Public Health. Children’s Healthcare of Atlanta, Grady Memorial Hospital, Piedmont Healthcare, WellStar Health System, Navicent Health, Northeast Georgia Medical Center, Union General Hospital, Inc., and WellStar West Georgia Medical Center were named “Most Wired Hospitals and Health Systems” by Hospitals & Health Networks.

Crisp Regional Hospital became the eighth hospital in Georgia to become Remote Treatment Stroke Center Accredited.

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Our Hospitals

Rehabilitation Innovations Advance Stroke Care

South Georgia Medical Center’s Kickstart devices takes recovery to the next level By Jeff Sunderland

SGMC rehabilitation therapists demonstrate how easy the Kickstart device is to use.

Georgia hospitals make great efforts to deliver the best health care to their communities. Evidence of these efforts can be seen with a quick search on the internet that yields many exciting “firsts” by hospitals in the state, including the numerous recognitions and designations Georgia hospitals rack up thanks to their innovative efforts in patient care. Emory’s Winship Cancer Center earned the comprehensive cancer designation from the National Cancer Institute and St. Francis Hospital became the first in Georgia to receive the Perinatal Care Certification from The Joint Commission. Likewise, South Georgia Medical Center (SGMC) was named the recipient of the prestigious Hospital STAR Award by the Georgia Coverdell Acute Stroke Registry. The award recognizes just one hospital annually for ensuring that Georgia residents receive the highest quality stroke care. “This is another example of the exemplary care that is available in Valdosta. Our stroke team has worked incredibly hard. It is very worthy of this award and the state and national recognition it carries,” said SGMC Laura Love, Director of Community Relations. SGMC has recently taken its stroke care to the next level by becoming the first hospital in the state to offer Kickstart, an easy-to-use neurorehabilitation device designed to accelerate walking recovery and functional improvements following a stroke, spinal cord injury and other neurological conditions. Supported by a wearable structure that provides stability, Kickstart’s core technology is a patented, bio-inspired Exotendon™ that works like an artificial tendon to assist proper leg advancement and amplify the user’s ability to walk.

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“This device literally gives patients a ‘kick start,’” said Rehabilitation Medical Director Natalya V. Bulaeva, MD, PhP. “The Exotendon™ technology facilitates efficient, proper walking motions, making patients feel safer and maximizing therapy endurance.” Bulaeva said patient outcomes are improved and patients can continue using the device at home if needed to promote continued recovery to walking. “It’s lightweight and less burdensome than other devices,” she said. “Our goal is for users to graduate from Kickstart to become as independent as they were before they were injured.” Kickstart is the latest advancement in SGMC’s outstanding stroke care. The hospital began its Code Stroke program in 2011, developed in accordance with nationally accepted standards of stroke care with the goal of reducing or eliminating long-term disability or death by strokes. SGMC has implemented coveted training programs in pre-hospital (EMS) care, including identification of stroke symptoms, emergency department care and acute rehab. It was also one of the first hospitals to pilot a program to address post-hospital transitions of care.

Brasfield & Gorrie supports the Georgia Hospital Association and celebrates its mission to advance the health of individuals and communities. Together, we can make a difference. From top: Northside Hospital East Cobb Medical Center, Marietta, GA Piedmont Fayette Hospital ED and Inpatient Expansion, Fayetteville, GA Hamilton Medical Center MICU and ER Renovation, Dalton, GA

brasfieldgorrie.com

twentyfourseven Summer 2017

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Our Hospitals

Shepherd Center Helps Keep Teens Safe on the Road

Free app educates parents and teens on driver safety By Jeff Sunderland

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As you travel around the state, you have probably noticed the Georgia Department of Transportation Interstate signs displaying an alarming messages, such as, “Georgia Roadway Fatalities This Year: 860.” Since 2008, more than 11,000 traffic fatalities have occurred in Georgia, according to the Governor’s Office of Highway Safety. What is even more troubling is the number of teens injured and killed. In fact, nationwide, traffic-related fatalities is the leading cause of teenager deaths. But hope is near as a Georgia hospital has created a one-of-kind resource to help decrease fatalities. The Shepherd Center, a top-10 rehabilitation hospital for people with spinal cord and brain injuries, has launched a free app to help prevent automobile accidents and injuries.


Partnering with the Governor’s Office of Highway Safety and IT management consulting firm CapTech, Shepherd Center’s certified driver rehabilitation specialists and injury prevention experts used their specialized training to create AutoCoach, an innovative app that makes it easier for adults to effectively teach their teens to drive defensively and safely. Logo courtesy of CapTech

AutoCoach tracks training hours as well as night driving hours. Both are prerequisites for obtaining a driver’s license in Georgia; however, the app’s curriculum is applicable in all 50 U.S. states. AutoCoach is available as a free download in the Apple App and Google Play stores. “With motor vehicle crashes being the leading cause of death for teens in our country, we must make sure our youngest drivers receive the proper training before they get behind the wheel,” said Harris Blackwood, director of the Georgia Governor’s Office of Highway Safety. “It has been a great pleasure to partner with Shepherd Center and CapTech in developing this first-of-its-kind, comprehensive driver’s education app that will help parents, grandparents and other adults provide training in a manner teens will be able to learn and use when they begin driving on their own.” AutoCoach features include a customizable parent-teen agreement, a graduated driver’s licensing quiz by state, distraction notifications, a driving log and a 10-chapter curriculum for parents based on best practices. The curriculum covers basic topics, such as adjusting mirrors, seats and tire pressure, and the difference between double yellow and dotted yellow lines, as well as complex driving skills, such as merging onto crowded highways, driving around 18-wheelers and safely recovering from an overcorrection. “Some parents might choose to spend very little time on the most basic chapters and spend more time teaching more complex skills,” said Emma Louise Harrington, MSPS, Ed.M., director of injury prevention and education at Shepherd Center. “And that’s fine. Some kids already know the very basics and their parents are comfortable with their teens’ knowledge of those.” Harrington continued, “But in the more complex chapters there are good refreshers for the parents. It’s vital that teens learn these things.” AutoCoach is a time commitment for parents, but the hope is that once parents weigh the time commitment against the risks, it will be an easy decision and can save lives. In fact, it could even decrease the number of on non-fatal accidents as well that send thousands others to Georgia’s hospitals. “Hospitals are encouraged to use and promote the app,” said Mitchell Fillhaber, Shepherd Center senior vice president of corporate development and managed care. “Our goal is to make this free app available to all Georgia hospitals so they then can make it available to their employees, donors and Board members, along with members of their communities across the state.”

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Our Hospitals

Remembering 1977 GHA Chair, Pioneer J. William Pinkston By Jeff Sunderland

A commitment and devotion to public health care is likely what J. William Pinkston will be remembered for most. Georgia’s health care industry recently lost this pioneer when he passed away this spring at the age of 92. Pinkston, GHA’s 1977 Chairman of the Board of Trustees, devoted nearly his entire career to hospital administration, becoming one of the state’s most respected health care leaders. Born in South Georgia, Pinkston attended Valdosta public schools. He earned prestigious Eagle Scout honors before serving in World War II with the Army Corps of Engineers in Fort Belvoir, Va. He later attended Emory University before working two years at Western Electric. In 1948, he began his health care career at Grady Memorial Hospital, where the patient population included polio patients in an Iron Lung Unit. Here he began employment as an assistant comptroller before working his way up to assistant superintendent. In 1964, Pinkston began a 25-year tenure as the executive director of Grady. During this time, he oversaw dramatic and far-reaching changes at the hospital, including integration of the hospital, installation of air conditioning throughout the facility, implementation of Medicare and Medicaid, creation of a burn center, and outreach programs for drug treatment and AIDS patients. Pinkston retired from Grady in 1989. At the time of his retirement, the late Dr. Edward C. Loughlin, former chairman of the Fulton-DeKalb Hospital Authority, said, “Bill Pinkston is Grady Hospital. This man is impeccable in his honesty and his work ethic. One of his greatest strengths has been a strong advocacy for the disadvantaged citizens of this city and state.” Pinkston served in numerous leadership positions within various hospital administration organizations. He was past president of the Metropolitan Atlanta Hospital Council. He served on the Executive Committees of the Public Hospital Section of the American Hospital Association and

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the Council of Teaching Hospitals of the American Medical Association. He was the first layperson to receive the Award of Honor from the Emory University Medical Alumnae Association. He was also a member of the Georgia Task Force on AIDS from 1987 to 1990. His commitment to Georgia health care earned him the coveted Georgia Hospital Association Gold Honor Award of Excellence. This prestigious honor has only been presented to eight health care leaders since the association was founded in 1929. “Mr. Pinkston was a leader, mentor and pioneer,” said GHA President Earl Rogers. “I can’t think of anyone who worked harder to improve public health care in our state. We will greatly miss his leadership and devotion, not only to our association, but also to the health and well-being of Georgia communities.”

D. Montez Carter, FACHE, Named Chair-Elect of Board of Trustees GHA congratulates D. Montez Carter, FACHE, president of St. Mary’s Hospital in Athens, on being named chair-elect of the GHA Board of Trustees. He will succeed current chair Steven L. Gautney, president of Crisp Regional Hospital in Cordele. Carter will be installed in November and will lead the Board in developing strategies for GHA hospital members, advocating for the highest quality care for patients, and supporting adequate reimbursement for hospitals. Carter has served as president of St. Mary’s Hospital since March 2017. He is responsible for all aspects of the hospital’s quality, operational and financial performance as well as ongoing foundation efforts. Prior to serving in this position, he was president of St. Mary’s Good Samaritan Hospital. During his tenure there, Carter was integral to the process of building a modern replacement hospital. He also managed a number of significant accomplishments, including the purchase of the region’s first 64-slice CT scanner, a vital tool in heart and stroke diagnostic imaging; the growth of services and medical staff; and enhanced stroke care through a partnership with Georgia Regents University in Augusta. Carter came to St. Mary’s from Greenwood Leflore Hospital in Greenwood, Miss., where he served first as director of pharmacy services and then as associate director of performance improvement and patient support services. “Montez Carter’s health care experience has had far-reaching positive effects for patients and communities locally and statewide,” said GHA President and CEO Earl Rogers. “He brings a wealth of knowledge to our Board and we look forward to his leadership.” Carter is a Fellow of the American College of Healthcare Executives. He earned a master’s degree in business administration from the University of Alabama in Tuscaloosa, Ala., and his doctoral degree in pharmacy from the University of Mississippi in Oxford, Miss.

