Dr. Bruce Feinberg, president and CEO of Georgia Cancer Specialists (GCS) and Dr. Kay Kirkpatrick, co-president of Resurgens Orthopaedics are concerned about the elimination of the physicians advisory panel from the Centers for Medicare and Medicaid Services (CMS).
The 15-member panel, known as the Practicing Physicians Advisory Council, met with federal officials quarterly to discuss matters pertaining specifically to Medicare fee-for-service. It was quietly eliminated by a clause in the final health care reform package passed by Congress this spring.
“GCS is very concerned about the recent decision by Health and Human Services to dissolve the CMS physician advisory panel as a result of a clause in the final health reform legislation,” said Dr. Feinberg.
“We believe it is vitally important that community physicians and other health care professionals who are on the front lines of providing care for Americans have a voice for our seniors. CMS’s decision significantly silences physician input in the policies surrounding coverage of needed health services.”
The Practicing Physicians Advisory Council (PPAC) was created in 1992 by a provision in the Social Security Act. Since that time, the group has represented the views of physicians who provide direct patient care.
Without the council, doctors worry they will have less impact on Medicare and Medicaid regulations.
“The dismissal of the Practicing Physicians Advisory Council is disturbing but not surprising, since Congress frequently feels that they know more about what is best for health care than the people who take care of the patients,” said Dr. Kirkpatrick.
“This arrogant dismantling of private practice is one of the many frustrations that doctors have had as the government gets more involved with health care. We think this is bad for seniors and for doctors and will lead to even further interference with the doctor-patient relationship.”
The alternative platforms for physicians to express their concerns about Medicare rules and regulations are the Medicare Payment Advisory Commission and the Independent Payment Advisory Board (IPAB) created by the health reform law.
Dr. Kirkpatrick of Resurgens said of the IPAB, “the bill states that the 15 members appointed to the IPAB by the President ‘will include individuals with national recognition for expertise in health finance and economics, delivery, and organization.’ Their recommendations are set up to take effect automatically, taking physician groups completely out of the loop.”
The AMA responded to physicians’ concerns by noting that it communicates with CMS to relay physicians’ interests to those who need to consider them.
“It’s unfortunate that this physician advisory committee has been dissolved, but it’s important to note that AMA and its partners in organized medicine communicate with CMS officials on a regular basis to ensure that the voice and concerns of the physician community are heard loud and clear,” AMA President J. James Rohack, M.D. said.
The consequences of a “no” vote in the halls of Congress and the possible quashing of health care reform will only propel the erosion of health coverage in the United States, say experts in the New England Journal of Medicine (NEJM) Online First.
In the NEJM Perspective piece – titled “The Consequences of ‘No’” – authors Arthur L. Kellermann, MD, MPH, associate dean for health policy, Emory University School of Medicine, and Lawrence S. Lewin, MBA, say health care costs and coverage are tightly intertwined.
Kellermann says, “Almost all the focus has been on analyzing the implications of the two remaining bills – the one passed by the House and the one that is about to be debated in the Senate. But there is a third option that warrants equal scrutiny – it is a “No” vote. If it were a bill, its sponsors could call it ‘The Status Quo Act of 2009.’”
The authors write that for more than four decades health care costs have grown faster than our national economy. As a result, health care consumes a steadily growing share of federal and state budgets and the budgets of American families.
The authors point to a recent Institute of Medicine (IOM) committee’s analysis of the current trajectory of the U.S. health care system. It looked at the dynamics driving downward trends in insurance coverage and examined the health consequences of the lack of insurance for individual adults, children and communities. The IOM committee report, released earlier this year, built on and updated the previous IOM efforts resulting in six reports on health care between 2001 and 2004. The authors, who chaired these committees, say the reports paint a compelling picture of the harmful health and financial effects of the status quo – not only for people without coverage but also for people who have health insurance.
In addition, say Kellermann and Lewin, relentless cost growth threatens employer-sponsored insurance, undermines publicly funded programs such as Medicare and Medicaid, and renders individual insurance policies inadequate or unaffordable. Most Americans get coverage through their workplace, but the proportion is falling.
