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Gold Dome

September 13, 2017

Special Edition Gold Dome Report - September 13, 2017

Greetings from the Gold Dome!  Lawmakers held a meeting of the House Rural Development Council in Metter over two days this past week.  The focus of these meetings was on healthcare.  Numerous presentations were made by several different groups involved in the industries impacting Georgian's healthcare needs.  More information on the presentations made is in our Report below.

Jean Rawlings Sumner, MD, Dean of the Mercer University School of Medicine, spoke about the need for healthcare in rural Georgia as economic development follows healthcare.  She also urged the Council to look at Georgia’s liberal scope of practice rules.  She noted that mid-level providers were a strong extension of service in the State.  Dr. Sumner also reminded the Council that Georgia leads the nation in telehealth.  In looking at “opportunities,” she noted that within the State Health Benefit Plan (the health insurance plan for Georgia teachers and State employees), telemedicine should apply to local physicians and mail order permission should apply to local pharmacies.  Other opportunities included addressing insurance credentialing issues for physicians as there are presently long delays in getting providers credentialed; she urged the Council to take a critical look at pharmacy benefit managers; she asked that healthcare transportation make changes so it is not dysfunctional and expensive – “uberization” of healthcare transportation is needed so that individuals do not have to call two weeks in advance for a ride; she also noted that nursing homes should be required to utilize telemedicine in order to lower emergency room admissions, increase specialty care to the patients and decrease unnecessary hospitalizations; she urged using telemedicine with emergency services (like what has been done with the Hancock Project and ambulances); incentivizing emergency medical services to provide minor care, chronic care and post-hospital care via telehealth; allow transportation to nearby qualified urgent care if appropriate in the county (incentivize the hospital system to allow this); provide a waiver for a hospital for 24/7 urgent care if serving a county without care and house emergency medical services there, requiring strong telehealth.  There were other opportunities for public health such as utilizing infrastructure for primary care; providing rotations for residency programs in rural areas; requiring medical student rotations in district and county public health; and utilizing public health fellowships for physicians.  There were further opportunities for medical education: 1) honoring the generalist physician; 2) allowing for interprofessional practice; 3) creating rural health interest groups; 4) recognizing the value of rural teaching physicians; and 5) providing leadership training.  Dr. Sumner highlighted the great work done by the General Assembly with the passage of HB 249 (the prescription drug monitoring program legislation) but that information needs to be disseminated to physicians, physician’s assistants, RNs with prescriptive authority, and pharmacists.   The need for them to be mandatory reporters over prescribers is needed.  She also urged even more requirements for methadone treatment programs (Rep. Sharon Cooper (R-Marietta) asked for Dr. Sumner to provide feedback on the proposed rules for these facilities with the passage of the 2017 legislation).  One thing that Dr. Sumner has mentioned in all of her comments is the need for rural healthcare workforce data with population health data.  She suggested that Legislators could conduct a pilot program on this data collection.  She also believes that the State needs to mandate county and regional healthcare planning as well as require continuous outcome data, looking at such county by county.  There were other ideas she proposed relating to supporting rural healthcare: 1) medical schools and residency programs which promote physicians to serve in those areas and utilize a Georgia Rural Scholarship, provide for an accelerated track at medical schools, and support graduate medical education; 2) counties and communities also need to step to the plate and support physicians as well as newly hired RNs and PAs which come to rural areas to work; 3) there are other legislative responsibilities such as incentivizing partnerships between rural providers and regional hospitals; 4) address liability issues and require that physicians and other providers enroll in Georgia Medicaid and be board certified; 5) she urged lawmakers to be “positive” about rural healthcare; 6) chambers of commerce (the State and local entities) should be educated on the benefits of rural healthcare; and 7) medical schools and urban hospital faculty also need some education on rural healthcare.