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Feature

Drive for Perfection

Why Northeast Georgia Health System’s leader will never stop looking for improvement By Erin Stewart

When she was a young child, Carol Burrell thought she might want to be an attorney but, “My desire to make a difference, along with my love of science and health care, won out,” she said. In her role as the chief executive officer of Northeast Georgia Health System (NGHS), Burrell finds opportunities to make a difference every day. Working in health care for more than three decades, as well as working in a number of areas around NGHS, thoroughly prepared her to lead as its CEO since 2011. In that time, she has worked to create a culture among staff in which everyone strives to “be better tomorrow than we are today,” a sort of motto one will hear throughout the health system. It stems from the philosophy that there is always room for improvement and that a better method of doing things is just around the corner. With the health system’s multiple recognitions and awards, such as being rated the state’s number one heart hospital 12 years in a row and being rated in the top 10 percent in the nation for stroke care, cancer care, pneumonia care and surgical care, one might assume that all goals have been met. But with the formidable link between hospital quality and patient care, Burrell is always evaluating how the processes of NGHS can be better. “She is committed to continuous improvement and I think the real basis of that is creating a safe environment for patients,” said Sam Johnson, M.D., chief medical officer of NGHS. “That’s the driver behind all that we do. Her focus on quality and safety and her drive toward that continuous improvement is a direct reflection of how we provide care to our patients and the patient experience.” One step that Burrell took early on in order to enhance the culture of care and ensure that all staff would be on the same page was to focus on the mission and values of the health system. Rather than simply printing a few words on paper and posting the mission and values on the hospital website and around the hospital, Burrell created a team culture where staff members not only know the values (respectful compassion, deep interdependence, responsible stewardship, and passion for excellence), but they also recognize how to use them concretely in their work each day. “We literally live by our four values,” said Tony Herdener, recently retired chief financial officer for NGHS. “It seems basic on paper, but if you do it right, it’s amazing what lessons can be learned from

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the key themes, and every day we see our staff living by those values.” Much of the staff’s favorable reception of the values is thanks to Burrell’s desire to implement them in a way that is easily understood. “When you go through the effort to really identify and live by the values, you can see who is a great teammate and who is a great fit for our organization. I think that was part of Carol’s thinking when she helped define them and that’s why we have such a great team culture here,” said Herdener. That great team culture is partly thanks to Burrell’s efforts to encourage chemistry, not just among team members throughout the system, but with her own staff as well. One reason staff members strongly respect her is that she leads with the right balance of direct instruction and a confidence in her team’s ability to do their jobs. “She allows us each to work our own areas and manage our own portions of the organization with her mainly as a supporter,” said Dr. Johnson. “There is that comfort level where she allows us to innovate and experiment. She doesn’t expect perfection all the time, which allows us to really create new, different and effective ways of doing things.” This level of comfort has created an environment in which team members are more likely to speak up with ideas or, perhaps more importantly, when they see an issue or problem that needs to be addressed. In fact, each meeting begins with a discussion of safety about not just patients, but employees as well.

“Doing the right thing for the right reasons at the right time is ingrained in our culture,” said Herdener, “whether that involves patients or employees. We’re focused on not just doing everything the right way, but we’re also constantly evaluating how we can do things better, and that’s thanks to Carol.”

Tony Herdener Northeast Georgia Health System

“Doing the right thing for the right reasons at the right time is ingrained in our culture,” said Herdener, “whether that involves patients or employees. We’re focused on not just doing everything the right way, but we’re also constantly evaluating how we can do things better, and that’s thanks to Carol.” Another notable characteristic of Burrell’s leadership style is that it is unassuming. Health system staff appreciate that she doesn’t have to be an authoritarian to see the results she is striving for, and that has created a high level of respect. “She’s a great leader because she is humble,” said Dr. Johnson. “She may well frequently be the smartest person in the room, but she always waits for others to have their say and she listens closely and intently to the input of others.”

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Feature

Physician Profile: Hospitalist Why one physician transitioned to this growing field By Erin Stewart

A growing trend among physicians and hospitals is the increase in hospitals’ hiring of hospitalists, who are dedicated in-patient physicians working exclusively in a hospital. When the American Hospital Association began tracking the number of hospitalists in 2003, there were about 10,000. Today, that number has increased by a whopping 420 percent, to 52,000, according to the New England Journal of Medicine. This jump in growth is partly thanks to the introduction of Medicare’s diagnosis-related-groups (DRGs) in the early 1980s. With DRGs rewarding hospitals for reduction of length of stays and better use of resources, hospitals needed the 24/7 availability of in-house physicians, rather than dealing with the potential delays of office-based ones traveling to the hospital to treat patients once or twice a day. Additionally, the increased use of electronic health records (EHRs), which enable hospitalists to see the medical history of inpatients very quickly, contributed to the growth. Another reason for the growth of hospitalists is the desirable lifestyle. Many hospitalists enjoy the ability they have to control their working hours and patient load. Dr. Charles Gordon, the medical director of hospitalists at Meadows Regional Medical Center in Vidalia, practiced as a traditional internist out of an office for 35 years before making the gradual transition to being a hospitalist. In addition to the benefits mentioned above, Dr. Gordon enjoys the complexity of being a hospitalist. His background as an internist helped tremendously with his transition to the field and with solving the “mystery” of what is ailing patients. “Inpatient care has become more complex and changes almost daily,” Dr. Gordon says. “Our goal as hospitalists is to be efficient, solve the mystery of what’s wrong with the patient, and maximize the efficiency of the system.” Physicians in the hospitalist field have experience working with all the bodily systems such as the neurological, cardiac, endocrine, and pulmonary systems. This vast knowledge helps with the intricacy of figuring out what is ailing patients. As Dr. Gordon points out, hospitalists perhaps have an advantage over physicians in an office practice because they tend to see a higher volume of certain diseases and illnesses in comparison.

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“You’re exposed to a higher volume [of illnesses], so over time you get better at diagnoses,” he says. “Practice makes perfect and, after a while, it’s like riding a bicycle. It’s hard to fall off.” Working out of the hospital means that Dr. Gordon is always in the right place at the right time, another feature he appreciates of being a hospitalist. When he had an office practice, patients that required admission to the hospital were not as accessible in terms of following their treatment plans. Rather than being able to walk over to check on the patient in person, he would have to make phone calls to other doctors at the hospital and get feedback that way. Now, he has personal access to other physicians who may also be treating the same patient. Part of Dr. Gordon’s day includes having lunch with other specialists where he can get an overall sense of what is happening with patients he is treating. “I’ve stamped out several emergencies just by being able to walk over to my patients and assess them myself,” says Dr. Gordon. “I can provide data on the patient directly to the proper hospital staff and cut out the middle man. I can keep an eye on my patients from admission to discharge.” Close proximity to his patients is also beneficial in terms of transition of care. Being able to assist patients in this way is another aspect of being a hospitalist that Dr. Gordon values. According to the National Transitions of Care Coalition, reasons that the U.S. health care system sometimes fails to meet the needs of patients during the transition of care from one care setting to another include rushed care, fragmented responsibility and poor communication between providers. Caretakers in the hospital setting, like Dr. Gordon, who are up-to-date on the status of patients admitted into the hospital by their primary care doctors, help guarantee a smoother transition of care. “[Transition of care] is a problem in the system,” says Dr. Gordon. “You have the primary care doctors who don’t come to the hospital anymore. So we kind of have to pick up with their patients where they left off. Then, when the patient is discharged back to the primary care doctor, we have to make sure the doctor is up to speed on what happened in the hospital. But I think we do very well with both of those things.” Overall, Dr. Gordon enjoys the level of personal care that hospitalists are able to provide to their patients. Not having to rely on phone calls or emails to other doctors to assess patients, but to be there in person to assess them, makes all the difference. “Medicine is both an art and a science,” he says. “The art of examining the patient, putting it together, making judgment calls, is better done in person rather than long distance.” Source: Merritt Hawkins, “The Growing Use and Recruitment of Hospitalists”

Merritt Hawkins is a permanent placement physician search and consulting firm endorsed by Georgia Hospital Health Services (GHHS).

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Feature

Health Care Superheroes Saving lives with advanced technology By Jeff Sunderland

It’s a bird! It’s a plane! It’s . . . Superman! – and the theme of GHA’s 2017 Patient Safety Campaign, an annual initiative to educate member hospitals and recognize their efforts in improvements in quality and patient safety. To many, when the question arises of who is the greatest superhero of all time, Christopher Reeve’s famous Superman character comes to the forefront of our minds. Although this fictional icon jumped leaps and bounds to save the world on film, in real life there is no Superman to save lives or protect people from undue harm. But, in our world, there are countless individuals in the health care industry who do saves lives every second of every day.

