JANUARY// FEBRUARY 2017

AN INSIDE VIEW INTO GEORGIA’S NEWS, POLITICS & CULTURE

RECLAIMING,

RECYCLING & REUSING

TIRES! PAGE 23

THELEGISLATIVE ISSUE

COLUMNS BY JOSH BELINFANTE • JOE BRANNEN • KAREN BREMER • SUSAN COLLINS • JERRY FULKSBRYAN GINN • EDWARD LINDSEY • BAKER OWENS • DANA RICKMAN • ELLEN SHAVER • CALVIN SMYREMATT TOWERY • LARRY WALKER • COSBY WOODRUFF

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DEPARTMENTS Publisher’s Message 4

Floating Boats 6

FEATURES Casino Gambling a Matter of “When” not “If” and Other Issues to Watch in 2017 9 by Matt Towery Scrap Tire Recycling Combining Sustainability and Development 23 by Baker Owens

COLUMNS Why Bankers Feel Good About 2017 11 by Joe Brannen

Restaurants Looking Ahead to a Productive Year 13 by Karen Bremer

Georgia’s 2017 Legislature Also Shapes 2018 Elections 15 by Josh Belinfante

Why Design is Critical to Business 17 by Susan Collins

Georgia Hospital Network Requires Stabilization 19 by Jerry Fulks

2017: Time to Make Education Resolutions That Stick 21 by Dr. Dana Rickman

Deductibles at Critical Levels: Collaboration & Innovation a Must 26 by Dr. Ellen Shaver

Georgia’s CON Law Strikes Delicate Balance in Care, Cost 29 by Edward Lindsey

Georgia Below the Gnat Line 31 by Larry Walker

Medical Association of Georgia Targets Patient Safety, Access 33 by Cosby Woodruff

“Dean of House”Outlines Democratic Legislative Adgenda 36 by State Rep. Calvin Smyre

GA-PCOM Grads Help Solve Georgia’s Primary Care Shortage 38 by Bryan Ginn

JAMES

On the cover:Bronze statue of James Edward Oglethorpelocated in the center of the Augusta Commonin Augusta, Georgia.

P U B L I S H E R ’ S M E S S A G E

have thought about casinos?) So we commend toreaders our varied writers who address these andother pressing legislative concerns. This issue of James also focuses on a very under-reported issue: The unsightly problem of countless oldtires that seem to be discarded in all too many places.Staff writer Baker Owens chronicles how Atlanta and anational company with a busy Atlanta tire recyclingoperation are aggressively tackling and solving a prob-lem. And James discovered an added benefit whenresearching this story— the reuse of recycled tire rub-ber for everything ranging from athletic fields to roadpaving applications. Finally, please know that we do far more under theauspices of our Internet News Agency, the parent com-pany of James and InsiderAdvantage Georgia. We periodically publish public opinion polls fromthe Atlanta-based Opinion Savvy company, which areespecially helpful to Georgia’s opinion molders. Wepublish The Southern Political Report, highlighted byregular reports from legendary Southern journalistHastings Wyman. And we believe that fresh informa-tion through our daily InsiderAdvantage online sub-scription service keeps us a relevant part of the com-munications and news fabric of the Georgia thatJames Oglethorpe founded. Check out the websiteinsideradvantage.com to subscribe. The subscriptionis $17.50 a month for daily IAG online news— andincludes a complimentary James subscription!

his year our magazine celebrates 13years of publication. It also marks twoyears since I’ve been CEO and publisher,

taking over the reins from founder Matt Towery. Yetafter all these years we still are sometimes asked thequestion: “Why is it named James?” Now, with our 2017Legislative Issue, it seems a good time (especially fornewer readers) to re-tell the story. Thirteen years ago the late John F. Kennedy Jr. hadstarted a (now-long defunct) national magazine namedGeorge— after the nation’s founding father Washington.So, for a Georgia magazine, Matt decided upon James—after Georgia’s founding father Oglethorpe! James Oglethorpe was really Georgia’s “first gover-nor,” since he established the British colony in 1733 waybefore it became part of the new United States ofAmerica. He founded Savannah (its distinctive patternof streets and public squares were his idea) and hisBritish-bestowed title was “Trustee.” He and a few othertrustees were given wide latitude by London to promul-gate laws, and they followed the motto Non sibi sed aliis(“Not for self, but for others”). Records show Oglethorpeopposed slavery, allowed persecuted religious minori-ties to settle, respected Indian culture and negotiatedland treaties according to Indian custom. Governing Georgia, of course, has gotten far morecomplicated since those 18th century days. Our cur-rent “trustees” have a lot on their 2017 GeneralAssembly plate: Everything from healthcare and edu-cation legislation to transportation, religious libertyand even casino gambling. (What would Oglethorpe

T

Reflections on Mr. Oglethorpeand Georgia’s Current Governance

Gov. Nathan Deal is working with lawmakers to give thestate more authority to let students transfer from the 153public schools on the state’s “failing” list. The list has grownfrom 127 in 2015, and Fulton and Chatham counties havethe largest increases of schools achieving a failing scorethree years in a row on the Department of Education’sCollege & Career Ready Performance Index. So far, though,this well-intentioned reform effort seems to be… Drifting

Graduates of Georgia technical colleges and universitiesnow have a place to compare earnings for different careersacross the state. The Governor’s Office of StudentAchievement developed a “dashboard and research report”which provides tools that are designed to help studentsseeking higher education make important decisions for theirfuture. The dashboard (learnearn.gosa.ga.gov) is an interac-tive site which allows users to explore earnings patterns ofgraduates for the first and fifth years after graduation. Formany students, this will help their boats… RISE

A state-owned Cyber Innovation and Training Centerwill be built near the U.S. Army’s Cyber Command head-quarters at Fort Gordon to teach students and educatorshow to combat hacking and other forms of cyber warfare. Itwill include a “cyber range” where cyber warfare trainingand technology development unfolds. This urgently-neededcenter being developed with the Department of Defense andNational Security Agency, to be located on downtownAugusta land once slated for a failed Golf Hall of Fame, nowhas the boats of Augusta, Georgia and our nation… RISING

A Fulton County Commission majority approved a plan topunish gas stations and convenience stores in an unincor-porated area that have high crime rates on their property. Ifthe businesses fail to take steps toward increasing safety—including employing security guards, purchasing cameras,and other expensive measures— the county could stripthem of their liquor licenses. Imposing a crippling punish-ment on private businesses that don’t spend inordinatemoney on doing what should be policework? For ChairmanJohn Eaves and his Commission allies, this wrong-headeddecision has their political boats… SINKING

The Zell Miller Institute for Public Policy has beenlaunched and in honor of its namesake will work to pro-mote “bipartisan solutions to the critical issues facingGeorgia.” With grandson Bryan Miller serving as chairmanand executive director, the group will also educateGeorgians on Miller’s long record of public service, and arelated entity will engage in Georgia elections through its“action fund.” Seeking to carry on the legacy of a greatGeorgia governor, the Miller Institute and its missionare… RISING

Savannah has broken ground on a massive constructionproject that will develop one of the largest pieces of undevel-oped, national historic district land in the country into one ofthe nicest mixed-use stretches of waterfront in the country.The redevelopment of the 100+ year-old decommissionedGeorgia Power Co. plant on iconic River Street will host twoluxury boutique hotels along with restaurants, bars, shop-ping, and a spa. Already known as one of the South’s mostbeautiful cities, this project from Richard C. Kessler hasSavannah’s ship… RISING

Even after a banner year for the Republican Party in a statewhere it controls the House, Senate, and every major electedconstitutional office, its financial standing is cause for con-cern. With only about $125,000 on hand and over $200,000 indebt, it’s trouble for a state party that should be flush withcash in a wealthy red state. A slew of candidates are lining upto run for party chairman with incumbent John Padgett setto retire, so expect the money issue to be the biggest topic ofdebate at its 2017 convention in Augusta. Even though theGOP has a firm hold on Georgia politics, with such a worryingfinancial situation the state party’s boat is… Drifting