David Hess, MD, the Dean of the Medical College of Georgia (MCG) at Augusta University, also made a presentation.  Dr. Hess stated that MCG is the country’s eighth largest medical school.  It also is the country’s 13th oldest medical school, opening its doors in 1828.  MCG has a “regional campus” model with its main campus located in Augusta.  With the “regional campus” there are a number of impacts: 1) pre-medical (SEEP program); 2) pre-clinical; 3) clinical; and 4) certificate of rural health.  Georgia also utilizes an AHEC (area health education centers) network. Georgia’s population is presently around 10.4 million individuals.  The school’s faculty is a total of 3,040 (2,000 of these are volunteer faculty).  There are 230 students in the class of 2021 (114 are women and 116 are men).  There is diversity in the class.  MCG has the lowest tuition at around $30,000.00 annually.  The average debt of an MCG graduate is $160,000.00 (excluding undergraduate education).  Dr. Hess shared that debt is why physicians are not going into “primary care.”  Specialty medical areas pay much more.  75 percent of the MCG students do conduct research.  He spoke some about the projected shortages of medical care in the coming years and in particular physicians.  Georgia is also very short on residency slots for its students.  He outlined some statistics about Georgia’s rankings: 41st in the country for overall health; 40th in the country in numbers of physicians (per population); 43rd in the country in infant mortality; 41st in the country for strokes; 36th in the country in cardiovascular deaths; 35th in the country for adult diabetes; and 44thin the country for clinical care.  Out of 159 counties, Georgia has 108 rural counties.  Georgia’s rural counties have death rates above the statewide average.  He mentioned too Georgia’s “coastal plain” and the link to health outcomes.  MCG does provide health telestroke services – it is the 1stprogram in telestroke, established in 2003 in Emanuel County.  1,200 individuals have been treated  with TPA (tissue plasminogen activator) in the State, but Georgia is in the “stroke belt.”   Dr. Hess remarked that smart phones are the key to providing coverage.  There is a large lack of emergency department coverage in rural hospitals – recruiting nurse practitioners is one way to help address these issues and having telemedicine support.  Dr. Hess mentioned the 1997 Balanced Billing Act and its impact on Georgia’s funded residency slots for new physician graduates – more such slots are needed at Emory and MCG.  Georgia also has four comprehensive stroke centers (Grady, Emory, Wellstar and MCG Augusta).  There is a fifth such center in development in Macon.

Georgia Partnerships for Telehealth, a 501(c)(3) entity, also provided an overview of its work.  They highlighted that they had provided more than 500,000 clinical encounters.  This Partnership started in 2004 with the purchase by Anthem of Blue Cross and Blue Shield.  Over three years’ time, they were funded with $11 million (at the time of formation).  Monthly partners’ payments presently fund the services in the network.  Rep. Darlene Taylor (R-Thomasville) inquired about billing for services provided and whether the same CMS medical codes are used.  Yes, those codes are utilized along with a modifier for telehealth.