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Making the connection of a superhero to a health care professional is not hard. Our dedicated nurses, doctors and other medical professionals give their time and, in some cases, put their own lives in jeopardy to save the life of a complete stranger. That is, in reality, a superhero. In addition to saving lives, there are other ways that hospital workers are like superheroes. Sure, Superman had many supernatural powers, such as X-ray vision, super human strength and laser vision. In health care, with the use of magnetic resonance imaging (MRI) scans and computed tomography (CT) scans, hospitals have the technology to see every cell, every bone, and every vein. Through the use of mechanical lifts, health care workers have super human strength. Lasers can coagulate tumors, make precise incisions, and cut through tissue. “It takes endurance, passion, and integrity,” said Teri Newsome, director of quality management at Habersham Medical Center. “The strength of health care isn’t in the buildings of brick and steel. It’s in the hearts of the personnel who dreamed big, have gone the extra mile, loved, shared empathy, and have worked hard to realize change.” Hospitals go the extra mile to administer life-saving care while working diligently to prevent infections, falls, and other forms of patient harm. For example, GHA’s latest quality improvement initiative helped Georgia hospitals successfully reduce catheter-associated urinary tract infections (CAUTI) by 13 percent. “It’s never crowded along the extra mile,” said GHA Infection Prevention Specialist Roben Summers. “In GHA’s work with hospitals to reduce CAUTI, we saw how staff members succeeded in ensuring infection reduction and keeping patients as safe as possible. To them ‘good enough,’ is never enough. They are on a constant mission to take any necessary steps to make sure patients are as safe as possible within our walls.” In some instances, just lending an ear or sharing a tear with a patient or family members can make a world of difference. “At the hospital where I used to work, I’d usually be the one called when patients were particularly unhappy,” said Summers. “I would go to their rooms and listen to them express frustration, anger, pain, and hurt. Most times, something as simple as just getting the patient out of the room and outside would be enough. So I’d get a wheelchair and a blanket and wheel the outside and pretend we were on a veranda and have sweet tea. For 20 minutes, I would listen, laugh, cry, and give all my attention to that patient. In those moments, I changed those patients’ worlds. I became their hero.” Of course, patients have their own heroic characteristics that are not forgotten by health care workers. “The patients fight to get better, sometimes through very tough diseases,” said Newsome. “Their fight and determination represent the true values of a hero.”

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Feature

Education: The History, Development and Growing Popularity of Hospitalist Programs By Kurt Mosley, Merritt Hawkins The following is an edited version of the Merritt Hawkins Whitepaper Series article The Growing Use and Recruitment of Hospitalists. For the complete version, click here. Introduction In 1996, Robert M. Wachter, M.D. and Lee Goldman, M.D., M.P.H., coined the term “hospitalist” to describe a new class of specialists defined not be the types of maladies or organ systems they treat but by the site of service in which they practice (i.e., the hospital). Twenty years ago, only a few hundred doctors practiced as hospitalists. By 2003, the first year the American Hospital Association began tracking hospitalists, Hospitalists are particularly there were some 10,000. Today, the number of physicians attuned to emerging models practicing as hospitalists has grown to approximately 52,000 The number of physicians practicing as hospitalists now ranks fourth among all medical specialties trailing only general internal medicine (110,000 physicians), family medicine (107,000) and pediatrics (55,000)1

of care because they have long worked in an environment of team care, outcomes data and treatment protocols.

Reasons for Growth The increased use of hospitalists was spurred, in part, by the introduction of Medicare’s diagnosisrelated-group (DRG) model of payment, which pays hospitals a fixed sum for various services independent of patient length of stay in the hospital. After DRGs went into effect, hospitals were focused on reducing length of stay and using resources appropriately. This required the presence of in-house physicians who would be available around the clock, rather than office-based physicians who would round once or twice a day to monitor patients and initiate discharges. The trend was further facilitated by the implementation of electronic health records (EHR) which made it possible for physicians meeting patients for the first time in the hospital to access their medical histories. Studies soon made it apparent that hospitalists could reduce costs, shorten lengths of stays, and, in some cases maintain, or even enhance, quality of care and patient satisfaction. The ongoing proliferation of value-based payment models encouraging team-based care, resource utilization, the elimination of errors known as “never events,” and hospital readmissions have further driven the growth of hospitalists. Hospitalists are particularly attuned to emerging models of care because they

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have long worked in an environment of team care, outcomes data and treatment protocols. Likened to orchestra conductors, hospitalists coordinate the interaction of patients, physician specialists, non-physician clinicians, support staff, data, and protocols to improve throughput, resource utilization and quality of care. A hospitalist might work with nurses on ways to reduce falls, develop measures for treating pneumonia or write up insulin drip protocols. For these reasons, they are a natural fit for accountable care organizations (ACOs), which are predicated on team-based and quality-driven principles of care. Almost one in four hospitalists are now in ACOs.2 The use of hospitalists also has increased as a key component of physician recruitment and retention. A growing number of physicians, particularly younger physicians, place great emphasis on a “controllable lifestyle,” including set hours and the reduction or elimination of hospital inpatient duties. It is extremely difficult in today’s market to recruit physicians to practice opportunities that do not feature a hospitalist program. Indeed, traditional internal medicine that includes inpatient work is one of the most difficult search assignments Merritt Hawkins now conducts. For these and related reasons, 75 percent of all hospitals now have a hospitalist program, including nine out of 10 hospitals of 200 beds or more.2 Going Beyond Primary Care The hospitalist concept has expanded in recent years and is no longer applicable to just primary care. The model migrated first to obstetrics/gynecology. “Laborists” are OB/GYNs who work at the hospital and perform deliveries, often for patients who do not have a regular OB/GYN or to relieve office-based OB/GYNs of off-hour deliveries. Neuro-hospitalists provide stroke care for emergency department patients; surgical hospitalists (also called acute care surgeons) take the place of community surgeons taking call; and “transitionalists” or “SNFists” see patients in post-acute settings such as skilled nursing facilities (SNFs), inpatient rehabilitation facilities, and long-term care hospitals. Transitionalists can be particularly important to preventing hospital readmissions, for which there are now financial penalties. Some endocrinologists today prefer to schedule protocols and don’t go to the hospital, handing off their patients to an endo-hospitalist instead. An emerging concept to address morbidities of hospitalized patients is the “comprehensivist.” In this model, a subgroup of hospitalists manages the care of a small panel of the highest risk, most frequently admitted outpatients, and remain involved when hospitalization is required.1 This approach dovetails with the concept of population health management, in which health care organizations take a more hands-on role in patient education, compliance and care management that extends beyond the hospital’s walls. Hospitalists today also may be involved in the co-management of surgical patients in the hospital.

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Recruiting and Compensation Studies soon made it apparent Hospitalists remain one of the most in-demand type of physicians in the United States. Demand that hospitalists could reduce continues to be strong, despite the fact that many costs, shorten lengths of stays, hospitals are emphasizing outpatient services. Even if inpatient services are reduced, hospitals must have and, in some cases maintain, inpatient services covered 24/7, creating the need or even enhance, quality of for hospitalists. Many smaller hospitals, which may have been reluctant to create hospitalist programs care and patient satisfaction. in the past, now find they cannot recruit primary care physicians to the community without such a program. This includes pediatricians, many of whom today are reluctant to assume inpatient duties. When “old-school” primary care doctors who have maintained inpatient practices retire, smaller facilities will face additional pressure to add hospitalists. Because of a dearth of physicians, some facilities will likely turn to nurse practitioners (NPs) and physician assistants (PAs) to supplement hospitalist services. According to the Society of Hospital Medicine, use of NPs and PAs in hospitalist programs rose from 53.9 percent in 2012 to 65.9 percent in 2014. Demand also is being driven by the fact that some hospitalists are complaining of burnout as their duties increase and are asking for caps in their contracts on the number of patients they see per shift. This essentially reduces overall FTEs and creates the need for additional hospitalists. At the same time, a growing number of primary care physicians have given up inpatient work and therefore may not be considered as candidates for hospitalist positions. Most hospitals want candidates who have recent experience with inpatient work, and many primary care physicians today have not seen inpatients for years, reducing the overall supply of viable candidates. Supply for permanent hospitalist positions also is constrained by the fact that many hospitalists are attracted to temporary (locum tenens) work. Since hospitalists don’t maintain continuity with patients in any case, some see no reason they should not work as locums. All these factors combine to make hospitalist searches increasingly competitive. It is to the advantage of hospitals, hospitalist groups, and others seeking hospitalists that many physicians, particularly in internal medicine, are expressing an interest in hospital medicine. By the same token, it should be considered that the growing number of primary care physicians (particularly general internists) choosing hospitalist positions reduces the number available for office-based practices, where they also are needed. So in primary care recruitment today, it is often a case of “robbing Peter to pay Paul.” Conclusion A variety of health care trends, including the drive toward a more value-based delivery system and the practice preferences of many physicians, are causing continued demand for physicians practicing hospital medicine, both in primary care and a variety of other specialties. Despite the current volatile nature of the health care market, these trends can be expected to continue. Sources: 1 The 20th Anniversary of Hospitalists, The New England Journal of Medicine, September 15, 2016). 2 Hospitalists: Riding the Wave of Changes in Healthcare. Medscape, April 26, 2016)

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Feature

Telemedicine Opportunities for Georgia Hospitals By Elliott Coward With contributions from Seslee Smith and Michelle Licht Morris, Manning & Martin LLP Introduction Hospitals and health care systems in Georgia and across the country are in a state of flux. Since 2010, seven hospitals—mostly rural—have closed (although some have reopened) and other hospitals have limited the services they provide, such as when a hospital in Adel made the difficult decision to halt emergency room services in an effort to save costs in a time of declining reimbursements. Even after this strategy was put in place, the fate of the entire hospital was in question until plans to build a new hospital were made. In addition to hospital closures, hospital mergers and partnerships, particularly in metro Atlanta, have increased in response to the demand for combining resources and the need for greater economies of scale. In the past two years, several metro-Atlanta hospitals have experienced huge growth and a few others have been in merger discussions. These changes are, largely, responses to a system of care that pays less while demanding more. Hospital quality standards are more stringent than ever; hospital readmissions are penalized; and changes in Medicaid and community benefit requirements demand that hospitals provide more charity or steeply discounted care while reaching the underserved. No single answer exists as to how to operate in a way that is successful yet economically feasible for hospitals and beneficial to patients. However, telemedicine expansion offers both a survival strategy for rural hospitals and a growth strategy for the future for larger hospital systems. Most importantly, telemedicine expansion offers a way to efficiently provide more care to more patients and to improve patient satisfaction. There are several benefits to telemedicine: • Telemedicine networks can help prevent unnecessary emergency visits and readmissions by providing preventive care and chronic care management to patients who would not otherwise seek such care. • The use of telemedicine networks through partnerships among Georgia hospitals can increase access to specialty care in rural areas. • Telemedicine can decrease physician costs. • Telemedicine can increase a hospital’s reach and patient base. Telemedicine in Georgia The growth of telemedicine in Georgia lags behind many other states, and a reason for this may be Georgia’s relatively restrictive telemedicine laws. Telemedicine rules in Georgia, set forth at Medical Board Rule 360-3-.07, impose certain restrictions that many other states’ laws do not. For instance, in Georgia, in order to treat a patient via telemedicine, the provider must have a medical history of the patient. In addition, an in-person exam is required prior to the provision of any telemedicine service unless one of four exceptions is met:

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• The provider has previously examined the patient in-person and is providing on-going care; • There is a referral from another provider who has previously examined the patient in person; • Care is provided, via telemedicine, at the request of a public health nurse, public school nurse, the Department of Family and Children’s Services, law enforcement, community mental health center, or through an established child advocacy center and the provider is able to use technology and peripherals (e.g., stethoscopes, otoscopes) that are equal or superior to an in-person exam; or • The provider is able to examine the patient using peripherals that are equal or superior to an in-person exam by a provider within that provider’s standard of care. Certain payer laws also restrict telemedicine. Particularly relevant to rural providers, as a condition of payment, the Georgia Medicaid Manual section related to telemedicine imposes restrictions on treatment settings (treatment at a patient’s home is not reimbursable) and generally would require the presence of a nurse or other health care professional to assist with utilization of peripherals. Despite the limitations on telemedicine in Georgia, there are strategies within these limitations that could benefit Georgia’s hospitals. In addition, there is opportunity for additional legislative or rule changes to expand telemedicine. Increase Patient Outreach and Prevent Unnecessary Emergency Room Visits and Readmissions Two contributors to the rural health crisis are 1) uninsured patients’ use of the emergency room as a primary point of care and 2) failure to reach patients with preventive care in order to manage conditions and prevent unnecessary hospital visits. Larger telemedicine networks for rural patients could provide increased revenue for hospitals as well as limit unnecessary emergency visits that are financially detrimental to smaller hospitals. Most patients who use an emergency room as their only point of care will do so repeatedly: Studies have found that between 1 percent and 5 percent of the population account for 12 percent to 18 percent of annual emergency department (ED) visits.1 Due to requirements of the Emergency Medical Treatment and Labor Act (EMTALA), a federal law that requires anyone coming to an ED to be treated regardless of ability to pay, each visit by the same patient, even in non-urgent situations, can ultimately cost the hospital significantly. Telemedicine offers hospitals a chance to identify patients who may overuse the ED due to lack of insurance or health care knowledge or as a result of an unmanaged chronic condition. The technology could help hospitals manage

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these patients’ conditions in a more cost-efficient and proactive way rather than waiting for them to return repeatedly to the ED. A program like this would involve the development of various applications or outside contracting that would allow physicians and hospitals to communicate with patients in their homes, at children’s schools, or at local, accessible points of care for patients in order to better manage chronic conditions and to provide ongoing preventive care. In addition, it is not always clear that such care would be reimbursed for uninsured patients, but the cost of a telehealth visit is significantly less than the cost of an emergency room visit, which can result in significant cost savings over time. Likewise, telemedicine is an important tool in reducing hospital readmissions. Recent data demonstrates that approximately 77 percent of rural hospitals faced penalties related to readmissions in 2015.2 The provision of better care management, preventive care and medication management can play a huge role in reducing readmissions. For many patients, complicated discharge instructions and medication schedules can make managing post-discharge very difficult. With remote monitoring via telemedicine, hospitals and physicians can manage patients’ adherence to their care and medication instructions as well as provide ongoing preventive care to catch changes in a patient’s condition before another trip to the hospital is indicated. As previously mentioned, this requires development of an application or contracting with a telemedicine company as well as patient education on the use of telemedicine. In some cases, this would involve changes to certain regulations or rules. However, with the high cost of patient readmissions, the cost saving opportunities are significant, as is the benefit to the patient. Partly as a result of flawed reimbursement systems, the American health care system has long lagged in its handling of preventive care. For example, the above strategies will likely require upfront, nonreimbursable costs for hospitals, which can be a deterrent to enacting comprehensive preventive care strategies through telemedicine. However, the preventive and maintenance care opportunities that telemedicine offers may result in significant cost savings and additional revenue for hospitals in the long run. Increase Patient Access to Specialty Care Telemedicine is also valuable to rural hospitals in its ability to increase access to specialty care and to create new partnerships between rural hospitals and larger regional referral centers. Physician recruitment to rural areas is becoming more difficult as the financial realities of specialty care practice in a rural area become more apparent. This results in a dearth of specialists in most rural areas and a concentration of specialists in urban centers. Many rural areas in Georgia are an hour or more from some specialty care. Telemedicine partnerships with larger referral centers can bring certain absent specialty care into rural hospitals and closer to patients’ homes. An example of this kind of partnership that can save lives in the short term is telestroke monitoring. A patient suffering a stroke has less than an hour to receive emergency care in order to minimize debilitating damage or death. For patients who live an hour or more away from a hospital with the capability and expertise to handle strokes, this distance can be fatal. Telestroke monitoring can bring this specialty stroke care into rural hospitals, allowing patients to be stabilized with proper care and administration of tPA (tissue plasminogen activator) as directed by a remote specialist before being transferred for further care.

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In non-emergent situations, telemedicine can also be used for specialized disease monitoring in rural hospitals. For example, patients who struggle to find a reliable means of transportation may find it difficult to visit their physicians as needed. Telemedicine offers an opportunity for local hospitals or physician clinics to work with distant specialists to bring that care to patients, ensuring that the patient receives care in a regular and timely fashion. This not only helps the patient, but also provides an opportunity for hospital revenue and prevents hospital readmissions and costly emergency visits. Decrease Hospital Physician Costs While having a physician on-site at a hospital is the gold standard in care, and is required for certain reimbursement policies, it is not feasible for all hospitals in Georgia to have adequate on-site physician coverage at all times. In some states, the answer to this problem has been “telehospitalists” or other telemedicine coverage of hospital patients. Rather than compensating physician employees or independent contractors on a 24/7 basis, it can be cost effective to utilize telemedicine physician coverage for monitoring of inpatients in conjunction with on-site advanced practitioners. Similar strategies can be used to fill gaps in emergency room staffing as needed. Regulatory considerations, such as hospital staffing and on-call physician requirements in the hospital licensure rules at DCH Rule 111-8-40, as well as patient care considerations, should primarily guide a hospital’s decision to use telemedicine physician staffing. Nevertheless, for some hospitals in Georgia this may be a safe and cost effective way to provide needed care when physician shortages or costs threaten the care that can be provided. Telemedicine Strategies to Increase Hospitals’ Reach Telemedicine also can be a valuable strategy to retain patients and increase reach. For most hospitals, patient admissions that are not from the ED come from provider referrals. While hospitals continue to build their brick-and-mortar primary care clinic networks throughout the state, studies show that younger patient populations tend not to have a single primary care physician, but rather prefer the convenience of urgent care centers or telemedicine visits via an app on their computer or tablet.3 Telemedicine offers an opportunity to reach these young health care consumers. In addition, a large telemedicine primary care reach can make patients of any age aware of particular health care providers. This opportunity is important not only to increase primary care revenue, but also as a more forwardlooking strategy to capture patients who may need high-margin specialty care in the future. Challenges and Considerations in Implementation of Networks This article is not intended to provide an implementation strategy for telemedicine in hospitals. Each community and hospital is different and will have unique needs and considerations that drive implementation of a telemedicine strategy. Organizations like the Georgia Partnership for Telehealth are making huge steps forward in bringing telemedicine to Georgia and in partnering with hospitals, schools, and clinics to bring telemedicine into rural areas. Nevertheless, there is still significant progress to be made in Georgia’s health care community. However, telemedicine strategies can be a costly upfront endeavor that will require the buy-in and assistance from communities and larger hospital systems as well as close attention to the rules and regulations surrounding use of telemedicine.

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In addition, as noted above, certain rules and regulations in Georgia may prevent full adoption of some telemedicine strategies. In this respect, additional work with the Georgia legislature and Composite Medical Board may be indicated in the future, requiring a more comprehensive strategy among providers across the state. Despite these challenges, across the country and world, it is becoming clear that telemedicine can be used to reach populations who may otherwise lack care while decreasing costs for hospitals and physicians and bringing in new revenue. Moving forward, and in order to keep up with population health requirements, value-based care requirements, and rising health care costs among a myriad of other issues, it is clear that hospitals and communities must move towards integration of telehealth into their care strategies to remain viable players in the changing health care industry. For additional questions, please feel free to contact Elliott Coward at ecoward@mmmlaw.com or the Morris, Manning, and Martin Healthcare Group. Sources: 1 Doupe et. al., “Frequent Users of Emergency Departments: Developing standard definitions and defining prominent risk factors,” Ann Emerg. Med. July 2012. 2 Boccuti, et. al., “Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program,” Kaiser Family Foundation, published online March 10, 2017. 3 See, e.g., http://www.beckershospitalreview.com/hospital-physician-relationships/more-than-50-of-millennials-weigh-conveniencecost-against-traditional-primary-care.html; http://www.ibtimes.com/healthcare-2015-why-millennials-avoid-seeing-doctors-whatmeans-rising-healthcare-2065473

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Feature

Physician Profile: Rural Family Doctor Why incentives weren’t needed to bring this physician back to his rural hometown By Erin Stewart The physician shortage crisis facing the United States, especially in rural areas, is a problem several stakeholders have been working to address for several years. According to the National Rural Health Association, the ratio of patient-to-primary care physicians is approximately 39.8 out of 100,000 people, compared to 53.5 per 100,000 in urban areas. As one might expect, the lower ratio in the rural areas has an adverse effect on the health of residents, including increased rates of diabetes and coronary heart disease as well as decreased access to mental health services. In Georgia, according to the Area Health Education Centers of Augusta University, compared with the national average, the supply of primary care physicians is lower, at 31 physicians per 100,000 population. Sobering statistics like these emphasize the need to produce more “homegrown” physician programs, which work to attract doctors to the rural communities in which they were raised and educated. Medical schools all over the country have established incentives and efforts to attract medical students back to their hometowns to practice. According to Augusta University, the implementation of dedicated rural admissions tracks have helped increase graduates in rural medicine. The programs recruit students from rural and underserved areas in order to return those students back to those areas. Efforts to recruit physicians to rural areas are not limited to medical schools. The Georgia Board for Physician Workforce offers a Rural Physicians Tax Credit, which allows physicians practicing in designated rural areas to receive a tax credit of $5,000 each year for five years. To some, special programs and tax credits may seem like the only enticements that would attract physicians to small towns. However, there are physicians, like Dr. Blake Milner of Eastman, who happily choose specifically to practice in these areas. Dr. Milner did not need an incentive to want to return to Eastman after graduating from the Medical College of Georgia in Augusta and completing his residency in Greenwood, S.C. “I love the way I grew up. I love a small town,” he says. “I knew I wanted to come back to my hometown, a rural area, and be a family doctor.”