The new stadiums for both the Atlanta Braves and AtlantaFalcons have come under criticism ever since theirannouncements, but as they near completion it has becomedifficult to find anything but praise. Georgia will have world-class facilities for two sports teams on the rise, with promisesof additional top notch entertainment already on the schedule.Set to open in 2017, Mercedes-Benz Stadium and SunTrustPark have Atlanta’s ship… RISING

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WHO’S RISING AND SINKING IN GEORGIA BUSINESS AND POLITICSF L O A T I N G • B O A T S

on’t let my time spent in Florida fool you.Clear skies, warm weather and palm treesonly serve to provide a clearer view of whatis going on in Georgia and D.C. in between

battling Atlanta traffic and dodging bullets whenI’m home. Here are the big stories I expect to emerge in 2017:

Georgia legislators will continue to movecloser to bringing casino gambling to thestate. The basic framework for how and

where it will take place has been tinkeredwith for over a year. With its promise to help

fund the HOPE scholarship and the new twist of set-ting aside some of those funds for minority studentsand others who might not otherwise currently be eli-gible, support from the public has soared to close to60 percent. If legislation to put casinos to a publicreferendum doesn’t pass in this year it will be com-pletely ready for a green light in 2018. After all, wait-ing one more year gins up more political donationsfrom interested parties, and the actual referendum(which requires a 2/3rd vote in both the House andSenate, but no signature by Gov. Nathan Deal) can-

not by law be voted on by the public until the 2018general election year.

Crime will become the majorissue in the race for mayor of

Atlanta. You can quote all the statsyou like, but Atlanta and its suburban

counties are becoming increasingly vio-lent due, in part, to rising gang-related

crimes. This has hit home particularly in the Atlantacity limits where home invasions, car jackings, bur-glaries and violent crimes have invaded the high-income areas both on the northside and southside.They join areas such as Midtown and the city’s eastwhere crime has become a major issue. No singleissue will galvanize voters more than tamping downon crime and the growing influence of gangs in thecity in the race for mayor.

As of the deadline for this column,the football championship fate ofthe Atlanta Falcons is unknown.

But regardless, the Falcons and theirowner prove that good things happen to

9JANUARY/FEBRUARY 20178 JAMES SEPTEMBER/OCTOBER 2016

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ne of the things I love about my job is that Iget to hear about the good work the peoplewho are bankers do every day that simply do

not make the headlines. It may be the lending officer in South Georgia whohelps a farmer finance a single piece of equipment thatcan be the difference in a profitable harvest. It may bethe call center representative in Middle Georgia whotakes the extra time and care to call and check on anelderly customer shehadn’t heard from in awhile. Or it may be agroup of bankers inNorth Georgia collectingtens of thousands ofitems and dollars for alocal food bank. Those types of sto-ries always keep meoptimistic about whatthe banking industrydoes and how much itmeans to the people ofGeorgia. Those types ofstories are a good backdrop to the positive businessand banking fundamentals heading into this new yearthat have bankers approaching 2017 with anticipation. Georgia’s economy is growing and family and busi-ness finances are better than they have been in quitesome time. The strength and health of our state’s bankingindustry is directly tied to those factors, so we’ve seenbank performance improve in lockstep with the econo-my. Total loans are above pre-recession levels; moneyon deposit is at an-all time high; and almost all ourbanks are turning profits by doing more business withpeople and companies in their hometowns. There’s plenty of choice for consumers about wherethey bank, with 228 FDIC-insured institutions fromwhich to choose in Georgia. And there is a lot ofcapacity for banks to make even more loans for busi-ness investment or family needs at interest rates thatare still really low.

So, with business fundamentals being good, we’relooking toward the state and national policy arenas in2017 with some specific priorities to keep the momen-tum going. In the Georgia General Assembly, our state’sbankers will get behind good bills that spur job cre-ation, encourage capital formation and make it easy forcustomers to do business with them. One issue of particular importance is a legislative

fix to ensure key liabilityprotections are in placefor Georgians who serveas directors and officersof banks and other com-panies. The GeorgiaSupreme Court in 2016delivered a ruling thatopened the door for thefederal government, pri-marily through the FDIC,and others to sue theseofficers and directors forliability in making ordi-nary business judgment

calls about loans and other key decisions. The court’sbroad interpretation of the Georgia law is unlike anyother state’s interpretation, and it has had a chillingeffect on the business climate for bank and other cor-porate directors. This was a bank case before the court, but it hasimplications for any business. We hope to see thataddressed this session. At the national level for banking, we’re optimisticthat 2017 will bring some common-sense changes towhat’s become a crushing amount of bank regulation. In many situations, the whole process for a personto get a traditional mortgage, business or personal loanhas gotten way too complex. Or, the money, time andrisk that comes with ensuring compliance has kept

good people. Falcons owner Arthur Blank has putmuch of his own money where his mouth (and busi-ness expansion) is by funding the vast majority ofthe new Falcons stadium privately. The team builtone of the most impressive offenses in NFL history,led by a genuinely good guy in Pro Bowl starter MattRyan. Here’s to good guys finishing first (or close toit depending on post-publication outcomes).

And let’s not forget two greatstadiums that are soon to beabandoned by their pro teams.Turner Field will at least seesome reprieve as an alteredstadium for Georgia State

University. But the Georgia Dome, for my money (lit-erally for years) the most comfortable venue imagi-nable to watch a game, will meet the fate of a well-planned implosion in the future. The individualswho sat on the governing authority of the WorldCongress Center and Georgia Dome are to be com-mended for their stewardship in overseeing thevenue. The Dome will be missed but those wholament its demise need to know that much of the

need to abandon it can befound in its roof that providedthose comfortably warm gamesduring not-so-nice weatheroutside. The roof, its replace-

ment and insurance for its unusual design all com-bined to make building a new stadium a morefinancially reasonable and practical move.

Eyes on the race for Georgia’snext governor seem focused onLt. Gov. Casey Cagle, who willbe the favorite to win the postas the race begins in earnestnext year. If Cagle jumps intothe race, that will leave thelieutenant governor job wide

open. I feel as confident in predicting that SenatePresident Pro Tem David Shafer would win the posi-tion of “Lite Governor,” should he run, as I did in pre-dicting Donald Trump’s potential several years ago.Shafer is a political force the likes which we havenot seen in many decades.

Matt Towery is an attorney, author and former Georgia state legislator.

O

continued on page 12

SEN. DAVID SHAFER

s we embark on a new year, we reflect onour victories and defeats from the previ-ous year and express refreshed opti-mism for what lies ahead of us.The new year is often a time toset out goals and ambitions for

what we want to achieve, as well as to antic-ipate the challenges we may face. With the2017 legislative session ramping up, theGeorgia Restaurant Association (GRA) aimsto continue protecting the bottom line forthe entire food service industry. The GRA serves as the voice ofGeorgia’s restaurants and we aim to set thebar high in 2017 to continue creating a thriv-ing and prosperous industry. Did you knowthat the restaurant industry is Georgia’s secondlargest private-sector employer, providing over438,900 jobs in Georgia, which amounts to10% of the workforce? Any legislation orregulation affecting our industry willhave a huge impact. With restaurants focusing on day-to-day operations, we willmake certain that theindustry is protected andwell-represented under theGold Dome. We will workto create awareness on thepart of our elected officialsand the public about the positive economic impactthe restaurant industry has on the state of Georgia.After all, the restaurant industry remains a vital com-ponent to job-creation, employment opportunitiesand economic development. In order to stay ahead of the curve, we must beable to anticipate what legislation is coming down

the pipeline. So here are a few key topics to keepan eye on:

THE “ BRUNCH BILL” Let’s change brunch on Sundays! For thepast two sessions, the GRA has worked tire-lessly to create awareness about the Georgia“Brunch Bill” and how restaurants wouldbenefit. This bill would allow for local munic-ipalities to opt-in to allow their restaurantsto start serving alcohol at 10:30 a.m. onSundays. Currently, state-owned facilities

such as the Georgia World Congress Centerand Lake Lanier Islands Resort are allowed to

serve alcohol starting at 10:30 a.m. on Sundays.Restaurants must wait until 12:30 p.m. In 2015, the “Brunch Bill” passed in theHouse of Representatives; however, the bill was

stalled in the Senate in 2016. State Sens.Renee Unterman and Ed Harbison are re-

introducing the bill for the 2017 legisla-tive session to give restaurants the same

opportunities as state-owned facilitiesand to create a level-play-ing field for all businesses.