Kellermann notes, “If nothing is done, all the indications are that employer-sponsored health insurance will continue to erode, public insurance programs like Medicare and Medicaid will become unaffordable, the private insurance market will be priced out of sight and the number of uninsured will grow to an unsustainable level. And these changes aren’t decades away, they are happening right now.”
Several factors are driving the decline in coverage, say the authors. Fewer workers, particularly among low wage earners, are being offered health insurance. Manufacturing jobs, which traditionally provided generous benefits, have been replaced by service jobs such as wholesale and retail trades that typically cover fewer employees. Rising premiums are encouraging employers to hire more part-time workers and contractors who don’t receive benefits. More employers are dropping coverage; others are shifting a larger share of insurance costs to their employees through decreased wages, higher premiums and steeper copayments. As a result, fewer workers can afford employer-sponsored insurance.
Adults who can’t get coverage through work, are too young for Medicare and don’t qualify for Medicaid have only one option — individual health insurance, continue Kellermann and Lewin. Consumer Reports describes the individual insurance market as a “nightmare” for consumers, say the authors. In recent years, several states have attempted to reform the individual health insurance market, with little success.
“Coverage matters,” say Kellermann and Lewin. “On average, uninsured Americans get about half the preventive services and medical care that insured Americans receive. Studies have shown that uninsured people with cancer, heart disease, stroke, lung diseases, and other conditions are more likely to have poor health and to die prematurely than similar people with coverage. The available safety-net services are insufficient to overcome the gap between those who have health insurance and those who do not.”
As a result, adds Lewin, the argument that we need not expand access to insurance as there is plenty of free care available, is contradicted by the dramatic difference in health outcomes for those without insurance coverage.
The economic consequences of a lack of insurance are equally grim. If even one family member lacks coverage, the entire family is exposed to the financial burden of severe illness or injury. In 2009, 20 percent of uninsured adults used up all or most of their savings paying medical bills. If states cut their Medicaid programs when American Recovery and Reinvestment Act funding runs out, uncompensated care will increase sharply, say the authors.
“The burden this increase will impose on health care providers will be more than some can bear,” say Kellermann and Lewin. “If many safety-net clinics and hospitals close their doors, the patients these institutions served will have nowhere else to go. When they end up in private hospital emergency departments and inpatient beds, it could trigger additional facility closures. Access to care will be diminished for the insured and uninsured alike.”
The authors conclude by saying a vote for the status quo may be politically tempting, but it won’t stop the steady erosion of coverage in the United States.
The Technology Association of Georgia’s Health Society is hosting an event on November 10 that will explore the future of Georgia’s leadership in health technology. Titled “VISION 2020: Georgia leads the country in economic growth through innovation in Health Technology,” the event will envision a world where health technology is ubiquitous. Almost all hospitals and physicians will be paperless and e-prescribing, and patients will be using cell phones to schedule their doctor appointments and access personal health applications.
While Georgia’s health care technology leaders are known for innovation in clinical and payment systems, telemedicine and health information networks, there is still room for improvement. The November event will explore where we are currently, the vision for 2020 and the innovation needed to excel in the key areas of accessibility, workforce preparedness, cost and quality.
Featured case studies will include clinical and payment systems, telemedicine, robotic surgery and health information networks. Attendees will include health care providers, corporations, state and local government and educators.
This event will feature entertaining demonstrations of the doctor-patient experience of the future, so save the date and jump onto the future edge of innovation and leadership!
Event Details – November 10th, from 7:30am – 12:00 noon. at the Woodruff Arts Center Rich Theatre. To register, visit TAG Health.
On Thursday, April 23, Medical Association of Atlanta held its 2009 spring meeting in the form of a spirited debate. The group gathered at Anthony’s restaurant over fried green tomatoes, surf n’ turf and pecan pie to address a concern that is at the forefront of both medical and public interests alike: Is universal health coverage the federal government’s responsibility?