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Dr. Milner has practiced family medicine in Eastman since 2003. Up until a few years ago, he practiced inpatient as well as outpatient care, admitting patients to the hospital himself, checking on them at the hospital and then going back to his practice and see patients there. “The hospital was kind of an extension of the office and vice versa,” he says. Now, with the growth of hospitalists (physicians whose focus is the care of hospitalized patients), Dr. Milner works primarily with outpatients out of his office. Although he works mostly out of his private practice, he also provides outpatient services at the local hospital, Dodge County Hospital. He works with the hospitalists, doing day and night coverage as needed. While Dr. Milner appreciates and values his work with the hospitalists and the care they provide, he sentimentally remembers the close natural connections that would occur with his patients previously, when he practiced both inpatient and outpatient care. “It’s different now than it was a few years ago,” he says. “I kind of miss those days; I miss doing both the inpatient and outpatient care. I think sometimes something is lost in the patient/physician relationship when there is that disconnect.” The disconnect Dr. Milner refers to is what he feels is an effect of the current system, where hospitalists are the ones who care for patients in the hospital and answer their questions, not Dr. Milner. He recalls that when he was the admitting physician, patients would call him with questions and he could better keep track of their progress, and “that creates a bond,” he says. “Now, loyalty to physicians isn’t as strong as it used to be because we don’t see patients through it all anymore.” But the fading connections and waning loyalty Dr. Milner sees gives him even more reason to practice in a small town. In Eastman, he has a chance to create relationships and bonds that might not happen in a larger city. Because so many community residents know Dr. Milner like family, they are sometimes more willing to be open about their lifestyle and health issues they may be experiencing. If they don’t, “their family will let you know about things going on with them,” says Dr. Milner with a chuckle. “Or you see them out and about in the community and can see their habits and their social history. It’s definitely an advantage in terms of bedside manner.” With the rural physician shortage, Dr. Milner is hopeful and believes there is a strong possibility that other primary care doctors will come to practice in the community, but that they will probably expect hospitalists to handle inpatient work while they handle the outpatient side of things. “It’s just the way the health care landscape has changed over the last few years,” he says. “I think the standard of being both the inpatient and outpatient doctor is behind us, at least for a while.” No matter the changes, Dr. Milner still gets to experience his favorite part of being a doctor, which is interaction with patients. He loves seeing patients that he has treated get better. ”Even if it doesn’t work out that way, you are still there, as part of that extended family to console or encourage or pray with the family or the patient. And it’s those kinds of things that really make it worth what you’re doing.”

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GHA Now

2017 Legislative Summary By Anna Adams The Georgia Hospital Association is proud to represent the diverse interests of our membership as we navigate the many challenges of the legislative session. As we prepared for the tumultuous 40 days, we knew of many of our overarching goals—ensure the renewal of the Hospital Provider Payment Program/Medicaid Financing Program; protect the ability of our hospitals to serve ALL patients; and advocate for adequate reimbursement for hospitals. I am pleased to say that Georgia’s hospitals were successful in the legislative arena this past Session because we continue to focus on the needs of our patients and communities. As an industry, we continue to face fierce and unrelenting trials. Challenges on both the state and federal levels remain as we strive to find a viable solution for our uninsured and underinsured patients. Efforts to repeal or reform the state’s health planning process, Certificate of Need, will continue and intensify. The issue of balance billing, ensuring that providers are adequately reimbursed while considering patient financial burdens, will return again next Session. And legislative initiatives will seek to enhance our ability to battle the opioid epidemic and other public health concerns, but will also place further demands on our limited resources. Yet only with your help can we realize success. I call on each of you to remain fully engaged hospital leaders. You can and do make a difference. Your personal relationships with your elected officials, welcoming them into your hospital so that they will be keenly aware of the good that you do for your community, is the key to your hospital’s viability. When determining policies that affect our health care industry, it is important for your legislator to keep in mind, “This is about MY hospital.” Heading into the 2018 Legislative Session, we must remember to remain unified as an industry, working collectively where we can to support our agenda, yet focusing our individual efforts on establishing and furthering relationships with our elected officials. It is only through such determination that our hospitals will remain successful.

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Summary of GHA Legislative Activities The Georgia General Assembly adjourned the 2017 Legislative Session Sine Die on Thursday, March 30, 2017, completing the first of the two-year biennium. The 40-day period saw the usual volume of legislation, with nearly 2,400 bills and resolutions introduced, along with countless amendments and substitutions, as elected officials focused their attention on the state’s budget and some challenging issues such as casino gambling, campus gun restrictions, medical marijuana and adoption reform. Below are some of the more high-profile healthcare-related legislative issues that were addressed during Session: Hospital Provider Payment Program and Hospital Medicaid Financing Program Senate Bill 70 – authored by Sen. Butch Miller (R-Gainesville), renews the Hospital Medicaid Financing Program Act and reauthorizes DCH to assess one or more provider payments on hospitals for the purpose of obtaining federal financial participation for Medicaid and to draw down available federal Medicaid funds for supplemental payments to hospitals. The bill allows DCH to continue the Hospital Provider Payment Program (HPPP) and the Hospital Medicaid Financing Program (HMFP) until June 30, 2020. The bill includes triggers to end the program if the federal matching funds end or if Medicaid rates are reduced. Gov. Deal signed the renewal into law on Feb. 13, 2017. Certificate of Need As you will recall, both the special category of CON (“Destination Cancer Hospital”) established specifically for Cancer Treatment Centers of America and the current CON exemption for physicianowned, single-specialty ambulatory surgery centers (ASCs) were included as part of SB 433, a comprehensive CON reform bill passed in 2008 as the result of intense, multi-year negotiations between all stakeholders. GHA continues to advocate for no changes to the state’s important healthplanning process. Marking the most active Session in the past 10 years with regard to efforts to repeal CON laws, the 2017 Session witnessed six pieces of legislation introduced to erode the state health-planning process: House Bill 299 – authored by House Judiciary Chairman Wendell Willard (R-Sandy Springs) would allow for a CON exemption for certain expenditures by a health care facility, purchases of medical equipment, and freestanding emergency departments. The legislation would further allow additional expansion of licensed beds when a facility can show two consecutive years at greater than 60 percent capacity. House Bill 464 – also authored by Chairman Willard, would remove the bed limit and out-of-state patient thresholds for Cancer Treatment Centers of America. As background, CTCA agreed in 2008 to certain requirements in exchange for the special “Destination Cancer Hospital” designation. Among those items were a 50-bed maximum and an annual patient base composed of a minimum of 65 percent of patients who reside outside of Georgia. Unsurprisingly, CTCA has for the past few years attempted to rescind that agreement, as it disingenuously claims to want to treat all cancer patients. (Hospitals will recall that, during the 2016 Session, Rep. Willard authored HB 1055, which called for a total eradication of the CON program in the state. That legislation would have created turmoil in Georgia’s health care system, allowing health care organizations the opportunity to “cherry pick” the most profitable patients with the best insurance.) Both HB 299 and HB 464 received a hearing in the General Government Subcommittee of the

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House Governmental Affairs Committee. GHA and many individual hospital members testified in opposition to those bills, which were tabled by the subcommittee. Each bill was recommitted to its committee of origin. Senate Bill 123 - introduced by Sen. Hunter Hill (R-Atlanta), would allow CTCA to circumvent those statutory requirements that it agreed to in 2008 and would seek to eliminate the limitation on the number of Destination Cancer Hospitals that can be issued a CON. This bill was assigned to the Senate Health and Human Services Committee but did not receive a hearing. It was then recommitted to the Senate HHS Committee. Senate Bill 157 – introduced by Sen. Ben Watson (R-Savannah) would allow for a CON exemption for single-specialty and multi-specialty ASCs not located in a rural restriction area, which is defined as a county served by a single hospital with no more than 100 inpatient beds. Senate Bill 158 – also introduced by Sen. Watson, would allow for CON exemptions for freestanding emergency departments, as well as for expenditures by a health care facility and certain multispecialty ASCs not located in rural restriction areas. Both of Sen. Watson’s CON bills were assigned to the Senate Health and Human Services Committee and did not receive a hearing. House Bill 517 – introduced by Rep. Tom Taylor (R-Dunwoody), would require diagnostic imaging equipment to be registered with DCH, which will manage the registration and periodic renewal of registration of such equipment. While not obvious as a CON bill, conversations regarding a similar bill from 2016 centered on amendments to the CON process for radiology equipment. The bill was recommitted to the House Health and Human Services Committee. GHA opposed that legislation and will watch for a substitute bill to be brought forth in 2018 that impacts CON. Surprise Billing The most common type of surprise bill occurs when a patient receives services in an in-network hospital, ambulatory surgery center or other health care facility from an out-of-network physician. Since the physician doesn’t have a contract with the insurer, the insurer pays the physician an amount less than what is billed and the physician sends the patient a bill for the outstanding balance. Senate Bill 8 – authored by Sen. Renee Unterman (R-Buford), prohibits physicians from balance billing for emergency services when the health plan pays the physician the greater of (1) the median network rate paid by the health care plan; (2) the rate of the health care plan in its standard formula for out-of-network reimbursement; or (3) the Medicare fee for service reimbursement rate. SB 8 also provides for disclosure requirements by hospitals, physicians and health insurers to help patients determine whether a provider participates in a particular health care plan. This bill was recommitted to the House Insurance Committee for the next Session.