Casinos & Pari-Mutuel Gambling

Casinos are a hot topic in 2017. They would bringthe opportunity for more education funding andunique possibilities for local restaurants to expand.However, obstacles such as alcohol licensing,increased oversight and regulation could bring an

banks on the sidelines from offering a variety of prod-ucts, services and flexibility that could be helpful. The avalanche of regulations is also among the fac-tors causing an environment that is not good for newbank formation and investment, increased fundingavailable for business growth and competitive choicesfor consumers that would follow. Having U.S. Sen. David Perdue justappointed to serve on the SenateBanking committee will be helpful. He’sa proven champion for the type of bankregulatory reform that can make a differ-ence in getting capital flowing backonto Main Street. And U.S. Rep. BarryLoudermilk has been named to theHouse Financial Services Committee. Healso brings real-world business experience tothe table and will be an effective voice. U.S.Rep. David Scott will be back on the House FinancialServices Committee and brings a moderate voice formeaningful reform to what has become an overly com-plex financial regulatory structure. Others in the dele-gation are also poised to take similar positions to helpbanks get back to doing what they do best: making

loans to qualified businesses and individuals. With that in mind, we welcome the opportunity towork closely with our elected officials at the state andnational level during the coming months as they shapepolicy to put our economy in an even higher gear. Finally, we’re feeling good about 2017 because of

something that really hasn’t changed. As Iexplained in the beginning, Georgia’s bankers

are true flag bearers for their hometowns. There are 60,000 women and menwho work in the state’s bankingindustry. Banking may be their job,but first and foremost they areGeorgians. They are from all walks oflife. They live and work in their com-

munities, and what they do every day isall about providing funding for the busi-

nesses and consumers in Georgia and finan-cial expertise to help their fellow citizens. That’s cer-tainly good news for everyone.

Joe Brannen is the president and CEO of the GeorgiaBankers Association.

The “Brunch Bill”would allow restaurants to start serving

alcohol at 10:30 a.m. on Sundays,instead of the current 12:30 p.m. law.

continued on page 14

undue burden to restaurants. The GRA will work toprotect restaurants in the surrounding areas of pro-posed casinos to afford them the same opportunitiesand equality in terms of regulations.

Religious Liberty Religious liberty was a highly-contested issuein 2016, ending with Gov. Nathan Deal vetoingHouse Bill 757. While some praised his actions,other elected officials were angered by the resultand vow to revisit the issue this year. Georgia leg-islators appear divided on this topic, with HouseSpeaker David Ralston recently suggesting thismatter should be discussed at the federal levelrather than within the state. The GRA will stronglyoppose any bills that come up regarding religiousliberty as we promote Georgia as a tolerant, inclu-sive and welcoming state for all tourists, residentsand businesses.

State Earned Income Tax Credit Other legislation likely to emerge throughout thesession that could impact restaurants and its work-ers would be in regards to the State Earned Income

Tax Credit— also known as the Georgia WorkCredit— being championed by the Georgia Budget& Public Policy Institute. This will add additional taxrelief for lower income workers.

Economic Growth for Small Business Several pieces of legislation will also be intro-duced by Sen. John Albers aimed to curb regula-tions, create tax exemptions and simplify licensing.These could reduce the burden of running a busi-ness for single-unit and small restaurant chains. In addition to the topics above, healthcare,transportation, military bases and education arelikely to draw headlines during this session. Yet beassured the GRA will continue to have our pres-ence be known and our voice be heard. We willkeep restaurants informed of the latest develop-ments throughout the session so that they canhave access to information that helps their busi-ness comply with the ever-changing regulatorylandscape.

Karen Bremer is the CEO of the Georgia Restaurant Association.

n the Book of Ecclesiastes, we learn that there is aseason for everything. For Georgia legislative poli-tics, that season officially starts with the Wild Hog

Supper and Georgia Chamber’s Eggs and Issues break-fast. Weather closed the former, and the latter gave us aglimpse of what to expect during the 2017 legislative ses-sion. But more broadly, the final two years of a governor’sterm-limited term brings additional, and predictable,dynamics to play. All these considerations promise thatthe 2017 legislative session will be one that could set upthe fault lines for next year’sstate wide elections. As background, all constitu-tional offices will be up for re-election in 2018, and Gov.Nathan Deal cannot run for athird term. There are a handfulof Georgians giving seriousthought to running for governorand, as we saw in 2014 whenU.S. Sen. Saxby Chamblessdecided not to seek re-election,vacancies in top spots cause acascading effect impactingraces from the governor’s man-sion to the city hall. Consequently, those eying different offices may consid-er the broader consequences of a vote more keenly than inprevious years. Likewise, some issues may percolate to thetop of the agenda that may not have otherwise, and otherissues that were expected to generate significant attentionmay fall off completely. Due to this dynamic, some policy-makers and advocates will seek to act boldly and tackle thetougher issues now, before the pressures of the 2018 cam-paigns grow more intense. Also, in the last years of a governor’s administration,some may unwisely view the governor as less powerfulthan before. Not so. The Georgia Constitution makes thegovernor one of the strongest in the nation. He controlsthe revenue estimate, which sets the ceiling on what theGeneral Assembly can spend each year. Agencies canpromulgate rules relatively quickly, and those rules carry

the force of law. The governor has the single most potentbully pulpit in state politics, and the veto (or “last vote”)of both budget items and legislation remains one of thegovernor’s most powerful tools. Some who have mountedchallenges to a governor’s power have found the experi-ence to be, in the words of John Locke, “solitary, poor,nasty, brutish, and short.” Finally, there is more uncertainty in Washington thanat any time in the past eight years. The fate of Obamacare,environmental regulations, banking, financial services laws

and several others are anyone’sguess. This too will dramaticallyimpact state lawmakers’ deci-sions on a host of issues. This is the season in whichthe legislators now find them-selves. And these external butpredictable, cyclical forces willweigh on decisions about howand when to address truly diffi-cult issues. Will legislators fundMedicaid as in the status quo?Will they address Certificate ofNeed, and if so, will the legisla-tion tweak or abolish the regula-tory process? Do legislators

believe that the HOPE Scholarship is in danger and, if so,is casino gaming the solution? And what are the governorand legislators going to do to improve education andreform education funding? Will transportation, and particu-larly mass transit, receive significant attention given thecall for more focus by the speaker of the House ofRepresentatives? Each question brings uncertain answers,particularly when they are juxtaposed with the pressuresthat arise when statewide elections are two years away. Iwish all who vote on— and advocate for and against— leg-islation the best of luck in this season. Turn, turn, turn.

Josh Belinfante practices litigation and regulatory law at Robbins

Ross Alloy Belinfante and Littlefield in Atlanta.