Denise Kornegay, Executive Director of the AHECs, gave some background and statistics as well as suggestions for the Council to consider.  There are six Georgia counties without a family physician; there are 31 counties without a general internist and 63 counties do not have a pediatrician.  Georgia needs to increase its numbers of physicians by 38 percent by 2030 (adding 2,099 more physicians to maintain status quo).  In 2015, there were 19,021 doctors in the State supporting 88,037 direct jobs.  She also shared statistics from the Economic Impact of Physicians in Georgia State Report (March 2014) and it noted that physicians had a total of $29.7 billion sales revenue impact.  Thus, Georgia doctors supported $16.6 billion in jobs, wages and benefits.  Recruiting the young for healthcare professions while they are in school is key.  Rural youth have a higher likelihood of practicing in rural areas but those youth need to be made more competitive to get into the schools.  She noted that specialists earn three times more than a primary care physician.  In 2016, Georgia physicians coming out of school had an average debt of $180,000.00.  She suggested that the General Assembly reimburse tuition of $29,000.00 per year for students who are admitted to the “rural track.”  She also suggested providing incentives for administrative support; and continuation of the funds for the statewide AHEC network so that they could continue health careers and recruiting programs.  There were 624 graduates from Georgia medical schools in 2016; those new physicians were asked to complete a survey.  That survey was conducted with 375 of those individuals responding.  She noted some of their comments:  the preceptorship tax programs should be credits; medical housing issues need to be addressed (for the two to eight week rotations); support is needed for regional campuses models; support for PCOM’s anchor model is needed; social integration strategies are necessary for those working in communities; technical assistance needs to be provided; incentive programs for graduates of Georgia medical schools need to be created, using a service pay back.  Resident physicians’ median age is 31 and 24 percent of those graduate from Georgia high schools; 25 percent graduate from a Georgia medical school; 11.9 percent graduate from overseas medical schools; 64 percent have debt over $200,000.00; and 49.4 percent have a starting salary of $200,000.00 or less (residents in Alabama and South Carolina make $10,000.00 more). Georgia has 600 new residency slots but only 192 are filled.  There are now 23 teaching facilities. GME training capacity is at 33 percent. There are a number of challenges offered: helping spouses get employment; addressing financial costs for new medical practices; billing for telemedicine; helping with tuition for physicians’ children's schools as local schools are not good; developing locum tenens programs; incentivizing engagement of rural communities; supporting workforce development policies and offering rural provider tax credits.  Residency hospitals also have challenges: financial needs and accreditation.  She suggested that Georgia look at Wisconsin’s program on rural rotations and how its program is funded.

Dave Flanders, with Candler County Hospital, spoke about some of his facility’s challenges.  Presently, it is not uncommon for Candler to have three to five days of operating funds on hand.  Candler is a 25-bed hospital which is county owned and governed by a local hospital authority.  In 2016, it had $1.6 million in indigent and charity care which is an enormous challenge.  The total population for Candler County is 11,000.  Mr. Flanders told the Council it was very hard to collect self-pay accounts and that the facility wrote off $4.7 million in bad debt in 2016.  “Legacy” debt is another issue – he noted that would include implementation of electronic medical records.  There are other financial challenges including an aging facility and equipment as well as dealing with payer contracts such as Blue Cross paid at less than the State’s Medicaid rate.  Small, rural hospitals have no bargaining power as a single hospital.  Provider recruitment is another problem and there is only one physician in Candler County.  Competition with other nearby facilities also is an issue; the local facilities, though, have entered into a collaboration so that they may share leadership and do group purchasing for certain needs.  He recited a number of “failures” to the Council:

  • No long-term solution to address insufficient Medicaid payments – he noted that they sometimes received 20 percent of allowable charges
  • SB 258 which helped rural hospitals but needs to be 100 percent credit
  • Indigent care costs and the need for the Indigent Care Trust Fund to cover a larger percentage of costs of care
  • Free standing emergency rooms – there needs to be a total overhaul of the system
  • Delays in UPL payments
  • Provider tax which should cover the cost of the tax (noting that the 11.88 percent add on does not cover those costs for some facilities although critical access hospitals do not have to pay this tax)

He did see some “successes” which would include: the creation of the Georgia heart hospital program; tax credit allowing upgrades; physician assistant and nurse practitioner loan repayment programs; newborn and obstetrical “add on” payment increase to $500; and rural hospital stabilization grants.  Candler Hospital also has its own successes which include: sharing of the electronic health records; renegotiation of the Blue Cross Blue Shield contract which helped with $700,000; upgrades on equipment using Foundation funds; swing bed rehabilitation program; and growth in specialty care.

Flanders also made recommendations for the Council’s consideration which are: preserve the Indigent Care Trust Fund; increase Medicaid reimbursement and address funding for emergency room visits and pay based on quality of care; move the rural hospital tax credit to 100 percent; provide physician incentives for those willing to practice in rural areas; provide incentives for collaborations so that larger hospitals will work with smaller facilities; encourage development of niche programs (such as swing beds); and protect certificate of need so as to save services for hospitals which generate revenues.

