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Archive for July, 2008

Atlanta Medical Association: National Meeting

Saturday, July 26th, 2008

July 26-31, 2008

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TAG: Clinical Technology in Women’s Healthcare

Thursday, July 24th, 2008

July 24, 2008 – 5:30 PM – 8:30 PM at Saint Joseph’s Hospital
www.tagonline.org

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CON Filed for Children’s at Hughes Spalding

Wednesday, July 16th, 2008

Children’s Healthcare of Atlanta plans to revitalize facilities at its Children’s at Hughes Spalding campus. Children’s hopes to break ground on the facility at Children’s at Hughes Spalding in the late Spring of 2008 with completion by late 2009. While the facility is still owned by Grady Health System, Children’s assumed management of this pediatric facility in 2006.

Children’s has identified several areas of focus for the future of Children’s at Hughes Spalding. These include primary care, sickle cell disease, asthma, and child protection, areas where Children’s at Hughes Spalding can play a unique role in meeting the needs of the community.

Children’s also has worked closely with the leadership from Morehouse School of Medicine to expand the school’s pediatric residency program. Morehouse residents will now have access to higher acuity patients at Children’s at Egleston and Children’s at Scottish Rite, in addition to their experience at Children’s at Hughes Spalding.

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The Perfect Combination of Technology and Expertise

Tuesday, July 15th, 2008

oct-2007.jpgThe physician team working with Northside Hospital Cancer Center’s new Trilogy, a stereotactic linear accelerator, appreciate the greatly expanded treatment options for patients.

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WellStar Physicians Group Expands

Monday, July 14th, 2008

Christopher L. Stevens , M.D., is now accepting patients full time at WellStar Urgent Care at Sandy Plains. Dr. Stevens received his medical degree in 2000. He completed his family practice residency training at Anderson Family Practice Residency in Anderson, SC. Dr. Stevens became Board Certified by the American Board of Family Practice in 2004. Prior to joining WellStar Urgent Care at Sandy Plains, Dr. Stevens was a founding member of Preferred Physician’s Group, LLC.Cristina Lau, M.D., is accepting patients at WellStar East Paulding Pediatrics.

Dr. Lau received her medical degree in 2000 from Universidad del Norte, Barranquilla, Colombia. She completed her pediatric residency training at Morehouse School of Medicine. Prior to joining WellStar East Paulding Pediatrics, Dr. Lau served as a member of the student medical committee and was honored with the Dr. Joseph Miller Service Excellence Award.

ana_zully-teran.jpgAna-Zully Teran, M.D., is now accepting patients at WellStar Psychiatry. Dr. Teran received her medical degree from Universidad de Carabobo in Venezuela. She completed her residency training at Emory University in Atlanta, GA.

Prior to joining WellStar Physicians Group, Dr. Teran completed a Physiology & Endocrinology, Clinical Research fellowship at the Medical College of Georgia. Her professional interests include Mood Disorders, Psychiatry-Ob-Gyn related illnesses: Postpartum Depression, pre-menstrual syndrome, peri & post menopausal syndromes and premenstrual dysphoric syndrome.

brumitt_kenytta.jpgKenyetta Brummitt, M.D., will be accepting patients at WellStar North Douglas OB GYN. Dr. Brummitt received her medical degree in 2000 from Morehouse School of Medicine in Atlanta, GA. She completed her Residency in Obstetrics and Gynecology at Temple University Hospital in 2004. In 2007, Dr. Brummitt was certified by the American Board of Obstetrics and Gynecology. Prior to joining WellStar North Douglas OB GYN, Dr. Brummitt practiced medicine in the Atlanta area for several years and previously served as Co-Chief Resident of Obstetrics and Gynecology at Temple University Hospital.

Kirk Hewling, M.D., is now accepting patients at WellStar Powder Springs Medicalkirk-hewling.jpg Center. Dr. Hewling received his medical degree in 2003 from Howard University College of Medicine in Washington D.C. He completed his residency training at Emory University School of Medicine, Department of Family Medicine. Prior to joining WellStar Powder Springs Medical Center, Dr. Hewling served at WellStar Urgent Care at Sandy Plains.

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Children’s Healthcare of Atlanta Designates $430 Million for Pediatric Research

Tuesday, July 8th, 2008

April 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.