14 JAMES NOVEMBER/DECEMBER 2016

Georgia’s 2017 LegislatureAlso Shapes 2018 Elections

By Josh Belinfante

I

Businesses are facing ever-increasing com-petition in a world that is changing fast around us. Thecompanies that deliver the best end-to-end customer anduser experience will win. How well an experience isdesigned is easily judged by one’s sense of ease or frustra-tion. While a great experience saves lots of time, moneyand headaches, a terrible experience will hurt a businessfaster than you can say, “Shoulda, woulda, coulda.” But, how does a businesssuccessfully design an end-to-end experience? Members of the Atlantabusiness community tackledthis subject recently whenSlalom Atlanta hosted ascreening of DesignDisruptors, an inspiring docu-mentary by Invision that callsattention to the transforma-tive power of design. DesignDisruptors highlights compa-nies like Apple, Uber, Netflix,Airbnb and Facebook, whohave designed businesses that repeatedly surprise anddelight their users, disrupting industry competitors inthe process. After the film, an expert panel of designersfrom multiple such industries as TV, healthcare, auto,wireless and education agreed on how critical it is fororganizations to build empathy for their clients and howimportant it is for organizations to invite designers tothe table early and often. Why designers? Designers are often misconstrued asartists, but their purpose is completely different. JohnMaeda, Design Partner at Kleiner Perkins Caufield &Byers, concisely explains, “Art is about making questions.Design is about making solutions.” What types of challenges do designers solve? You

name it— it’s not just the company logo and letterhead.The adaptation of new technology is rapidly changing theway businesses reach and interact with consumers. Andconsumers are begging organizations to make things eas-ier by making use of new technology. Web sites, mobileapps, and social media have quickly changed the waypeople shop, communicate and consume media andadvertising. Ben Blumenfeld, co-founder of Designer

Fund, said, “The biggest chal-lenge designers are facingright now is the fact thatthey’re designing a lot ofthings that are new— thathave not been done before—in organizations that areevolving and changing, andfor audiences that are evolv-ing and changing.” One type of designer,however, cannot solve allyour business problems.Different kinds of designerssolve different business chal-

lenges, and they all work together. The types of design-ers that most small businesses should seek out includeuser-experience (UX) designers, user-interface (UI)designers, front-end designers, graphic designers, prod-uct designers and interior designers. Before your head starts spinning, let’s look at whateach type of designer brings to the table.

The UX designer understands the customers’ needs,figures out how to improve their experience and coordi-nates with other types of designers to achieve the cus-tomers’ desired outcome. continued on page 18

emergency medicine, the “golden hour” immedi-ately after a traumatic event like a car accident or

a heart attack, is the time in which the patient’s chance ofsurviving can be most improved by access to skilled med-ical care. Today, Georgia’s healthcare system faces a “gold-en hour” in which legislative action is required to ensurethe long-term survival of the local hospitals that protect ourfamilies, our communities, and provide high-qualityhealthcare and well-paying jobs. Hospitals are the lifeblood of the communities weserve. They are where sickness is treated, lives are savedand children are born. They foster wellness, provide quali-ty jobs and give us the assurance that if an accident hap-pens, help is nearby and available 24 hours per day.Unfortunately, too many communities across our statehave either lost or are at risk of losing this lifesavingresource. Five Georgia hospitals have closed since 2010,and at least 10 are at risk of shutting their doors. Simply put, our statewide hospital network requiresimmediate stabilization to ensure that no more communi-ties lose access to healthcare. Whether rural or urban, 50 beds or 500, Georgia’s hos-pitals face an uncertain future. Changes brought about bythe Affordable Care Act, lower reimbursement rates forservices, and an expanding population of uninsuredpatients are just a few of the very real challenges providersface every day. While the incoming Trump administration and mem-bers of Congress have pledged relief, those changes willtake time to identify, implement and, most importantly, tounderstand the impact they will have on insurance,Medicaid and the cost of care. This is the backdrop against which the GeorgiaGeneral Assembly will be making decisions about healthcare as they reconvene on January 9. The first measure to stabilize our hospitals is renewalof the Medicaid provider fee, which helps fill in a financialhole left by the federal system. Some call it a “bed tax,”though no tax is levied on patients or on hospital beds.Without legislative renewal, the provider fee will expire onJune 30, 2017, and Georgia will lose hundreds of millions ofdollars of our own federal tax dollars.

Georgia’s legislative leaders have made it clear thataddressing the renewal of the Medicaid provider fee willbe a top priority for the coming session and we hopethey succeed. Another area in which Georgia’s community hospitalsneed stability rather than increased risk is maintaining thecertificate of need program that protects local hospitals. Georgia’s certificate of need law was put into placenearly 40 years ago to ensure that all citizens would haveaccess to care— no matter where they live, what theirincome level or how serious their condition. These lawsrequire that any new medical facility or hospital expansionmeet a true unfilled need. Why is this important? Because hospitals, especiallynot-for-profit facilities, rely upon a delicate balance of serv-ices, patient mix and reimbursement levels to maintaintheir financial viability. Requiring proposed expansions ornew facilities to go through the certificate of need processhelps to safeguard that critical balance while expandingmedical care where it is needed the most. Proposed changes to the certificate of need law will beamong many health care issues our legislators debate thiscoming year, but few will be more important given thepotential impact on local communities throughout ourstate. In some cases, those decisions could mean the dif-ference between a hospital staying open or closing; in oth-ers, difficult choices about what services to provide oreliminate. No one should ever lose a loved one or suffermore than necessary because they did not have timelyaccess to quality care. Georgia’s local community hospitals are in a goldenhour of their own, in which their financial health must bestabilized after years of change at the federal level. Georgiais fortunate to have elected leaders who share our commit-ment to maintaining a health care system that all citizenscan rely upon and we look forward to continuing to workwith them to ensure continued access long into the future.

Jerry Fulks is President of WellStar West Georgia Medical Center inLaGrange, Georgia, and serves as chairman of the Board of Directorsof the Georgia Alliance of Community Hospitals.

The UI designer develops the interfaces for web sitesand apps to accomplish user goals in an intuitive andaesthetically pleasing way.

Front-end designers bring the interface designs tolife by coding web sites and apps.

Graphic designers design visual communication andwork on projects like brand identity (logos, letterhead,business cards), marketing materials, product packagingand presentations.

Product designers bring products to life through pro-totyping, testing and iterating. And interior designerstransform spaces to make them functional and enjoyable.

Lucky for you, some designers may have expertise inmore than one area. Even luckier, there are design firmsthat can do all of this. Keep in mind that as technology and customersevolve, so must the experience. This means that designing an end-to-end experienceis not a one-time deal. In order for designers to solveproblems effectively, businesses have to receive and

review customer feedback, adjust the experience, lather,rinse, repeat…you get the picture. Sounds pretty expensive, right? Well, it can bedepending on how complex the business challenge. It isbest, however, to look at the end-to-end experience interms of investment. It’s much like the costs of preventa-tive healthcare. Good nutrition, exercise and regularcheck-ups can save you money in the long run, moneythat without preventative care might have to go to hospi-tal bills and medication. Putting more thoughtful care intothe overall customer experience upfront by applyingdesign principles will set your business up for successand help you avoid major problems down the road. Imagine how great it would be if your organization’send-to-end experience was smooth and enjoyable foreveryone. Fewer calls to customer service, more repeatbusiness, higher employee retention, great reviews onYelp and more authentic smiles. Wouldn’t that be won-derful? Isn’t that worth investing in?

Susan Collins is the TBS/TNT Digital Creative Director with 20 yearsof experience creating exceptional digital experiences for TBS, TNTand various companies based in Atlanta.