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House Bill 71 – authored by Rep. Richard Smith (R-Columbus), mandates that hospitals ensure that all health care providers on a hospital’s medical staff participate in the same health benefit plan networks as the hospital. Requiring every physician on a hospital’s medical staff to participate in all the same health plan networks as the hospital before the physician is allowed to work in the hospital will create significant access to care issues for patients. This bill was recommitted to the House Insurance Committee for the next Session. Rural Hospitals During the 2016 Session, the General Assembly passed SB 258, which established the Rural Hospital Tax Credit. That legislation allowed businesses and individuals to receive tax credits of 70 percent for direct contributions to eligible rural hospitals. GHA worked from the onset of the 2017 Session to increase the tax credit amount to 90 percent. Three bills were introduced by legislators to effect such improvements: House Bill 54 – authored by Rep. Geoff Duncan (R-Cumming), would alter the 2016 Rural Hospital Tax Credit by increasing the tax credit percentage from 70 percent for individuals and corporations to 90 percent. The legislation also would have standardized the aggregate amount of tax credits allowed from 2017 through 2019 to $60 million per year. An amendment was added to the legislation during the committee process that would ensure individual donors continue to receive the tax credit benefit from the Department of Revenue even if there are certain reporting errors. This bill did not receive final passage. Senate Bill 180 – authored by Sen. Dean Burke (R - Bainbridge), raises the donation credit percentage from 70 percent to 90 percent and, beginning in tax year 2018, increases the population threshold for rural areas from 35,000 to 50,000 individuals in Georgia’s Rural Hospital Tax Credit program. The legislation also limits companies from charging more than 3 percent of revenue when assisting hospitals with their Rural Hospital Tax Credit program. Individual taxpayers are now allowed a tax credit equal to 90 percent of their contribution up to a maximum of $5,000 as a single filer, or $10,000 for couples filing jointly. Corporations are also eligible for a tax credit up to 90 percent of their contribution or 75 percent of the corporation’s income tax liability, whichever is less. The legislation altered the limits of the amount of tax credits for all rural hospital organization to $60 million in each tax year from 2017 through 2019. Individual rural hospital organizations are still limited to $4 million annually. This bill received final passage and was signed into law by Gov. Deal. Senate Bill 14 – also authored by Sen. Burke, establishes a grant mechanism for “rural hospital organizations,” which authorizes the State to make grants, as funds are available, to hospital authorities and rural hospital organizations for public health purposes. The General Assembly will consider appropriating available funds for the grant program in a future budget year.

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The Georgia Opioid Crisis In response to the opioid epidemic that is sweeping our nation, Georgia legislators worked this year to pass several pieces of legislation that would help address this serious issue within our state. What resulted was the passage of several bills that each take a different approach to solving this problem. Under new state laws, responsibility for addressing opioid prescriptions and abuse will be spread between physicians, nurses, pharmacists, patients and patient families to ensure that support for addiction is readily available and accessible. The following three bills were all signed into law by Gov. Deal. Senate Bill 121 – The “Jeffrey Dallas Gay, Jr. Act,” authored by Sen. Butch Miller (R-Gainesville), authorizes the State Health Officer to issue a statewide standing order prescribing an opioid antagonist, such as naloxone, to be made available in retail pharmacy locations and dispensed by licensed pharmacists over-the-counter. Gov. Deal signed this bill into law on April 18, 2017. The availability of this life-saving drug ensures that families of addiction patients have access to naloxone in the event of an overdose. To date, this drug has already saved hundreds of lives in Georgia. Senate Bill 88 – authored by Sen. Jeff Mullis (R-Chickamauga), addresses the large number of methadone clinics located in Georgia, some of which were suspected of doing more harm to addiction patients than good. New requirements are outlined dealing with these treatment programs in the areas of quality, services, licensure, records, and rules and regulations. The hope is that those facilities that are operating without acceptable standards of care will be eliminated, and patients seeking addiction treatment will have better results and a lower chance of relapse and overdose after completion. House Bill 249 – authored by Rep. Kevin Tanner (R-Dawsonville), addresses opioid abuse from many different aspects. The most comprehensive opioid bill to appear this session, it calls for increased responsibility among providers and places certain restrictions when prescribing opioids and benzodiazepines. The bill also requires all prescribers to register with the state’s prescription drug monitoring program (PDMP) and, when prescribing for longer than three days, begin checking and reporting certain prescriptions by July 1, 2018. Additionally, each prescription written for opioids and benzodiazepines must be checked and updated every 90 days by prescribers before a refill can be written and administered. Physicians and pharmacists will be required to educate patients on the dangers and addictive nature of these drugs so that patients can make an informed choice and reduce their risk of addiction and overdose. 2017 Study Committees, Councils and Task Forces GHA will participate in several health care-related study committees, councils and task forces that were passed and appointed by the General Assembly during the 2017 Legislative Session. The study committees will address several topics, including health care reform, access to adequate health care, rural health care, and stroke trauma centers. To see the full version of the 2017 GHA Legislative Summary, click here. (Login required)

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GHA Now

2017 Hospital Heroes By Erin Stewart

Lifetime Achievement Winner Douglas C. Morris, M.D. Professor of Medicine, Emory University School of Medicine Emory Healthcare Douglas C. Morris, M.D., began practicing at Emory Healthcare in 1973 and joined the Emory cardiology faculty in 1975. Since his time at the health system, he has seen great strides in the treatment of heart disease. Back when he began practicing, it was unknown whether clots in a coronary artery caused a heart attack or were a consequence of it. Once a heart attack started, doctors were unable to stop it; rather, they could only deal with complications as they arose. That all changed in 1977, when balloon angioplasty – a procedure that involves inserting a catheter into a patient’s obstructed coronary artery and inflating a tiny balloon to restore blood flow to the heart - was invented. Dr. Morris traveled with his Emory cardiologist colleagues to Zurich, Switzerland, to learn the technique firsthand from famed cardiologist Andreas Gruentzig, M.D., whom Dr. Morris and his colleagues eventually helped recruit to Emory. They were then able to perform and advance the lifesaving angioplasty procedure. Physicians all over the world came to Emory to learn the technique, and Dr. Morris was the driving force behind sharing the wealth of knowledge with others. Dr. Morris is known for being a gracious and kind leader as well as a passionate physician advocate. He is well-loved by patients because he not only cares about their health, but he also cares about his patients as individuals. With more than 40 years of service at Emory Healthcare, Dr. Morris is currently grooming and preparing Emory physician leaders of the future by overseeing the Emory Medicine Professional Leadership Enrichment and Development Program. The program focuses on augmenting leadership skills, enhancing business knowledge and promoting collaborative effort across the enterprise.

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Physician Hero Randy Smith, M.D. Plastic Surgeon, Board Chairman Emeritus University Health Care System As one of Augusta’s most esteemed plastic surgeons, University Health Care System Board Chairman Emeritus Dr. Randolph Smith, M.D., is an athlete, veteran and community leader. In an age when plastic surgery is often associated with elective procedures, Dr. Smith has traveled the world using his time, talent and personal resources to restore hope and ease the pain of those disfigured from birth defects, fires and war injuries. He has volunteered in China, South Korea, Palestine, Nigeria, Chile, Venezuela, Poland, Honduras and El Salvador – a total of 36 trips through last year. Mothers would bundle their children and camp outside the makeshift clinic waiting for the “American surgeon.” Dr. Smith has made a dramatic difference in the lives of thousands of families, working with limited water, no laboratory and rudimentary instruments. There are countless examples of lives changed by Dr. Smith. Boarding his plane after a visit to Poland, a woman who had been maimed during a double mastectomy ran after him, begging him to help alleviate her painful scarring. He delayed his departure to counsel her and plan her future surgery. In the spring of 2016, he traveled to Palestine for the ninth time and performed surgery on children with burns and congenital deformities at the Ramallah Medical Complex. Dr. Smith is a natural leader, holding many leadership positions in the community as well as serving as chair of the department of plastic surgery and as president of the medical staff of University Health Care System. He served on University’s boards from 1992-2014, and chaired the system board, University Health Inc., from 2001-2014, after which he was named Chair Emeritus. With Dr. Smith as board chair, University expanded to Columbia, Aiken and McDuffie Counties, restructured its retirement and investments and formed an insurance captive – strategic ventures setting University up for growth and financial success.

Sheryl Adams, RN Registered Nurse The Medical Center, Navicent Health In her role as a clinical nurse lead for renal unit of The Medical Center, Navicent Health, Sheryl Adams is an experienced clinician who is known by colleagues for her skills in working with challenging patients and families. She does so with the utmost kindness and respect and is very intuitive, identifying and preventing issues before they occur. One of those challenging patients was proving to be difficult for many staff members, but Adams stepped in to offer the best care she could. The patient was an elderly man with a developmental disability, who could be very stubborn and trying at times. He would frequently skip his dialysis treatments, which led to frequent hospitalizations on Adams’ unit. She dedicated her time to

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becoming more than a nurse, but also a friend to him. She went out of her way to make him feel special, frequently bringing him small gifts to brighten his day and even coming in on her off days to keep him company. For Adams, caring for this patient was not just about treating his illness; it was also about holistically treating his emotional well-being. Community residents, not just patients, also frequently benefit from Adams’ generosity. One day, when she saw an elderly man walking unsteadily on the side of the road, she pulled over, gently began a conversation, and learned he had no family. Over the next few weeks, she “adopted” this man, grocery shopping with him, driving him to medical appointments, and inviting him to family dinners. Her involvement helped him enjoy many more months in the community before home care was necessary.