Charles Owens, a professor with Georgia Southern University (GSU), spoke about GSU’s involvement with rural healthcare.  He noted that GSU’s enrollment is 20,674 and 20 percent of its students are from rural areas.  92.4 percent of the students are from Georgia.  He did remark that GSU is in the process of consolidating with Armstrong University; with that merger, enrollment at GSU will be in excess of 27,000.  GSU has worked with the Department of Public Health on public health accreditation, assessments and evaluations.  Also, the school is working on LEAN training and certification and bringing that to the State’s critical access hospitals. He noted that emergency medical services are problematic and need financial assistance.  GSU has provided some technical assistance, testing and monitoring for public health needs (e.g., lead, bacteria, etc.).  He noted that GSU’s students do practicums and research (including service learning).  GSU’s school of nursing is the 10th most affordable on-line program – they have nursing programs for Registered Nurses through Advanced Practice Registered Nurses.  They partner with the Georgia Partnership for Telehealth.  GSU received a $1.6 million grant from HRSA for its development of the advanced practice registered nurse program for rural communities.  He noted that GSU’s Center for Gerontology has commenced a senior companion program which will pair low income individuals with older and frail adults as well as those with disabilities (they serve a nine county area).  GSU’s Department of Writing and Linguistics has engaged in a writing project to help schools in surrounding counties teach students better writing skills.  Under its psychology program, GSU has implemented master level counselor and psychologist programs.  In the college of liberal arts, they have an “aquaculture” initiative which has provided filming of Georgia’s shrimping industry as well as for marketing Georgia’s seafood and coastal commodities.  Mr. Owens noted that for economic viability, there are requirements which include education, health and healthcare services, workforce, industry and business, and a tax base to insure local infrastructure.  However, there also needs to be a broad-based community plan with a needs assessment, suggesting that a triage of the region, county and community be made; ranking of assets; ranking of needs; identifying assets and unique resources; and identifying deficiencies. 

Cindy Turner, the CEO of Bacon County Hospital, and Kyle Lott, the COO of that facility, spoke about its status and suggestions.  They noted that nationally 81 hospitals closed since 2010.  They noted a number of market factors forcing these facility closures including declining population and high unemployment.  Critical access hospitals need volume to survive.  One half of Georgia’s rural hospitals are unprofitable.  Many are plagued with the burden of providing indigent and charity care and the UPL cuts and Indigent Care Trust Fund decreases.  Bacon County Hospital receives no county funding but it has received some SPLOST funds to do facility upgrades.  Looking nationally at critical access hospitals versus those in Georgia, one will find that Georgia critical access hospitals are less costly per day.  Georgia critical access hospitals have a lower percentage of outpatient revenues and their cost to charge is two times that of PPS.  They noted that their top three needs are a family practitioner, a psychiatrist, and internal medicine doctor.  They have recently hired a pediatrician but it took one year.  Competitive salaries are needed so that the rural areas may compete with larger markets.  One issue they asked for help with is the credentialing of providers – noting that it takes 120 days to get a practitioner credentialed with insurers.  They also use mid-levels in their facility but they would like to see an expansion of those individuals’ scope of practice.  Medication shortages are another issue.  In particular, they mentioned these shortages: salt water (saline); diprivan (propofol); zosyn (an antibiotic); IV solumedrol; and IV protonix.  They remarked too that the State Board of Pharmacy should have someone representing hospitals (this is currently the case but it is a representative from a large hospital).  They also remarked that hospitals’ regulatory restraints are enormous – both with the federal and state governments.  Information technology is another large expense for these facilities – they also require multiple interfaces.  The hospital spends $650,000 annually on IT needs (software supports for things like Meditech, PCC, PACS, Radius, etc. – excluding salaries).  They suggested ways in which to cut those IT costs perhaps using universities.  Telemedicine is useful but more is needed for cardiology and stroke.  The Medicaid cuts are another area of concern.  Those force facilities to have layoffs of staff, eliminate services, increase charges to payers, or close.  There are also other impacts – longer wait times for patients, reduced access to care, longer patient travel times, and higher insurance premiums.  EMTALA was another issue of concern.   They mentioned that hospitals (which are contractors) are not paid costs like other contractors (they mentioned road contractors).  Rep. Parrish (R-Swainsboro) inquired about credentialing of providers and billing constraints – they explained that billing was not retroactive once a provider was credentialed but Medicaid will allow back to the date that the documentation was signed and submitted).  Rep. McCall (R-Elberton) asked about legislation pending in the Ways and Means Committee addressing hospital bad debt, noting that perhaps it would move in 2018.  Rep. LaRiccia (R-Douglas) asked about collaborations – noting that Bacon County had shown leadership with its collaboration and that Bacon was using leadership hired from within that community.  They suggested that funding a recruiting fair for physicians to work at rural hospitals would be helpful.  They were asked about why hospitals wanted Medicaid expansion and whether it would not be better to have Medicaid pay facilities better (this was a question from Rep. Rynders (R-Albany)).  Rep. Rynders also inquired about the hospital provider fee; they acknowledged that critical access hospitals do not have to pay the provider fee (tax).  Ethan James, with the Georgia Hospital Association, told the Council that this year there was a $60 million loss from the provider fee.  When the fee was first implemented, its intention was to break even – he did acknowledge that the provider fee has been helpful to rural hospitals and that GHA supports the fee.  Rep. Powell (R-Camilla) asked about information technology and what the legislature could do – they suggested the support of a regional consortium (the state of Iowa does this).  Rep. Dickey (R-Musella) asked about indigent care and the Fund’s payments.  There is a lack of payment for the care rendered.