Georgia Hospital NetworkRequires Stabilization

by jerry fulks

In

appy New Year! In spite of much ofthe negativity that seemed to perme-ate the air as 2016 came to a close,I’m optimistic about 2017. Big thingsare happening and it’s sure to be anexciting year. This is certainly anexciting year for the Georgia

Partnership for Excellence in Education as well— it’s our25th Anniversary! During any major milestone— whether it be the turn-ing of a new year or the celebration of an anniversary—it’s natural to take time toreflect and examine pastchoices and commitments,evaluate priorities moving for-ward and make resolutions toachieve new goals. At theGeorgia Partnership, we havebeen reflecting on the manychanges and opportunitiesfacing our public school sys-tems. We are also making res-olutions about how to contin-ue to move our work forward.For us, the motivation is thecommitment to ensure all children in Georgia receive aworld-class education. The Georgia Partnership for Excellence in Educationkicks off every new year with the release of the annualTop Ten Issues to Watch, which analyzes many of thechallenges and opportunities facing education today. Thejust released 13th edition begins with the debate aboutthe proper role of government at all levels— federal, state,

and local. It also examines other pressing issues such asrecruiting and retaining highly effective teachers andleaders, barriers to completion for higher education,access to early learning opportunities, funding equity andwhat to do about chronically failing schools. Throughout 2017 Georgia will be considering educa-tion reform strategies, policies, and programs aimed atstrengthening the education pipeline— from ouryoungest citizens to our adult learners. These debatescome at a time when there are many challenges facingour state. More than one-quarter of Georgia’s children

live below the poverty line,ranking Georgia as the ninthhighest in the nation. Moredistressing, Georgia ranks10th highest in the country forthe number of children livingin extreme poverty. Thesecommunities generally lackequitable access to high qual-ity schools, health care, com-munity supports and the eco-nomic opportunities thatcome with them. Education is viewed as

the great equalizer that enables upward mobility.However, persistent achievement gaps have called thisnotion into question. In Georgia, as in the rest of thenation, low-income students are significantly less likely toread on grade level by 3rd grade, be proficient in math by8th grade, and graduate high school on time. Too often,the relationship between education and prosperity is now

Nope. All it takes is a scratch or two. Because every time you play the Lottery, Georgia kids are the real winners. That’s because for over 20 years the Georgia Lottery has contributed more than $17.8 billion to education. On top of that, more than 1.7 million HOPE scholars have gone to college and more than 1.4 million four-year-olds have attended a Lottery-funded Pre-K Program. That qualifi es as a rocket booster in our book.

IT DOESN’T TAKE

WITH THEIR EDUCATION.TO HELP KIDSA ROCKET SCIENTIST

galottery.com

galottery.com

IT DOESN’T TAKE A ROCKET SCIENTISTTO HELP KIDS WITH THEIR EDUCATION.

continued on page 22

id you know the average tire lasts around50,000 miles, depending on how often onedrives and the kind of road being traveled?

Eventually they need to be retired and, for a long time,they ended up in landfills. By the 1960s they started tak-ing up too much room and began to have their ownstockpiles— some estimates put it at 3 billion tires. Bythe 1980s however, the environmental problem of thesestockpiles really began to be understood. Scrap tires play host to two main hazards: mosquitoesand fires. They are capable of holding water for long peri-ods of time— a perfect breeding ground for “skeeters.”(Remember Zika— the mosquito-borne virus?) As forfires, tires are difficult to ignite but once going they arevery difficult to extinguish. The shape of the tire actuallyallows air drafts to help stoke the fire— and a tire firecould last for weeks or even months. In the 1990s Georgia finally began to take action toaddress the problem. The Peach State implemented a feeof $1.00 on each new tire sold for scrap tire management. But what do we do with all those used tires?

Oftentimes, a carrier will collect tires for a small fee andthen find a place to illegally dump them for free. Liberty Tire Recycling, fortunately, came to the rescuein Georgia’s sprawling capital city. The Pittsburgh-headquartered company, one of thelargest providers of tire recycling services in NorthAmerica, has had an office in Atlanta for 25 years and hasbeen doing yeoman work. Liberty collects these old, dis-carded tires and turns them into tire-derived fuel ormulches them— down to as small a size as two-hun-dredths of an inch. Liberty Tire in Atlanta recycles an incredible 8 milliontires every year. One of their products may be familiar tofrequenters of big-box home improvement stores:GroundSmart Rubber Mulch or Vigoro. It can be used asa ground cover, weed-blocker or play surface. Accordingto Liberty, a six-inch layer of rubber mulch can cushion achild’s fall from as high as 16 feet. Thanks to a quirk of the sausage-making that is law-making, back in 2010 state Rep. Randy Nix, R-LaGrange,was pushing for passage of a bill that ended up getting

23JANUARY/FEBRUARY 2017

backwards. A child’s poverty status determines their edu-cational outcomes, instead of students being able to useeducation to move up the socio-economic ladder. As the Georgia Partnership for Excellence inEducation moves into our 25th year, we invite allGeorgians— from state leaders to individual parents— tojoin us in our continuing resolution to ensure every childhas access to a high-quality education which allowsthem to pursue their dreams. This is a time of promise and opportunity for educa-tion. With strong, committed leadership at all levels, wecan meet our challenges and accomplish great things. The Top Ten Issues to Watch can help inform conver-sations with policymakers, educators, and communityand business leaders about these challenges and oppor-tunities. Together, with a common vision for excellence,we can all commit, recommit, and evaluate strategiesthat will ensure educational success and a brighter futurefor all our students, our state, and our nation. You can download a copy of the report at gpee.org.

Dana Rickman, PhD is the policy and research director for the Georgia

Partnership for Excellence in Education.

continued on page 24

1. The Shifting Federal Landscape and State Policy • What’s Ahead?

2. Teacher Recruitment and Retention • Keeping Teachers Teaching

3. Leadership • New Challenges, New Opportunities

4. Preparing the Workforce • Role for K-12

5. Higher Education • Barriers to Completion

6. Funding • Equity for All

7. Early Learning • Increasing Quality and Access for All Children

8. Student Mental Health • Time to Take Center Stage

9. The Economics of Education • Breaking the Poverty Cycle

10. No Opportunity School District • What Now?

could bring up to 200 tires. Says Liberty Tire RecyclingRegional Vice President Dewey Grantham Jr.:

“We were pleased to co-spon-sor with the Keep Atlanta BeautifulCommission and AtlantaCouncilwoman Joyce Sheperd thisfree business scrap tire collectionat our tire recycling facility onHuber Street. Our mission is sim-ple: to assist the overall crackdownon scrap tire dumping within theAtlanta city limits.”

One goal this year is a pilot pro-gram in Sheperd’s district to usethe rubberized asphalt. Local gov-ernments are responsible for moremiles of road than even GDOT—and Atlanta’s efforts may help makeit more common across otherGeorgia cities. “I am excited aboutthe possibility to be sustainable andpreventing illegal dumping,”Sheperd tells James. Other groups interested insustainability are starting to takenotice. The Ray, a stretch of I-85from the border of Alabama

extending to LaGrange named for the late environmen-talist and carpet magnate, aims to be the most sustain-able highway in the world. The Ray is a living lab and proving ground for emerg-ing innovations “to create a regenerative highwayecosystem,” says Ray Executive Director Allie Kelly. Shetouts a recent report citing rubberized asphalt as one thetop solutions for sustainable roads. The rubber, indeed, is meeting the road.

Baker Owens is a staff writer for James magazine.

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the $1.00 tire fee reauthorization attached to it. Nixdecided to further research the fee and find out whyreauthorization was so necessary. The inquisitive legisla-tor also hoped to find further options for recycling therubber. As it turns out, another option for recycled tires isrubberized asphalt. According to Peter Wu of the Materials andResearch Office at the Georgia Department ofTransportation (GDOT), rubberized asphalt has a 25 to30 percent longer life than regular asphalt. For aboutone mile of paving, 2,000 tires are used. Rubber modi-fied asphalt also decreases the amount of spray thatcomes off the road and reducesroad noise. (Phoenix, Arizona,started using rubberized asphalt inthe 1960s and the entire state hasbeen using the product for morethan 20 years.) By 2013, Nix and GDOT hadupdated road construction specifi-cations to include tire rubber as analternative to conventional poly-mers. That move allowed the DOTto work with various constructioncompanies, including ReevesConstruction, on projects plannedfor the 2013 paving season. Sincethe spec was changed, GDOT hasused about 500,000 tires. Nix seesthe issue as a two-fold solution;“There are just so many win-wins.Getting an environmental problemtaken care of and it being used in ahelpful method.” Atlanta City CouncilmemberJoyce Sheperd also sees tremen-dous potential in rubberizedasphalt and in partnering withLiberty Tire Recycling. “Atlantahas a huge problem with illegal tire dumps. Liberty hasbeen very helpful— pro bono oftentimes— to help getrid of the tires. Tires need to be seen as a commodity.”Sheperd even helped start a Tire Commission to dealwith the issue. Liberty Tire Recycling has been workingwith the city for years and periodically holds “round-upevents” or “amnesties” at its facility where businessesbring in scrap tires at no charge. The last “round up” was in December and businesses