Ann Boriskie Director, Brain Injury Peer Visitor Association Shepherd Center Nearly 20 years ago, a car accident left Ann Boriskie with a serious brain injury. With limited resources and no one to guide her through the traumatic experience, the recovery was long and painful. Not wanting others to be without support, she vowed that when she got better she would help others going through the same ordeal. In 2006, Boriskie joined Shepherd Center as a volunteer peer visitor and, three years later, had logged an impressive 4,000 volunteer hours. Around this same time, she created the Brain Injury Peer Visitor Association, which is modeled after the American Stroke Association’s Peer Program for stroke patients and their families. Her volunteers began visiting brain-injured patients at Shepherd Center in 2009. At Shepherd Center alone, Boriskie’s team visits patients, families and caregivers on five different days each week. All team members have either recovered from brain injuries themselves or are family or caregivers of a brain injury survivor. The volunteers lend a supportive ear to patients and their family members while modeling how it is possible to thrive after sustaining a serious brain injury. Volunteers also distribute packets of information about brain injuries that Boriskie developed after struggling to find information about her own injury. Today, the Brain Injury Peer Visitor Association has 150 trained volunteers who conduct peer visits in 41 hospitals and rehabilitation facilities in the Atlanta metropolitan area and throughout Georgia — as well as in Florida and Wisconsin. As of December 2016, approximately 40,000 peer visits have been completed and more than 41,000 volunteer hours have been donated, with Boriskie personally donating more than 10,000 hours.

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DeAnn Flanders, RN, CIC Director of Quality Management Bacon County Hospital and Health System As the director of quality management at Bacon County Hospital and Health System, DeAnn Flanders is a champion for high-quality standards and patient safety at the hospital. Beginning work at the hospital in 1990 as a registered nurse, her passion for patient care was evident early on. Her advanced education in nursing and experience as an RN, in addition to her excellent leadership, make her an expert in the delivery of culturally sensitive care to patients and families. Under her leadership, the hospital has received numerous safety awards and recognitions, including The Joint Commission Golden Key Award, which recognizes accredited hospitals on accountability measure performance. Flanders recently completed training for TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), an evidence-based framework to optimize team performance in the health care delivery system. Flanders has passed her knowledge on to numerous hospital employees, teaching TeamSTEPPS classes to more than 300 employees since 2015; many hospital departments now have their own TeamSTEPPS projects in the works. Perhaps the most exciting result of Flanders’ training was being asked to share the hospital’s TeamSTEPPS success story at a quality meeting of the American Hospital Association in front of her national peers. Flanders is just as passionate about the health of the community. In 2004, she implemented “The Biggest Loser” contest at the hospital and in the community. Continuing today, the contest promotes employee wellness, friendly competition, encouragement and teamwork throughout the organization and community. Flanders even further assists community members in their fitness goals by teaching aerobics classes at her church, which she has done for the past 20 years.

Rev. Dr. W. Jeffrey Flowers Director of Pastoral Care Augusta University Health As the director of pastoral care at AU Health in Augusta for more than 20 years, Chaplain William “Jeff” Flowers works to counsel patients and families as they navigate the difficult waters of health care. His dedication to his work has positively affected patients, families and communities. Early in his career, he worked to staff the hospital with a team of chaplains who shared his same values and were capable of doing meaningful ministry, as well as support other important health care disciplines. Under his leadership, the Pastoral Care department has flourished and the chaplains have provided extraordinary spiritual care to patients and families. In addition to standard counseling, Chaplain Flowers and his team have helped patients in countless other ways. They have taken the lead with advance directives and end-of-life decisions with the hospital’s patient population. The department actively participates on the ethics committee, and Chaplain Flowers has been instrumental in educating many medical students in the areas of ethics, faith and medicine and spirituality. He is the point person for families participating in the Living

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Donor program. His careful, compassionate presence assist families in making the best decisions at critical times. Chaplain Flowers has created partnership with the Legal Department, Patient Access Services, Pathology and others that have helped to relieve difficult situations related to unclaimed bodies after a death, or simply to give an ear and a heart to a family going through a tough time. Chaplain Flowers has successfully chaired and co-chaired the annual Employee Giving Campaign for the past two years, generating maximum giving and participation among hospital employees. He constantly creates for his staff opportunity for training, education and support. He works with his staff to provide monthly support groups, quarterly and annual memorial services, an annual clergy conference, and weekly meetings that recharge his staff and prepares them to be effective in ministry.

Leslie Fordham, DVM Member, Board of Directors St. Mary’s Sacred Heart Hospital As a volunteer board member for St. Mary’s Sacred Heart Hospital, Leslie Fordham, DVM, is a vital part of the hospital’s efforts to improve quality and perception of care at the hospital. But it is her work with the Outdoor Dream Foundation (ODF) that is especially beneficial to the community. ODF offers pediatric patients with severe or terminal illnesses an opportunity to go hunting or fishing, often far from home, at no charge. The experiences give the patients time away from thinking about their medical ailments and allows them a much-needed escape. Fordham, a fifth-generation farmer and experienced hunter, began her involvement with ODF when she assisted terminally ill children whose dreams were to go deer hunting in Wyoming. As part of ODF’s team of volunteers, she has taken children who have terminal cancer, heart transplant rejection, Duchenne’s muscular dystrophy, brain tumors, and other life-limiting conditions into the woods for the simple pleasure of hunting. For the children and teens, hunting is a special way of being outside. It is active, requires focus, and allows a time to be outside in nature and offers a release from daily medical troubles. As a champion for children in their most vulnerable times, Fordham’s work has greatly benefited St. Mary’s Sacred Heart Hospital and the entire community.

Michelle Hollaway, RN, BSN, CCRN Critical Care Nurse Southeast Georgia Health System – Brunswick Campus When Hurricane Matthew traveled toward the Georgia coast in October 2016, communities and hospitals raced to evacuate before the storm hit. Hospitals like Southeast Georgia Health System – Brunswick Campus had to work to evacuate as many as 200 admitted patients to hospitals out of the path of the

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storm. All patients at the health system had been moved safely, save for one surgical patient who remained in critical condition. Doctors worked to find a facility that could accept the patient, but, because of the impending storm, air transport was not an option and ground transport squads were largely unavailable. Despite these obstacles, it was determined that the patient definitely needed to be moved because of the severity of the storm. Luckily, Navicent Health, a Level I Trauma Center in Macon about 200 miles away, agreed to accept the patient. An EMS squad from Macon would travel to Brunswick to transport the patient, but given how unstable the patient was, a critical care nurse needed to travel with them. Critical Care Nurse Michelle Hollaway, RN, BSN, CCRN immediately volunteered. The ambulance would not return to Brunswick, so, knowing she would need her own transportation back, Hollaway handed her car keys to a fellow nurse colleague, Mary Quigley, and asked her to follow them in her car. Hollaway helped load the patient on a stretcher with pumps, blood and fluids and the journey began. Throughout the trip, Hollaway stayed in contact with the patient’s doctor, providing continuous updates. After arriving in Macon and handing the patient off to the trauma team, Hollaway and Quigley braved the storm on the long drive back to Brunswick. Nearly 12 hours after their day began, they arrived safely back in the area at the height of the storm.

Gary Rice Emergency Preparedness Coordinator Phoebe Putney Memorial Hospital Earlier this year, two natural disasters tore through Dougherty County and the Southwest Georgia community in the span of 20 days. With the heroic efforts of Phoebe Putney Memorial Hospital Emergency Prepared Coordinator Gary Rice, the hospital was successfully able to help the community with its extensive recovery efforts. Rice’s work on behalf of the hospital was so extraordinary that the local government took notice and decided to enlist him for their own disaster response. While performing his regular duties at the hospital, he also managed the county’s recovery efforts as a special consultant. Thanks to his dedication, the area received much-needed assistance from the state government. During each crisis, Rice ensured that hospital operations continued to run smoothly so patients could continue to receive essential care. Throughout the day and night, he ensured the safety of patients and staff through constant communication to everyone involved with the relief efforts. Even in the midst of chaos, Rice made sure he was available to perform new tasks or change assignments as needed. Working on little to no sleep, his positive attitude never changed and his dedication to helping the community never wavered. After his workday was over, he did not stop relief efforts, continuing to help his fellow co-workers by delivering firewood to those without power and assisting in their clean-up efforts.

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Lisa Robinson, RN, MSN Nurse Educator Tanner Health System Over the years, Tanner Health System’s Lisa Robinson has served in many nursing roles, from the emergency department to the medical-surgical unit to her current position as a nurse educator where she trains nursing students and staff. She is well-respected by numerous colleagues around the hospital for the care she provides, but it is her work delivering meals to those in need that is especially noteworthy. A few years ago, she and her husband, a paramedic with West Georgia Ambulance, started a community service project to deliver hot meals to people in need on Thanksgiving. The first year, the Robinsons covered much of the expense themselves, but over the years, the program has grown tremendously, with more volunteers, donations and churches offering their kitchens to prepare the food. West Georgia Ambulance and Air Evac started donating money to buy all the meat and cook it. Tanner Health System began donating paper products, to-go containers, serving utensils and packaged silverware. It has grown from serving about 40 people in 2013 to 500 people in 2016. Robinson also volunteers with the Community Christian Council in Haralson County, which helps feed needy families through a food bank, meals served on-site twice a week and a Christmas dinner. On Christmas 2016, they fed 800 people on-site and delivered 800 meals throughout the community. Thanks to the help of so many community members, Robinson and her husband are able to provide hot meals to people in difficult situations and help brighten their holiday season. One year they learned of a 16-year-old boy who had been in an accident and was living with his grandmother and two siblings in a small motel room. Realizing there were others in motels that could benefit from their services, they decided that year to target motels and extended-stay facilities, serving more than 200 plates thanks to even more volunteers and donations.