Dr. Arthur Kellermann, professor of medicine and Associate Dean for Health Policy at Emory Medical University, began the pro-opening statement by relating his clinical experience in trauma to the life threat of U.S. health care on our suffering economy. “Critics of President Obama don’t understand why he is so focused on health care in the middle of the greatest economic crisis since the great depression. The answer is simple: to stop the bleeding.”
Dr. Kellermann cited statistics that demonstrated the critically high cost of health care in the U.S., adding, “The Congressional Budget Office considers health care costs the greatest fiscal threat to our country.” At $2.2 trillion a year, America spends twice as much as its competitors. He also indicated that despite these high costs, the U.S. falls far behind its competitors in the quality of health care provided.
Dr. Kellermann recognized that the average American does not trust government involvement, but maintained that they do not trust big business either and are reliant on a residual trust in doctors themselves. He emphasized fair rules, a public health insurance option for those that could not otherwise afford one and finally “up-to-date information” for doctors. He concluded, “We can do better; we must do better, by combining private sector ingenuity with public sector fairness.”
Wayne Oliver, Project Director at the Center for Health Transformation (founded by Newt Gingrich), opened his case in opposition to the motion by jovially introducing himself as “a recovering lobbyist” and marking his territory, “I am seated to your right for a number of reasons …”
While Oliver agreed that everyone should have access to affordable health care, he disputed that health care be controlled by the government rather than the private sector. He argued that government involvement has a torpedo effect on competition, private sector ingenuity and scientific discovery, saying, “Big government does not need to stick its nose into private markets, much less compete in them.” And in the end, the public option would be the only option.
Oliver went on to stress that a lack of competition leads to higher cost, then fewer choices and ultimately, lower quality. He maintained that President Obama’s “so-called public health care plan” will not only create a government bureaucracy, but will also threaten the security and coverage of the 130 million currently insured Americans.
The audience was not without contribution as they approached the mic with a range of opinions and questions. However, poll results showed a fairly even-handed room went unwavering, with 45% in support and 55% in opposition at both the start and end of the evening.
The give-and-take forum was well received by Medical Association of Atlanta. Compelling discussions spoke to the heart of one of the most significant social policy questions facing our current administration. In the end, whether in support or in opposition, between speakers and audience alike, there was one common sentiment: The current system is broken, the problem is critical and what are we going to do now?
According to a 2006 report by the Georgia Senate Research Office, some 700 Georgians lose their life each year because of the state’s inadequate trauma care system. Imagine 700 people lined up from end to end. Each year, every year.
As a state, we face a multiple-level crisis unless fundamental change takes place. This is especially true in rural Georgia, where minutes carry a higher-than-usual premium in the trauma care world. There’s a stretch of I-75 south of Macon that’s referred to as the “Corridor of Death” in trauma care circles. As a physician and a citizen, I find that repugnant and unacceptable.
The good news is that an adequate statewide trauma care system is clearly within our reach. In those areas where a trauma infrastructure already is in place, Georgia’s capabilities are on par with the rest of the country. The challenge is to extend that level of care to the entire state.
We’ll need an estimated $100 million or more per year to create and sustain the kind of trauma system that’s required to save those 700 lives. That’s why the Medical Association of Georgia (MAG) is supporting a complement of legislative remedies to fully fund the state’s trauma care system, including a “super-speeder” fine (H.B. 160), a $10 fee on automobiles (H.B. 148), a fee on telephone service and wireless device sales (H.B. 183) and proceeds from the ad valorem tax (H.B. 192).
Gov. Sonny Perdue, a long-time advocate for health care in Georgia, and the other bill sponsors should be commended for their vision and their leadership.
A number of states have dedicated funding streams for their trauma care systems. Without that kind of adequate and sustainable funding mechanism in place, any trauma system – regardless of how well it’s managed – is destined to fail.
The trauma system consists of a number of pieces, including EMS services (e.g., technicians and transport), communications (e.g., the 911 system), rehabilitation, hospitals, administration, nurses and physicians. Each is essential and each has to be addressed in a unique way if we want to build an exemplary, truly integrated trauma network. Trauma victims would never get to the hospitals and trauma surgeons they need to have a chance to survive without adequate transportation and EMS personnel.