Liberty Tire Recycling Regional VicePresident Dewey Grantham, Jr. at his Atlanta

Huber Street facility oversees a growingrecycling operation.

frustrating. Technology is driving the conversations,but ask anyone in the medical field and they will tell youa complete rebuild of the technology foundation inhealthcare is due. (For example, the billing languagestandards in place are commonly referred to as X12 orASC-X12. Can you guess when this data interchangeprotocol was introduced? No? The answer is 1979.Technical deficiencies such as this example bog downthe ease of information flow, as well as progress.) Ten years ago it would have been appropriate to saythis cannot be changed overnight. But what used totake 10 years now takes two months. The key in today’stechnology environment isn’t how (can we fix this) butmore like “who” will be the first to market with areasonable, scalable solution. The key here, however, istotal acceptance and the initiative by all industry playersto get on board. Innovation must push forward! Most importantly, this innovation must be inclusiveto protecting the physician’s cash flow— making surethey get paid. If this discussion hasn’t made you worry for dear ol’doc yet, then these stats will have you question thefuture of medical care as we know it. In 2001 there were106,318 nurse practitioners/ physician assistantsemployed in the US. In 2012 that number doubled to208,713. Today that number has swollen to over323,000. In contrast, in 2000 there were 798,633licensed, practicing physicians in the United States.Today? 896,712. The shift, is palatable. We are seeingfar more students with the capacity to become MDstake the path of a PA or LPN. I don’t believe incoincidence. The deep dive shows that rising insurancecosts, lack of tort reform and now a healthcare systemthat places the majority of non-catastrophic carepayment on the patient means physicians will get paidless, for more work, more liability and then the luxuryof having to chase their profits. Wanted: Brilliant scientific minds needed for the rollof MD (practitioner). Lower pay than your peers 15 yearsago. Must be willing to collect 50% of total compensation,pay exponential increases in malpractice premiums,utilize dated technology, fight annually over contractreimbursement rates from insurance providers. If I were in college again, I believe I’d ignore thatcareer calling as well.

Dr Ellen G. Shaver of Augusta is Board Chair of CopernicusMD,an SaaS platform that enhances the patient experience as well asthe physician revenue cycle with patented technology and proprietaryprocess. She is a board-certified neurosurgeon and can be contactedat eshavermd@coperinicusmd.com.

ealthcare has become that nasty word we don’tspeak of at family gatherings, office functions and

social settings. It stirs emotions, anger and disappointmentin what our healthcare system has become. Indeed, thesword that cuts all ways— deductibles— has beenwounding both patients and physicians with greater impacteach year. And these wounds are now severe. What should scare us is the rate at which physiciansare either closing shop or simply refusing to sign carriercontracts that deliver punitive payment schedules, thusputting more burden on a physician and their staff tonavigate the payment process. But the culprit isn’t justlower reimbursements to doctors. It is the ever-changingand growing deductible landscape that is causing the grief. The Kaiser Foundation’s annual report on healthcare isscary to read. Consider some sobering facts:

Since 2010 deductibles are up 67 percent, whileinsurance premiums are up 24 percent. Take that in.That’s nearly a 3 to 1 ratio of increase, in just six years.

Worker earnings, by contrast, rose just 10 percentover that period. There is a story in these numbers,and I’ll give you the spoiler: The average patientdoesn’t have savings equal to their deductible.

With an average ACA Bronze plan deductible of$5700.00, the medical industry is headed for a crisis, andthis crisis will cut both ways. Either the patient seeks andreceives treatment, and fails to pay the associated billsthat come with that deductible and plan, or theunintended consequence is the patient ultimatelydeciding to forego treatment all together. This, for themedical industry, is a lose-lose.

A National Discussion That Needsto Occur Has Many Facets

First, the transition to a value- based, rather than feebased, reimbursement system is going to create havoc, costpractices money and in the end dilute the value of carereceived. But in this value-based transition, increasinglymore responsibility for fees will fall on the patient. Lesstransaction means fewer procedures, meaning that theodds of a patient exceeding their deductible and copayobligations get even less than in the fee-based model. Second is the demand by all parties for a better patientexperience. This is still your father’s medical care system.The demand for interaction at a digital level has saturatedjust about every consumer facing vertical under the sun,with medical sharply behind. The idea that I still can’tshare digital documents with or between my providers is

26 JAMES JANUARY/FEBRUARY 2017

H

eorgia’s thoughtfully considered health policy frame-work is again under siege at the state Capitol, with the

2017 legislative session marking the latest scrimmage in analmost decade-long campaign by well-financed, out-of-stateinterests to radically reorganize the delivery of health care. This year, as with too many before it, these out-of-state

forces are expected to propose abandoning Georgia’s impor-tant “certificate-of-need” (CON) framework, which createscommunity-responsive requirements that promote access toquality health care throughout Georgia while also controllingcost by forgoing unnecessary, redundant facilities. Said another way: this law prevents the operation of

duplicative health care centers absenta demonstrated public health careneed. It prevents, for instance, a majorout-of-state corporation from contriv-ing a new and unnecessary healthcare center that selectively targetsonly the most-profitable patientgroups and skirts existing require-ments to offer care for the indigent—a responsibility that our full servicehospitals are required by law to bear. Changes of the sort proposed in

sessions past would directly jeopard-ize the financial health of Georgia’shospitals, both rural and urban, and shred the critical safetynet installed to protect the poorest among us. The Hippocratic Oath, the prevailing ethos of modern

medicine that imprints in our doctors a moral and universalresponsibility to care for their all patients, is not selective, sowhy then should our hospitals be? That’s an easy answer:they shouldn’t, and certificate-of-need laws see to that with-in the current, managed framework. There are no easy answers in health policy. Possible

reforms require careful consideration. That’s why two yearsago, Gov. Nathan Deal created a special commission ofhealth care experts and state and local policy makers toidentify solutions to help Georgia’s struggling rural hospitalcommunity. The commission, which was co-chaired byHouse Appropriations Committee Chairman Terry England,concluded in its 2015 report that “in order to maintain andprotect the fragile rural hospital infrastructure, existingCertificate of Need (CON) laws need to be maintained.” Opponents to Georgia’s certificate-of-need law have

done their level best over the last decade to characterizetheir cause as conservative. But don’t be so easily fooled: aswith many matters of public policy dealing with health care,it’s far more complicated and simple labels do not apply. Modern hospitals operate in an uncommonly treacher-

ous regulatory and business sphere. Not only is there com-petition from other hospitals, but also from those who wishto cherry pick and siphon off the profitable areas of medicalcare without assuming the responsibility for insuring accessto such care for all. Certificate-of-need rules exist as a safety net not only for

the state’s poorest patients but also the state’s broaderhealth delivery system. Absent theseimportant, patient-driven laws, anout-of-state for-profit could open anew center in Georgia that would ran-sack our hospitals and leave all of usout in the cold. Admittedly, as with all regulation,

reforms are periodically required tokeep laws responsive in our dynamicworld. In 2008, following a compre-hensive audit of the state’s existingcertificate-of-need laws, the GeorgiaGeneral Assembly did just that bystreamlining the regulatory approval

process for new systems. In the years since, earnest stakeholders in the StateCapitol and throughout the state’s health care community,including the governor’s commission and a special Senatestudy committee, have evaluated the present system andrecommended no additional substantive changes to the cer-tificate-of-need program. Georgia is one of 36 states with a responsible certifi-

cate-of-need program because our governor, legislative lead-ers and health care experts understand the critical role thisframework serves in balancing quality care, access and cost. Don’t get lost in the jargon: Georgia’s certificate-of-needprogram puts Georgians, not out-of-state corporations, first.