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Quantum And Wellstar Bring 256 Ct Scanner To Atlanta

Friday, July 4th, 2008

July/August 2008

mdn-july_aug-2008150.jpgDrs. Cinnamon and Datta of Quantum Radiology detail the amazing benefits of the new 256 Philips CT scanner.

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FDA Clears Breast Cancer Specific Molecular Prognostic Test

Thursday, July 3rd, 2008

March 2007

The U.S. Food and Drug Administration (FDA) cleared for marketing a test that determines the likelihood of breast cancer returning within five to 10 years after a woman’s initial cancer. It is the first cleared molecular test that profiles genetic activity.

The MammaPrint test uses the latest in molecular technology to predict whether existing cancer will metastasize (spread to other parts of a patient’s body). The test relies on microarray analysis, a powerful tool for simultaneously studying the patterns of behavior of large numbers of genes in biological specimens.

The recurrence of cancer is partly dependent on the activation and suppression of certain genes located in the tumor. Prognostic tests like the MammaPrint can measure the activity of these genes, and thus help physicians understand their patients’ odds of the cancer spreading.
MammaPrint was developed by Agendia, a laboratory located in Amsterdam, Netherlands, where the product has been on the market since 2005.

“Clearance of the MammaPrint test marks a step forward in the initiative to bring molecular-based medicine into current practice,” said Andrew C. von Eschenbach, M.D., Commissioner of Food and Drugs. “MammaPrint results will provide patients and physicians with more information about the prospects for the outcome of the disease. This information will support treatment decisions.”

Agendia compared the genetic profiles of a large number of women suffering from breast cancer and identified a set of 70 genes whose activity confers information about the likelihood of tumor recurrence. The MammaPrint test measures the level of activity of each of these genes in a sample of a woman’s surgically removed breast cancer tumor, then uses a specific formula, known as an algorithm, to produce a score that determines whether the patient is deemed low risk or high risk for spread of the cancer to another site. The result may help a doctor in planning appropriate follow-up for a patient when used with other clinical information and laboratory tests.

The MammaPrint is the first cleared in vitro diagnostic multivariate index assay (IVDMIA) device. Several months ago, FDA issued a draft guidance document concerning the need for these complex molecular tests to meet pre-market review and post-market device requirements even when the tests are developed and used by a single laboratory. Although FDA regulates diagnostic tests sold to laboratories, hospitals and physicians, it uses discretion when regulating tests developed and performed by single laboratories.

Prior to clearance, FDA requested evidence that the MammaPrint had been properly validated for its intended use. Agendia submitted data from a study using tumor samples and clinical data from 302 patients at five European centers. These studies confirmed that the test was useful in predicting time to distant metastasis in women who are under age 61 and in the two earliest stages of the disease (Stage I and Stage II) and who have tumor size equal to or less than five centimeters and no evidence that the cancer has spread to nearby lymph nodes (lymph node negative). FDA plans to publish a special controls guidance document describing types of data that should support claims for genetic profiling for breast cancer prognosis.

PHYSICIAN’S VIEWPOINT

srinivasiah.thumbnail.jpgFollowing are the comments of Jayanthi Srinivasiah, MD (Dr. Jay)

The current testing that has been approved, MammaPrint, looks at 70 different regulator genes for breast cancer, which can predict chances of recurrence in a distant site in women who have stage one and two breast cancers that are node negative and resected. Similar profiling assays like the Oncotype DX assay (21 gene profile assay) is currently available in the United States and is being evaluated in an an ongoing Taylor RX adjuvant clinical trial for Breast Cancers that are node negative and ER positive. [Jayanthi Srinivasiah] Both these tests and other similar gene profiling assays will hopefully avoid toxic therapies in the low risk subset of patients and help provide more aggressive and directed therapies for high risk patients. The mammaprint and oncotype DX are some of the prototypes of more sophisticated assays to come in the future. Evaluation of these and similar tests in clinical trial settings in conjunction with newer therapies would be exciting.

Dr. Jay is a physician with Georgia Cancer Specialists. She is board certified in Oncology and Hematology, has received several “Top Docs” awards nationally and locally, and was a cover story feature in M.D. NEWS’ December 2003 issue.

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Medical Practices Facing a Lease or Purchase Decision

Tuesday, July 1st, 2008

July/August 2008

By Larry E. Willey, CCIM

mdatl_larry.thumbnail.jpgMedical 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%.

mdatlobjective.jpg

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.

 

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