This year’s Hospital Heroes will be honored at a special awards luncheon in Atlanta in November. Is there someone you would call a Hospital Hero at your organization? Nominate him or her for the 2018 Hospital Heroes Award.

When to nominate? Nominations accepted from January 1 - February 26.

How to nominate? Visit www.gha.org/HospitalHeroes and click on the nomination form. For more information about the Hospital Hero awards and other GHA awards contact Erin Stewart at estewart@gha.org or (770) 249-4513.

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GHA Now

WellStar CEO and Grady Health System CEO Elected to AHA Board of Trustess By Erin Stewart WellStar Health System President and Chief Executive Officer (CEO) Candice Saunders, FACHE, and Grady Health System President and CEO John Haupert, FACHE, have been appointed to the American Hospital Association (AHA) Board of Trustees for three-year terms beginning Jan. 1, 2018. The Board of Trustees is the highest policy-making body of the AHA and has ultimate authority for governance and management of its direction and finances. Saunders joined WellStar in 2007 after being named president of WellStar Kennestone Hospital. In March 2013, she was named the system’s president and COO and she assumed the role of president and CEO in January 2015. Under her leadership, WellStar has become the largest health system in Georgia featuring 11 hospital campuses, more than 250 medical offices and numerous outpatient facilities across the state. WellStar employs more than 20,000 people across its numerous sites. Haupert has 25 years of health care leadership experience, beginning his administrative career at Methodist Health System in Dallas, Texas in 1992. In 2006, he accepted the position of chief operating officer (COO) of Parkland Health and Hospital System in Dallas and remained there for five years before being named president and CEO of Grady Health System in 2011. Upon assuming this role, he successfully engineered a series of changes that helped strengthen the hospital’s revenue cycle management and moved the hospital to electronic medical records. As a result, Grady has seen increased profitability, is adding more community services and is renovating many areas of campus to better serve its patients. Saunders and Haupert were nominated to serve on the AHA Board by GHA President and CEO Earl Rogers. “Candice Saunders and John Haupert are examples of health care pioneers who have made great strides in advancing health care through the improvement of population health, lowering costs and enhancing the patient experience,” said Rogers. “The AHA Board and AHA members will greatly benefit from their guidance and leadership.”

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GHA Now

Georgia Hospitals Contribute $47.8 Billion to State’s Economy By Kevin Bloye While Georgia hospitals are known for being the guardians of community health for the state’s more than 10 million residents, hospitals also play a huge role in bolstering Georgia’s economic health by pumping nearly $47.8 billion into the state’s economy in 2015 according to a recently released report by the Georgia Hospital Association (GHA). The report also revealed that hospitals supplied more than 143,000 full-time jobs and indirectly created over 349,000 jobs in Georgia. “Georgia hospitals are making a positive difference in people’s lives, both at the bedside and in their communities economically,” said GHA President and CEO Earl Rogers. “In communities throughout the state, hospitals are among the largest employers and are a key component of the infrastructure necessary to attract business to those areas.” Despite their importance to the state economy, many Georgia hospitals continue to face a wide array of financial challenges that have resulted in reduced services and employee cutbacks. Since the beginning of 2013, six Georgia hospitals have closed, and others — especially those in rural areas — are struggling to keep their doors open. According to the most recent Georgia Department of Community Health Hospital Financial Survey, 42 percent of all hospitals in Georgia had negative total margins in 2015, while 68 percent of rural hospitals in the state lost money in the same year. A huge strain on hospital finances continues to be the explosive growth of uncompensated care. According to the GHA study, in 2015, Georgia hospitals absorbed more than $1.74 billion in costs for care that was delivered but not paid for. “Throughout Georgia, hospitals are the only source of medical care for most uninsured residents,” Rogers explained. “Add to that a growing number of residents who actually have insurance but cannot pay their high insurance deductibles, and hospitals end up absorbing even more losses. These dynamics are not sustainable long term.” In 2015, Georgia had the second highest percentage of uninsured residents in the country at 14 percent, according to a recent study by the Kaiser Commission on Medicaid for the Uninsured. Only Texas, with 16 percent, had a higher uninsured rate. To make matters worse, Medicaid pays Georgia hospitals, on average, only about 87 percent of actual costs, meaning hospitals lose 13 cents on every dollar spent treating a Medicaid recipient.

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“The financial pressure that Georgia hospitals face is greater than ever,” said Rogers. “Hospitals have a commitment to be there for their communities 24 hours a day, seven days a week, but for many, just remaining financially viable is a challenge. When hospitals suffer financially, access to care and services for all Georgians is at risk.” The report also shows that the presence of a hospital is a major source for jobs in any given community, both directly and indirectly. In 2015, Georgia hospitals provided 143,554 full time jobs. But when an employment multiplier is applied, it indicates that hospitals supported over 349,000 full-time jobs in the state. The employment multiplier considers the “ripple effect” of direct hospital expenditures on the economy, such as medical supplies, durable medical equipment and pharmaceuticals and several different retail establishments that depend on the hospital and its employees for business. “These are well-paying jobs close to home that not only sustain Georgia families, but also the local and state tax bases that provide vital community services,” Rogers explained. “These are the kind of jobs that are truly indispensable to our communities and state.” The hospital economic impact report also measures hospitals’ direct economic contributions to Georgia’s working families. Using a household earnings multiplier, the study determined that hospitals generate over $15.2 billion in household earnings in the state. The household earnings multiplier measures the increased economic contributions from individuals employed directly or indirectly by hospitals through daily living expenditures.

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GHA Now

GHA Subsidiary: Georgia Hospital Health Services

Learn about GHHS and how it vets organizations for GHA-member hospitals. By Mallory Garrett

Nearly 30 years ago, the Georgia Hospital Association recognized the need to help members in the area of endorsed services and vendor relations. From these extensive talks, a for-profit subsidiary of the association was born – Georgia Hospital Health Services (GHHS). GHHS serves member hospitals by partnering with, and vetting, various types of programs and services. Curently chaired by West Georgia Medical Center Chief Financial Officer Paul Perrotti, GHHS can also create a program to serve a membership need; exclusively market a program for GHA members; or endorse services and assist in creating awareness plans. All programs typically offer a discounted rate and/or additional benefits not readily available to non-member hospitals. “Through GHHS, members are offered some guidance when it comes to potential programs or services of need,” said Perrotti. “Years ago, GHA recognized yet another method of helping hospitals and created this valuable service. GHHS partners only with companies and programs that are of high quality that provide a benefit to our members and who fit within GHA’s strategic plan.” The products and programs that GHHS endorses have all gone through a rigorous due-diligence process, helping ensure that members get the best of what the industry has to offer. “Potential vendor partners’ business practices are investigated and current and prior customers are interviewed to look for any potential red flags,” said GHA Senior Vice President of Business Operations Bill Wylie. “The endorsement is finalized only after a board of hospital leaders, who serve as the GHHS Board of Directors, approve of the findings.” The GHHS Board includes Perotti, Dodge County Hospital CEO Kevin Bierschenk, Piedmont Fayette Hospital CEO Michael Burnett, Houston Healthcare CEO Cary Martin, Floyd Medical Center CFO Rick Sheerin, and Gwinnett Medical Center COO J. Thomas Shepherd. “Our goal is to find or create the best solution-based products and services that will also be the best fit for Georgia and our diverse hospital landscape,” said Wylie, who has been running GHHS for the last 14 years. “GHHS serves as one of GHA’s largest sources of non-dues revenue,” said GHA Executive Vice President Chuck Adams. “The income generated through these partnerships helps to financially support GHA in its advocacy and educational endeavors.”

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Additionally, GHHS’ coordination of GHA’s Rural Floor Budget Neutrality Appeal has returned approximately $48 million to GHA hospital members. Thanks to these partnerships, GHA is able to bring in more non-dues revenue, which has allowed the organization to keep its dues structure unchanged since 1998, despite inflation and additional programs and resources now provided.

Exclusively Marketed Programs GHA contracts with several exclusively marketed programs through GHHS, where GHHS serves as the liaison between these programs or companies and GHA-member hospitals. Healthcare Staffing Services is a GHHS vendor partner that is a partnership with the South Carolina Hospital Association (SCHA). It works to meet hospitals’ traveler contracted staffing needs while improving quality, saving time and potentially reducing costs. Currently, 10 state associations participate in the program, which allows SCHA to leverage the collective volume of more than 250 facilities into a single application. One central contract with all the approved staffing vendors in an easy-to use-tool is what makes this program so attractive. As a result of compiling the vendors into one pool, they have increased market competition in the areas of billing rates, contract terms, performance standards and qualified candidates while concurrently eliminating the burden of multiple contract negations. Ten new Georgia hospitals contracted with this program in 2016. In Georgia, there are currently 17 entities and 34 locations that participate in Healthcare Staffing Services. Another exclusively marketed program that will be making big waves this year is the Georgia HEART Hospital Program, an organization that will assist eligible rural hospitals in taking advantage of the Rural Hospital Tax Credit. This recently increased tax credit now provides a 90 percent Georgia state income tax incentive for individuals or corporations who donate to one of the eligible hospitals. The amended credit also doubles the amount any single individual or a head of household may donate from $2,500 to $5,000 and any married joint filing household from $5,000 to $10,000. Out of the 49 current need-based eligible hospitals, Georgia HEART has 40 enrolled in its program. For these 40 hospitals, Georgia HEART will provide a full range of services, including contribution marketing, processing, tracking, and reporting services. This will allow the hospitals to receive the needed income without placing an additional strain on their workforce or budget. “The Georgia HEART Hospital Program was initially created to help rural and Critical Access Hospitals increase their funding and their ability to provide for the health care needs of their communities by way of the Rural Hospital Tax Credit,” said Adams. For more information on Healthcare Staffing Services, Georgia HEART Hospital Program or other GHHS Partners, please contact Bill Wylie.

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