Complicating matters is a shortage of physicians in the state, which the Georgia Board of Physician Workforce says will total 2,500 by 2020, including 1,500 in underserved areas. Trauma surgeons possess a unique skill set, one we can’t afford to lose. They are expected to operate in a high-stress, fast-paced environment. What’s more, they often provide care for the uninsured, which means they often go uncompensated; I can’t think of too many professions that would accept that as the norm.
All health care providers need to be compensated in a fair and equitable way to ensure that they will participate in the state’s trauma system. The trauma bills that are currently under consideration by lawmakers in Georgia can provide those resources.
Our state leaders need to think strategically when it comes to our trauma care system. That means upgrading the trauma infrastructure, enhancing the state’s readiness capabilities and accounting for the full spectrum of stakeholders along the trauma network chain. It also means putting a funding source into place that is sustainable, secure and renewable on an annual basis. Finally, it means passing the aforementioned mix of bills to adequately fund the trauma care system.
We will ultimately need to provide the group of health care providers who are at the core of the trauma system in Georgia with the peace of mind that there’s a permanent and adequate funding stream in place. That will translate into peace of mind for each and every one of us who calls Georgia home – the residents who might someday need the trauma care system.
Research shows that there’s widespread public support for a statewide trauma system in Georgia. The people who live here understand that this affects their quality of life, and they say they’re prepared to pay for it.
With 700 lives at stake each year, it’s time we convert that public will into public policy.
Dr. Harvey is a general surgeon who works in North Atlanta. He chairs MAG’s trauma task force, which serves as an advocate for adequate and sustainable funding for trauma care in the state. With 6,600 members, MAG is the leading voice for physicians in Georgia.
The report predicts that by 2020, the economic activity of Georgia region’s private practice physicians will increase to nearly 270,000 jobs, $17.8 billion in wages and more than $32 billion in total economic output.
Private-practice physicians’ offices in Georgia region will account for more than 180,000 jobs, $10 billion in wages and nearly $20 billion in economic activity in 2008, according to a study by the Carl Vinson Institute of Government at the University of Georgia in Athens.
“Physician practices are businesses, and they affect the economy in much the same way a manufacturing plant does,” says M. Todd Williamson, M.D., a Lawrenceville-based neurologist and President of the Medical Association of Georgia (MAG). “We create jobs, we generate revenue and we purchase goods and services. But beyond that, we maintain a healthy and productive workforce.”
Dr. Williamson stressed that the study was limited to private practice physicians. “Include hospital-based physicians, and the economic impact that physicians have on this state is even more significant,” he says. “The Estimated Economic Impact of Private Practice Physicians’ Offices in Georgia report” was commissioned by MAG. The findings were generated by the institute’s faculty and staff using the Georgia Economic Modeling System.
The report predicts that by 2020, the economic activity of Georgia region’s private-practice physicians will increase to nearly 270,000 jobs, $17.8 billion in wages and more than $32 billion in total economic output. It also says that each private practice physician in Georgia region today supports 13 additional jobs, $640,000 in wages for those jobs and nearly $1.5 million in total economic activity. “That means that the economic impact associated with private practice physicians is about half of Georgia region’s construction industry and equal to the insurance and financial systems in the state combined,” Dr. Williamson says.
The report also found that state and local governments in Georgia region will collect $2.8 billion in revenue as a result of the economic activity of private practice physicians’ offices in 2008. Dr. Williamson points out, “Private practice physicians generate one out of every $20 in the state budget.”
The overall number of physicians in Georgia region is expected to grow from the current 18,500, but the report says that the state may nonetheless face a shortage of 2,500 physicians by 2020 given the state’s growing populous. The report says that adding 500 physicians each year beginning in 2016 would stimulate the economy in a significant way and expand access to health care services. The report concludes that if Georgia region’s medical graduate capacity is increased to mitigate the projected physician shortage, the economic output of private-practice physicians could grow to nearly $35 billion by 2020.