Monty Veazey, with the Georgia Alliance of Community Hospitals, spoke.  Some underlying issues for the rural areas are generational poverty and the lack of economic development.  Broadband access needs to be available to all parts of the State; he noted in one west Georgia town that the only internet access available to school children was at the public library.  Mr. Veazey provided some numbers for the Council’s consideration on the payer mix for obstetrical care:

 

Gwinnett County

North Metro Atlanta

Medicaid

50 percent

10 percent

Non-citizens

20 percent

1 percent

Commercial insurers

30 percent

90 percent

 

 

 

 

Mr. Veazey asked the Council to preserve Certificate of Need.  He noted that it dealt with adverse impact and appropriate distribution of resources.  Providers need stable payer mixes and CON assures that.  In 2015, Georgia’s uninsured rate was 13.9 percent.  Hospitals need to have a bottom line of a positive 6.4 percent in order to be financially stable (otherwise they cannot do facility upgrades or support their bonds).  However, many hospitals have a bottom line of a negative 3 percent.  Hospitals are concerned about the proposed use of Medicaid block grants – their concern is that will lead to more Medicaid cuts.  The federal government will look to the state legislatures to make requisite cuts under the block grant funding.  There is also further added uncertainty with their financial picture with the phasing out of disproportionate share hospital (DSH) payments (under the Affordable Care Act) and cuts to UPL payments.  Mr. Veazey stated that DSH needs to be reauthorized.  There are other challenges for hospitals including opioid and mental health issues – those problems impact hospitals, emergency departments, police, emergency medical services, etc.  An average overdose can cost a hospital $92,400.  In August in middle Georgia, there were several patients who overdosed.  Individuals and hospitals have a number of challenges in rural areas – poverty and finance; distance to care; and access to care.  From 2014 to 2017, there were seven counties which funded support for hospitals through a tax.  He noted that O.C.G.A. § 33-24-64 defined telemedicine which has been a topic of discussion through the Council’s meetings.  There are current tax exemptions which benefit hospitals – he urged that those be kept: 1) sales tax (which saves hospitals $171-$189 annually) where the film tax credit has cost the State income taxes (2016 in the amount of $199 million; 2017 in the amount of $222 million; and 2018 in the amount of $244 million) and corporate taxes (2016 in the amount of $139 million; 2017 in the amount of $155 million; and 2018 in the amount of $170 million).  Hospitals also employ 45,000.  The other tax exemption enjoyed by hospitals is property tax (but it only applies to locations providing care; locations providing services; and locations providing training and education of physicians and nurses).  The Alliance conducted a study in 2010 of sales taxes and free care provided by the hospitals; that study is in the process of being updated.  They found a return on investment of $5.60 per dollar (projected in the new study) for uncompensated care.  Rep. Cooper (R-Marietta) inquired about the tax exemption and whether it was based on cost for services or what – Mr. Veazey explained it was not charges.   Rep. Cooper also noted that there was a new entity Serum using unused medications which were captured and then made available to individuals who cannot afford those medications; a pilot program was conducted on the effort and it is now ready to be rolled out statewide.