Edward Lindsey is a partner of Dentons US LLP and a formermember of the Georgia House of Representatives.

Former State Rep. Edward Lindsey.

G

hen I went to the Georgia House ofRepresentatives in 1973, my district

number was 100. What this meant, in part, was thatthere were approximately 99 house members in Georgiathat lived north of me and approximately 80 housemembers that lived south of me. When I left the Georgia House in 2004 my district num-ber was 146. That would mean that there were 34 housemembers in Georgia south of my district and 145 north. In 1973 we had not fully “weened ourselves” fromthe effects of the old county unit system, and the 1973numbers were probably skewed in favor of SouthGeorgia to some extent. But there was no doubt aboutthe strong political influence and clout found south ofthe gnat line in 1973. Jimmy Carter from Plains was governorwhen I got to Atlanta. He served the final twoyears of his governorship, and then thepeople elected George Busbee fromAlbany for two eight-year terms.Georgians haven’t had a governorfrom South Georgia since Busbee in1982 unless you count Sonny Perdue wholives on the gnat line in Bonaire. We’ve hadsome great governors since 1973 including our presentone, Nathan Deal from Gainesville, but none from south ofthe gnat line. Ah, the “gnat line.” It’s that imaginary line that fol-lows the fall line, splits the Piedmont plateau and is a linerunning from Columbus just south of Macon toAugusta— south of which there are abundant gnats. It isthe “line” where there are sometimes gnats and some-times not, and with the “sometimes are” usually prevail-ing. The political power in this state is now north of thegnat line. The gnats are south of the gnat line. We have 14 U.S. congressmen from Georgia. Fivehave substantial districts south of the gnat line. The othernine are to the north. The congressional districts in thesouth are geographically very large. In fact, there is atremendous amount of geography south of the gnat line.

And while there are “areas of prosperity” south of theline, many communities, once prosperous and vibrant,are dead or on life support and have little hope for any-thing better. Some of our colleges to the south are losingenrollment. Some of the hospitals in the south are infinancial trouble. When I was in the state legislature I was close friendswith Joe Frank Harris, one-time chairman of the House

Appropriations Committee and later governor. He isfrom Cartersville in north Georgia. I was also a close

friend to Marcus Collins, a big, burly farmer(his arms were bigger than my legs) from

Cotton in Mitchell County deep in SouthGeorgia. Marcus chaired the House Ways and

Means Committee and he and Joe Frank wereclose friends. Joe Frank seldom allowed any

agitation to show, even if he was irritated.Marcus was constantly saying to Joe Frank:

“We never get any money south of thegnat line.” One day in an exas-perated tone Joe Frank,

responded: “Exactly, where is the gnat line?” Marcus,retorted in his deep Southern drawl: “Well, it’s that linebelow which we never get any money.” South Georgia, at least much of it, needs help. Thesolutions are difficult and perhaps financially impossible.But, at a minimum, something desperately needs to bedone about the inadequacies of many of the publicschools and some of the hospitals in the southern part ofour state. I know that work is being done, as evidencedby Governor Deal’s recent efforts, but he has to have help. It seems that it will be very difficult to get new indus-tries, with the much-needed jobs, to locate in SouthGeorgia communities where there are marginal publicschools and much non-sustainable healthcare. I’ve talked to lots of people about this matter. Mostagree that something must be done, but few have ideasof anything that possibly could help. An exception to thisis Lindsay Thomas. continued on page 37

W

he Medical Association of Georgia wants the statelegislature to pass bills that it says will increase

patient access to safe medical care. MAG executivedirector David Palmisano says perhaps the most impor-tant of those would be a reform package requiring insur-ers to expand physician networks, especially in emer-gency room situations. “We continue with our mission to find ways and solu-tions to have better access for the patient,” he said. “Thatis always first and foremost.” Any patient may have to search to find a doctor who ispart of an insurance plan’s network to get the best cover-age and pricing, but the issuebecomes acute when emer-gency care is needed.According to Palmisano, apatient may show up at a hos-pital that is in his or her net-work for emergency care, onlyto find out later that the radiolo-gist or other care provider work-ing at that hospital is not in thepatient’s network. That usuallyresults in higher co-paymentsand out-of-pocket payments. “The problem arises because insurance networks arenot adequately disclosed to patients,” he notes. “At theend of the day, it is not fair to the patient.” Actually, MAG’s attack on this issue will have threeprongs. Beyond expanding networks, it wants to see legisla-tion that makes the negotiating process more transparent.And, since emergency room bills are often among themost difficult to collect, it wants to see a payment methodthat ensures physicians are paid for their work in the ER. This is where MAG expects one of its toughest leg-islative battles of the session. Insurance companies,which have well-funded lobbyists, are likely to resist leg-islation that requires them to expand networks. “Thehealth plans will fight us all the way,” MAG governmentrelations director Derek Norton says.

Overall, Palmisano and Norton expect to find afriendly atmosphere under the gold dome. That will beimportant as they see 2017 as a year with the potentialto get a lot done. In 2018, every member of the legisla-ture will be up for election, as will an open governor’soffice. Anything that comes up then will face the usualelection-year resistance to making big changes. “Someyears you can really get into the meat of the issues,”Norton said. “This is one of those years.” MAG also is hoping the legislature supports a pro-gram encouraging patients who have had a negative out-come in health care to work with the provider to identify

the cause of the outcome andto reach a fair settlement with-out litigation. It expects fullpushback from personal injuryattorneys but insists the pro-gram would be helpful to bothpatients and providers.

“The patient wants toknow what happened andwhat is being done to preventit from happening in thefuture,” Palmisano said. “Thisis to try to encourage the

physician and the patient to talk about what happened.” Some of MAG’s legislative focus will be defensive. Itopposes bills that would allow physician assistants andoptometrists to perform additional duties. It also expectsa bill to allow physician assistants to prescribe ScheduleII narcotics. That, according to MAG, would contribute toa growing opioid problem. “We should not allow more andmore prescribers,” Palmisano said. In fighting the opioid epidemic, MAG points to Gov.Nathan Deal’s recent decision to have naloxone approvedto use on an emergency basis. That move was by execu-tive order, and the association would like to see it madestate law in the legislature. continued on page 37

T

aving been around a few years, I havecome to know that the second Monday ofeach January is the convening of the 2017Georgia General Assembly right

after Sunday’s Wild Hog Supper. This will mark my43rd Legislative Session and it isan honor to be recognized asthe “Dean of the House” and“Chairman Emeritus” of theHouse Democratic Caucus.Like all other sessions, thisone will be filled with com-pelling and competingissues. By far, the mostimportant matter in eachlegislative session is thestate budget. It is the onlyconstitutionally mandatedlegislation that we arerequired to do as legisla-tors— and it is the oneissue that always definesthe legislative session. One of the pressingissues that we will addressduring the budget process is the Quality Basic Education(QBE) funding formula. The House Democratic Caucusbelieves that every child should have access to a high-quality public education regardless of where they live,what their parents do, or any other characteristic.However, we must invest the funds necessary to ensure

our students receive the education they deserve, or werisk making them— and by extension, Georgia— lesscompetitive in the national and global economies. Georgia’s public schools have not recovered from

more than a decade of austeritycuts. Although recent budgetshave restored more money to theclassroom, our schools still do not

receive the full fundingrequired by the QBE for-mula. The long-termeffect of these cuts has

meant educators losingtheir jobs across the state and95% of school districts increas-ing class sizes.

While we have mademajor strides in the last fewyears to improve funding, theannual education budget stillfalls short. Changes to theeducation funding formula willbe up for discussion, and welook forward to workingtowards a formula that prom-

ises a sustainable, long-term solution. When the budget process unfolds, we must also turn

an eye toward other critical issues that impact the healthand economic security of our residents. While the fate of

35NOVEMBER/DECEMBER 2016

continued on page 36

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Ready for 201 7! InsiderAdvantage Georgia enters into 2017 with additional staff writers! Also, as in past years,we are operating out of a satellite office in the press gallery inside the Coverdell Legislative OfficeBuilding in downtown Atlanta to cover the 2017 Georgia General Assembly. With veteran journalists Baker Owens and Cindy Morley as our lead reporters, we’ll bring youdaily updates on what’s happening when the legislature is in session. Cosby Woodruff is ournewest writer who covers various political, business and cultural topics, as does our operationsmanager/staff writer Patrick Hickey. Furthermore, check out the Forum opinion section on the InsiderAdvantage.com website. We pub-lish commentaries from leading Republicans, Democrats and others on vital public policy issues.