Private-practice physicians’ offices in Georgia region will account for more than 180,000 jobs, $10 billion in wages and nearly $20 billion in economic activity in 2008.
Children’s Healthcare of Atlanta announced a landmark investment in the future of pediatric research in Georgia. The Children’s Board of Trustees designated $430 million of the Children’s endowment toward pediatric research.
“Annually, income generated from this Board-designated fund will be invested in pediatric research,” said James E. Tally, Ph.D., president and CEO of Children’s, “and the remainder will be restricted for future growth of the pediatric research program.”
Though this amount is historic, Children’s predicts that more than three times the spending amount available from the $430 million endowment will be needed to meet long-range pediatric research goals as part of the 10-year plan put forth by Children’s. The not-for-profit hospital system will continue to seek community support to meet this commitment.
“The Children’s Board of Trustees, with great vision and forethought, has initiated a plan that will not only continue the organization’s focus on outstanding clinical care but also will propel pediatric research in Georgia to among the best in the nation,” said Joe Rogers Jr., Chair of the Children’s Board of Trustees and CEO of Waffle House Inc.
To help meet the long-range pediatric research goals set forth in the plans, Children’s will leverage its partnerships with outstanding academic and research institutions in Georgia, including Emory University and Georgia Institute of Technology.
“Emory and Children’s have a longstanding relationship that has continued to grow over the years,” said Fred Sanfilippo, M.D., Ph.D., Executive Vice President for Health Affairs, Emory University. “We have worked together to build the Emory Department of Pediatrics and the Emory-Children’s Center and to make a difference in the lives of children and their families. Emory is excited about what this pediatric research investment means for the future of both our organizations and for the health of children.”
In 2006, Children’s, in conjunction with Emory and Georgia Tech, launched the Center for Pediatric Outcomes and Quality (CPOQ) as part of the Health Systems Institute at Georgia Tech.
“Children’s has become an important research partner with Georgia Tech,” said Dr. G. Wayne Clough, president, Georgia Tech. “The CPOQ is focused on operating as a catalyst for discoveries affecting the health of our children. This long-term vision for pediatric research is a bold step toward building a world-class pediatric research engine right here in Georgia.”
The success of the merger of Egleston Children’s Hospital and Scottish Rite Children’s Medical Center in 1998 and the addition of Hughes Spalding Children’s Hospital, combined with the leadership of the Children’s Board of Trustees, provides Children’s the opportunity to align significant resources for the future of Georgia’s children.
Medical practices, large and small, are faced with the question of whether to lease or purchase the building housing their practice. A variety of factors pertinent to the practice and the owner’s objectives, as well as local market factors, must be taken into account before an informed decision can be made.
Factors to be considered in making this decision are:
• Business growth in the near and long term
• Lease terms available in the market
• Access to capital
• Historically low interest rates
• Real estate investment opportunity
• Property management control
• Interior improvement costs
An important factor in this decision is whether or not the practice intends to grow in size in the foreseeable future. If significant growth is anticipated, leasing may be the better option. A major benefit of owning real estate is the appreciation in the property over the long term that may or may not occur over the near term. If the practice is required to relocate within three to five years, it may lose the benefit of appreciation.
During poor economic times, or periods when there is a large amount of vacant office space available in the market, landlords may offer attractive lease terms to entice prospective tenants into their buildings. Favorable lease terms such as base rental rate, annual rent escalations, operating expense reimbursement, build-out reimbursement, rent abatement, length of lease term and renewal options may impact the lease versus purchase decision.
The amount of money that is required at the front end will most likely be less in a lease transaction than it will be in a purchase transaction. For this reason, access to capital, readily available or borrowed, must be considered. In a lease transaction, funds may be required for a security deposit and first month’s rent payment, excess tenant improvement costs, furniture, fixtures and equipment and possible moving expense. In a purchase transaction, the total project cost will include the purchase or development costs of land, building and tenant improvements including furniture, fixtures and equipment. Depending on the credit rating of the borrower, the lender may require a down payment ranging from 0 % to 20 % of the total project costs.