Tony Marshall and Pam Clayton, with the Georgia Health Care Association, spoke to the Council outlining more specifics about Georgia’s long-term care industry.  Georgia has a total of 362 nursing homes and of those 145 are in rural areas.  There are a total of 39,704 beds and of those 13,543 are in rural parts of the State.  Medicaid days in total are 8.6 million with 3.57 million of those in rural facilities.  Georgia, per Mr. Marshall, is a “low-bedded” state.  There are 1,881 assisted living and personal care facilities in Georgia with a total of 30,421 beds.  Nursing homes provide 59,000 jobs and are a $7.4 billion industry.  From 2010-2030, there will be 1.5 million Georgians over the age of 60 which will increase to 2.5 million over that time.  Georgia is behind the State of Florida in terms of its growth in numbers of citizens over the age of 65 and Georgia is the leader of states with individuals over the age of 85.  In 2007, Georgia nursing homes had 90.2 percent occupancy with 75.1 percent paid by Medicaid.  In 2016, they had an occupancy rate of 84.4 percent with 72.1 percent paid by Medicaid – the difference is the State’s utilization and funding of home and community based services (such as SOURCE).  72 percent of individuals in nursing homes are served by Medicaid; 12 percent by Medicare; and 16 percent by private pay/Veterans Affairs or Medicare Advantage.  There are differences between urban and rural facilities – urban facilities see 68 percent paid by Medicaid and rural see 79 percent paid by Medicaid.  Further, in urban facilities, Medicaid pays $10.00 more per day than in rural areas ($177.37 versus $167.15).  These differences impact staffing.  In FY 2015, nursing home costs were $179.47 per day (Medicaid) and they were paid $169.11.  In part, they remarked this was due to an unfunded mandate from President Obama.  In 2018, the costs are per patient day of $194.41 and they are reimbursed $178.08 per day.  There are many differences with facilities now than years ago – admissions are now 24/7; there are more unfunded mandates; volume of admissions has changed; workforce has changed and nursing staffing has changed.  Challenges remain including how to enhance telehealth; providing top of license practice; care coordination networks (direct admission to SNF from ED); service model alignment with community and health system needs (such as ventilator patients).  Mr. Marshall indicated that Florida had made changes with its staffing requirements so as to require 2.6 hours per day of CAN time and added time for registered nurse care – it required the Florida legislature to invest $100 million.