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the Affordable Care Act is uncertain, it cannot and willnot be dismantled overnight. Therefore, we must addressthe pressing need to expand Medicaid in order to preventthe closure of a dozen rural hospitals in our state, andbring healthcare to nearly 500,000 Georgians. I expect therenewal of the hospital provider fee, or “bed tax” to be asignificant issue, as the fee is set to expire at the end ofthe year. Medicaid and PeachCare funding is extremelydependent on the fee. Closures are devastating because rural hospitals do

more than just provide healthcare— they are the econom-ic engines of communities across the state. When a hos-pital closes, surrounding businesses are shuttered, jobsare lost, and people are forced to endure ambulance waittimes for as long as 90 minutes. The cost of saving ourhospitals is too high for Georgia to handle alone. Onesolution available to prevent further hospital closures isMedicaid expansion. The House Democratic Caucus willurge legislators on both sides of the aisle to come togeth-er to address this issue. In addition to building a healthy workforce, we mustwork collectively to build a well-educated workforce thatis prepared to enter our thriving economy. While GeorgiaDemocrats must work to ensure that K-12 education isappropriately funded, we must also provide students withthe opportunity to attend college. A college education isincreasingly important for working Georgians.

Approximately 60 percent of jobs in Georgia willrequire some form of postsecondary education by 2020,but many students under our current HOPE scholarshipsystem still struggle to pay for a higher education. Between 2013 and 2014, 13,000 students in good aca-

demic standing were dropped because they couldn’t payfor classes. This problem persists, and tuition costs andmandatory fees have risen consistently over the last sev-eral years, while state funding per student has droppedby 26% since 1990. The House Democratic Caucus is committed to work-

ing across the aisle to address the issue of college afford-ability. Having served on the 2015 Preservation of HOPEScholarship Program Study Committee a statewide refer-endum to allow casino gambling in Georgia was pro-posed and tabled during the 2016 session, but it isexpected to return to the General Assembly for consider-ation this session. While the Caucus has not taken a posi-tion on the proposed referendum, our goal is that anysuch proposal also includes a commitment to fundingneed-based aid and gap funding under the HOPEScholarship Program— what we call “HOPE 2.” I, along with the Georgia House Democratic Caucus,

look forward to a productive session where we continueworking on behalf of all families in Georgia. It is our honorto continue to serve.

Larry Walker is a practicing attorney in Perry. He served 32 yearsin the Georgia General Assembly and serves on the UniversitySystem Board of Regents.

State Rep. Calvin Smyre is a Democrat from Columbus.

from Georgia Below the Gnat Line, page 31

Lindsay, who lives on his family home place in WayneCounty, is a former member of Congress (10 years) andlater the executive director of the state Chamber ofCommerce. Lindsay can articulate the problems muchbetter than I can and has realistic ideas about whatmight help. One of his intriguing suggestions is that there be anemphasis on eco-tourism with our state parks beingexpanded and improved to the extent that they becometourist destinations. Lindsay envisions such things asriver rafting, fishing, quail hunting, camping, hiking andsimilar opportunities to entice Georgians and non-Georgians to spend time and money in South Georgia. My idea is that the state, through tax and otherincentives, encourage the agriculture industry— fertilizerplants, equipment manufacturers, feed plants, etc. Inother words, try to pair industries with agricultural inter-ests and workers that know about agriculture. And, bythe way, we do have some of the best farmers in theworld south of the gnat line as evidenced by our state’sleadership in pecans, peanuts, peaches, timber, blueber-ries, cotton, onions and other crops. What about some government consolidations? I won’tgo there this time. However, I do think it is like Marcustried to tell Joe Frank many years ago: We are going tohave to spend some more money south of the gnat line.

from Medical Association of Georgia, page 33

MAG also expects a bill that would allowoptometrists, rather than only ophthalmologists, toadminister injections in or near the eye. “We don’t wantoptometrists to be able to perform injections to thatextent,” Palmisano said. Other issues on MAG’s radar would largely be invisi-ble to patients, but they matter to providers. Doctors are required to periodically pass a mainte-nance of certification exam, but MAG insists those testsoften do not reflect a doctor’s skills. Still, a doctor’slicense or privilege to work at a certain hospital can beimpacted by the exam. “These tests are not related toimproving care of patients,” Norton said. Instead of measuring patient care, the tests havebecome a bureaucratic nightmare that has the potentialto turn into a mountain of red tape. So MAG wants to

ensure these tests are not used to impact a doctor’sability to practice, and it wants to reduce the burden ofpreparing for the exams. According to MAG, the examscan cost more than $10,000. The group also will push legislators to continue tofund the Medicaid parity payment program for all areas ofprimary care. This basically ensures physicians whoaccept Medicaid patients will be paid a reasonable ratefor their services. And MAG basically admits one of its legislative prior-ities is going no place fast. The group had hoped toexpand coverage for uninsured Georgians, but nationalpolitical changes mean that effort won’t happen this year.

Cosby Woodruff is a staff writer for James magazine.

y the year 2025 Georgia is expected tohave a shortage of 1,310 primary carephysicians. This shortage is primarily dueto the state’s population growth, as well asto the aging of the population, according

to a study released in November by the U.S. Departmentof Health and Human Services National Center forWorkforce Analysis. Five medical schools across the state,together with numerous hospitals, are working to allevi-ate this deficit by educating medical students, in addi-tion to working to establish new residency programs Eleven years ago the Philadelphia College ofOsteopathic Medicine, a medical school founded in 1899in the “City of Brotherly Love” and steeped in tradition,established a branch campus in Suwanee— becomingthe fifth medical school in the state. With a focus on help-ing to fill Georgia’s needs, especially for primary carephysicians, Georgia Campus— Philadelphia College ofOsteopathic Medicine (GA-PCOM) is now seeing resultsas our graduates finish residency programs and begin thepractice of medicine. Our students further their training in residenciesacross all specialties from neurosurgery to radiology toprimary care. We are pleased to report that 42 PCOMgraduates have chosen to practice family medicine inGeorgia following their three year residency program. In

addition, 29 physicians in the specialty of internal medi-cine are practicing in the state. This data was culled fromreports provided by the Georgia Board for PhysicianWorkforce. The majority of these primary care physiciansare graduates of the Georgia campus with a handful hav-ing graduated from our Philadelphia campus. Many of our graduates have served as chief residentsfor their programs. Chief residents, who are in their finalyear of training and with the support of their peers andfaculty, serve as a bridge between the residents and fac-ulty members, thus using many of the skills they learnedwhile undergoing osteopathic medical training. These primary care physicians practice across thestate in towns and cities from the Piedmont region to theBlue Ridge area to the Coastal Plains. They call cities likeThomasville, Leesburg, Moultrie, Blairsville, Nashville,LaGrange, Tifton, Lavonia, Waycross, Albany andHazelhurst home. We celebrated the 10 year anniversary of GeorgiaCampus last year. During that time we appreciated whatDenise Kornegay, executive director of the GeorgiaStatewide Area Health Education Network, said:

“The establishment of GA- PCOM ten years agowas a critical development in the face of Georgia’sextreme physician shortages. Each year, largenumbers of GA-PCOM graduates are choosingboth residency opportunities and practice opportu-nities in our state. GA-PCOM is truly a part of ourstate’s ‘solutions.’”

Bryan Ginn is the Chief Campus Officer of the Georgia Campus of the

Philadelphia College of Osteopathic Medicine.

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