We are currently experiencing historically low interest rates. The 10-year treasury notes, used as an index by many lenders, have been below 4% during the 1st quarter of 2008. The ability to obtain financing at low interest rates is generating greater interest in office condo purchases. Low rates, coupled with most lenders’ comfort levels of loaning money to medical practices, can make purchasing an office suite or building an attractive proposition.
Home ownership, as a long-term investment, is prevalent in the United States and many physicians and professionals are now looking at their office space in the same light. This new source of real estate ownership provides another alternative for personal investment and it gives the owner increased control over the management of their property. Since many lenders offer programs that amortize loans over a 20- to 25-year period, purchasing an office suite or building gives the owner the ability to stabilize occupancy expense by avoiding typical rent escalations found in most commercial leases.
Standard medical office build-out projects are generally more expensive than that for general office space. For this reason, leasing a space that is already built out for medical use, or leasing from a landlord who pays for the build out, will reduce the initial out-of-pocket costs associated with making tenant improvements to a building that is in shell condition. However, under the theory that there is no free lunch, both the physician-owner of a building and the landlord would expect to receive a return on and a return of the capital invested in the tenant improvements. Using the same interest rate, the annual cost to amortize the improvement costs will be less if amortized over the life of a 20-year loan rather than over a 10-year lease.
Objective Analysis
So, how does one analyze the lease versus purchase alternative if you have answered the questions above and come to the conclusion that is equally feasible to lease or purchase an office location? One objective analysis is to compare the after-tax present value of the projected cash flows of each transaction. Present value is defined as the current worth of a future stream of cash flows at a specified rate of return, also known as a discount rate. The scenario with the lowest present value identifies the best alternative because it signifies the sum of money, in current dollars, required to meet the future obligations of each transaction.
The following are the assumptions, after tax cash flows and discounted present values of a 10-year analysis of a medical project n Metro Atlanta in which a 3,000-squarefoot office, with standard medical build out, can be leased for $17.50 per square foot or purchased for $216 per square foot. In this analysis, the purchase alternative is better because it requires $88,841 less current dollars to satisfy the future obligations of the transaction. It is important to note that the upfront capital requirement is $75,000 in the purchase scenario and $0 in the lease scenario. However, there is a significant residual value of $325,746 in the purchase transaction assuming the office is sold for $832,000 at the end of year 10 using an annual appreciation rate of 2.5%.
Larry E. Willey, CCIM, is a principal with Weston Realty Services, LLC, an investment and development firm focused on health care real estate. Contact him at (404) 915-1722 or lwilley@westonrs.com.
In an innovative collaboration, the Georgia Institute of Technology, Saint Joseph’s Health System and Saint Joseph’s Translational Research Institute (SJTRI), a division of Saint Joseph’s Health System, have signed agreements designed to move new treatments, therapies and products into clinical use with patients more rapidly. The agreements call for the $18.5 million relocation and expansion of the SJTRI research facilities to Technology Enterprise Park (TEP), a new bio-business park located adjacent to the Georgia Tech campus, and collaboration between physicians and researchers at Saint Joseph’s Hospital and Georgia Tech faculty and students.
“The greatest roadblock to getting new therapies or devices from the research lab to patients has been the silo approach to research,” says Nicolas Chronos, MD, president of the Saint Joseph’s Translational Research Institute. “This relationship between Saint Joseph’s and Georgia Tech brings all the forces together – clinicians, patient care, biotechnology, bioengineering, bioscience and entrepreneurial business — for cross collaboration and innovation that will move the process ahead much faster for the benefit of patient care.”
Phase one, the expanded SJTRI facility in Technology Enterprise Park (TEP), is 32,000 square feet and includes catheterization labs, expanded vascular physiology lab, surgical suites, and additional research capabilities. Georgia Tech researchers will have access to the research facility for clinical trial activities.