Richard Lamphier, RN, with the Georgia Nurses Association, presented remarks.  He noted that everyone needed to know about “FAST,” as saving heart muscle saved lives.  He spoke of the need for more education so as to get LPNs to go back to school to become RNs and perhaps even APRNs; thus, bridge programs were necessary.  Costs of education are an issue (LPN can cost from $4,000 to $5,000 and becoming an APRN may cost between $85,000 to $300,000).  Nursing debt may range from $50,000 to $100,000 (for RNs and APRNs).  He noted that there were different funding streams to get these nurses trained (HOPE grants, scholarships, foundations and corporate scholarships).  Business leaders need to look at corporate incentives; provide on-site healthcare; engage in emergency preparedness; encourage individuals to go back to school; providing an onsite gym; provide health and career fairs so individuals can find their “dream job.”  Healthcare organizations need to provide flexible work schedules; offer benefit packages; fund college; and promote cost of living.  Foundations can also provide assistance such as provide moving costs for providers.  The State needs workforce data; address scope of practice; invite nurses to participate; and provide tax credits for preceptorships and in particular in rural practice areas.  Local governments can also participate by supporting school nurses; engage nurses in emergency preparedness; promote health and career fairs.  He noted some best practice suggestions such as needs assessment for the industry; resource identification; implementation; reassessment; scope of practice changes; use of school nurses; spousal supports; and encouragement of work-life balance.  He noted that the states of North Carolina and South Carolina had “full scope” of practice.  Health Resources and Services Administration (HRSA) conducted a study on nursing jobs and demands – see www.hrsa.gov .  He told the Council that the average age of Georgia nurses is 45.   An average LPN salary in Georgia is $37,330; an average RN salary is $61,630 and an average APRN salary is $80,000 or more. There are a total of 171,268 licensed nurses in Georgia (1,000 came into Georgia by way of endorsement).  He noted a number of challenges to the nursing industry – in particular a lack of faculty to train nurses; lack of clinical placements; above-average entry qualifications to rigorous programs; numbers retiring; turnover rates after one or two years; collection of workforce data; and numbers of nurses no longer working.  He suggested that more recruiting be done from other states; create partnerships across nursing programs; and establishment of workforce data collection.  Rep. Cooper (R-Marietta) inquired about the State Board of Examiners and minimum requirements for examination.  She indicated that many applicants are good test takers and have no problem; the issue is turning out nurses who cannot function on medical-surgical floors without being mentored which is costly to a hospital.  Wellstar started a program for six months of mentoring new nurses – she stated that medication errors occur with the new nurses.   She also asked about nurse practitioners who claim to be better than primary care physicians – Rep. Cooper asked if “full responsibility” was “admitting” and Mr. Lamphier indicated that was what the IOM Report included but he was not advocating that but did seem to think a pilot program would be helpful.

Michael Azzolin, PharmD, COO with PharmD on Demand, Inc., was the last presenter.  He focused his remarks on automated dispensing cabinets and pharmacy needs of rural hospitals.  He told the Council that there were inconsistencies with O.C.G.A. § 26-4-5 (which defines remote pharmacist) and O.C.G.A. § 26-4-80 (which specifies a pharmacist must physically come into a hospital within 24 hours of remote order entry occurring).  There are also Rules and Regulations on remote entry and what is required of a hospital pharmacist.  He stated specifically that O.C.G.A. § 26-4-80(7)(c) contradicts with O.C.G.A. § 26-4-5, noting the requirements of the American Society of Hospital Pharmacists (ASHP) guidelines.  He called the O.C.G.A. § 26-4-80 the 24-hour law.  He suggested that the legislature eliminate the 24-hour law and eliminate the simultaneous law (which prevents remote order entry from occurring when there is one pharmacist in a hospital (it allows it if there are at least two pharmacists), preventing small facilities from having the option of this service to promote enhanced clinical service by the onsite pharmacy staff for the patients in those hospitals) so that all pharmacists can provide remote order entry from any location under conditions (hold a Georgia pharmacist license; hold future Interstate Remote Pharmacy License (NABP regulated)).  Rep. LaRiccia inquired about representation on the pharmacy board of a hospital representative – there is a large hospital pharmacist on that board. There is no rural hospital representative.

Lawmakers will continue their economic development study over the next few months.  The next Council meetings are slated to be held in Brunswick on September 26-27; however, due to the recent weather events, those meetings may be shifted to another location or moved to a later date.