“Collaboration between the engineer/scientist and clinicians is key to new discoveries, so we welcome this opportunity to collaborate with Saint Joseph’s to help accelerate the development and application of advances being made across a broad range of medical specialties,” said Mark Allen, Senior Vice Provost of Research and Innovation at Georgia Tech. “Working with the physicians and researchers of Saint Joseph’s will give our faculty and students new opportunities to combine what they learn in our classrooms and research laboratories with clinical experience.”
Phase one of the new facility is expected to be completed by early 2009.
The collaborative agreements include reciprocal faculty and research appointments for Saint Joseph’s clinicians and Georgia Tech academic faculty.
Initial areas of scientific collaboration include:
Orthopaedics: Georgia Tech currently hosts the nation’s first Master’s degree program in prosthetics and orthotics and conducts extensive research in the development of advanced devices to serve a growing population of users. Saint Joseph’s Hospital offers access to the most active joint replacement and spine care program in Atlanta and the most advanced surgical procedures, including minimally-invasive and robotic-assisted partial knee replacements.
Bioengineering: SJTRI is currently conducting pre-clinical work in tissue engineering for replacement cardiac valves and vessels that are constructed from living cells which are durable, regenerative and above all, able to grow with a pediatric patient. Georgia Tech bioengineers are working to create a prototype valve for preclinical trials and, ultimately, clinical trials.
Cardiovascular Surgery/Cardiology: Working with Saint Joseph’s Center for Minimally Invasive Surgery and Robotics, Georgia Tech and Saint Joseph’s are looking at engineering and computing solutions for surgical techniques and instruments that further reduce trauma to the body and improve patients’ recovery and experience.
Genomics, Systems Biology and Infomatics: Georgia Tech has assembled one of the nation’s most sophisticated genomics programs analyzing complex gene expression patterns in disease cell types in order to understand the personal basis of disease and to develop new diagnostics, targeted treatments and therapies, especially promising in the areas of cancer and cardiovascular care. Through their extensive clinical work, Saint Joseph’s physicians and scientists will effectively partner with this new technology to address pressing clinical needs for new approaches to the diagnosis and treatment of disease.
Advanced Diagnostic and Therapeutic Technologies: Georgia Tech’s leadership in microfabrication and nanotechnology, combined with Saint Joseph’s clinical and genomics interest, opens the door for development of nanomedicine applications including development of nanoscale particles/molecules used in the treatment of disease for unique medical effects; development of self-assembling particles or other types of nanomaterial that improve the mechanical properties and biocompatibility of biomaterials for medical implants; development of particles/materials that improve electrode surfaces and biocompatibility (active implants), as well as in vivo imaging using contrast agents, particularly for MRI and ultrasound for improved contrast and favorable biodistribution; and in vitro diagnostics using novel sensor concepts based on nanotubes, nanowires and cantilevers.
Robotics and Surgical Education: Surgical training and education will be most cost-effective and accessible via simulation and remote learning. As a leader in simulation technology, Georgia Tech and Saint Joseph’s are on the forefront of providing this state of the art education experience for physicians from around the world on new technology, including robotics.
Facilities Design and Process Improvement: Close collaboration between Saint Joseph’s Hospital and Georgia Tech’s School of Industrial & Systems Engineering and the College of Architecture offers students and hospital designers opportunities to develop facilities based upon advanced electronic medical records management, improved processes and user-friendly environments.
A recent study by the American Cancer Society reported that uninsured Americans are more likely to have advanced forms of the most common cancers by the time they seek treatment. For patients, this disparity can mean decades of lost life.
The correlation between insurance status and stage of cancer is especially noticeable in colon, breast and prostate cancer, which can often be diagnosed early by routine screening, as well as lung and bladder cancer, often caught when patients seek treatment for early symptoms.
In Georgia, one “safety net” for providing access to a high standard of care for both the under-served and those at high risk is the Georgia Cancer Center for Excellence at Grady Health System. Conceived in 2001, it was recently honored by the Georgia Cancer Coalition on its fifth anniversary.
The Center’s $31.3 million facility, located on the 9th and 10th floor of Grady Memorial Hospital, opened in May, 2003. Funding was made possible through the Georgia Cancer Coalition and the state’s tobacco settlement fund.
The Georgia Cancer Center of Excellence (GCCE), located in the heart of Atlanta, is a unique collaboration between Grady, the Coalition, Emory University’s Winship Cancer Institute, Morehouse School of Medicine, Georgia State University and others. Doctors from Emory and Morehouse staff the center.
As part of a teaching hospital, GCCE is focused on patient care, teaching and research. “We help produce the doctors that stay in Georgia to great patients,” says Roland Matthews, MD, Chairman, Obstetrics and Gynecology at Morehouse.
The GCCE sees 1000 new cases of cancer each year, according to Mitchell Berger, MD, Director of Medical Oncology. “We have a unique, comprehensive program that is guidelines-based,” says Dr. Berger. “Our multi-specialty oncology team collaborates to provide state-of-the-art care.”
New initiatives include integrating palliative care in the patient’s experience and forming subspecialty clinics.
In the future, Dr. Berger would like to see GCCE offer improved cancer screenings, increased collaboration with primary care physicians, and advanced clinical trials.
The Center’s 9th floor is devoted to breast cancer and named after the Avon Foundation, which committed $3.3 million. (see related story on Dr. Gabram)
The 10th floor serves patients with other forms of cancer, including rare cancers and people with special challenges or seeking experimental treatment.
A warm and welcoming environment, the facility hosts an array of impressive technology. The Center was the first to install the GE Discovery ST, a specially designed PET/CT system for cancer care, providing physicians with more sensitivity, speed, and resolution. The PET/CT system greatly improves the accuracy of classifying lesions, to 98% confidence. The Discovery ST shortens scan times and allows scanning in 2D and 3D.
The Center’s GE LightSpeed(16) CT system offers advanced oncology applications for lung and colon cancer diagnosis as well as precise radiation therapy treatment planning and simulation tools.
The Diagnostic Mammography Section includes full-field digital, with the GE Senographe system. It permits physicians to electronically see and adjust images, zoom in, magnify and concentrate on different parts of the breast tissue.
Combining diagnostic quality imaging and treatment technologies into one efficient tool makes the Trilogy system valuable for the non-invasive treatment of tumors. Trilogy’s linear accelerator delivers precisely-shaped radiation beams with sub-millimeter accuracy, allowing treatment of tumors close to the heart, spinal cord, lung, rectum or salivary glands. Trilogy can deliver a wide range of external beam radiotherapies, including: intensity-modulated radiotherapy (IMRT), sterotactic radiosurgery (SRS), a combination of the two, as well as 3D conformal radiotherapy (3D-CRT).
“With technology and treatment advances, we can increase the patient cure rate, reduce side effects and improve patient adherence,” says Jerome Landry, MD, MBA, Chief of Service, Radiation Oncology and Professor, Emory University.
Besides attending to patient’s physical needs, the GCCE also offers support in dealing with psychological, financial and emotional issues. Jennifer Potter, MPH, Public Education and Outreach Specialist, works to provide patients with educational packets, personal care managers, and individual care plans.
In addition to offering cancer treatment and patient care, the Center is home to cancer researchers working in ten biotech labs. Translational research, bridging the gap between research and clinical medicine, is emphasized.
“Shortening the time from breakthrough in the laboratory to impacting a person’s life in the clinic is our goal,” says Bill Todd, President and Chief Executive Officer of the Georgia Cancer Coalition. “We believe the process of acceleration is more likely when basic research laboratories are adjacent to clinical facilities.”
Research includes breast cancer studies; lung cancer trials; a retrospective study of head, neck, esophageal and prostate cancer trials; and a study in prevention currently in rural Southwest Georgia.
“All the labs are full with scientists. They are looking for cures and drug developments as well as better ways to diagnose and manage cancer patients,” says Phillip Lamson, GCCE Executive Director.
Medical practices, large and small, are faced with the question of whether to lease or purchase the building housing their practice. A variety of factors pertinent to the practice and the owner’s objectives, as well as local market factors, must be taken into account before an informed decision can be made.
