суббота, 6 октября 2012 г.

ACADEMY LEADERS CARRY FAMILY PHYSICIANS' MESSAGE TO WHITE HOUSE, CAPITOL HILL. - States News Service

Leawood, KS -- The following information was released by the American Academy of Family Physicians:

In the wake of legislation that reversed a cut in Medicare physician payments through March 31, AAFP leaders once again fanned out here to deliver their message about the value and importance of primary care and family medicine to the White House and congressional leaders.

AAFP President-elect Roland Goertz, M.D., M.B.A., left, and other representatives from the medical community listen carefully as President Obama calls on Congress to vote on his health care plan within the next few weeks.

During a series of meetings with administration officials and lawmakers on March 2-3, AAFP President Lori Heim, M.D., of Vass, N.C.; AAFP President-elect Roland Goertz, M.D., M.B.A., of Waco, Texas; AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho; and AAFP EVP Doug Henley, M.D., stressed the importance of family medicine and the patient-centered medical home, or PCMH.

Goertz, who was invited to stand on the podium behind President Obama during a speech in which the president asked Congress to vote on the revised health care proposal, had an opportunity to meet one-on-one with the President. In a subsequent interview with AAFP News Now, Goertz said that he told Obama that family medicine and the medical home are both essential cornerstones of any health care reform plan.

'I appreciate the opportunity we have had to try and influence the health care reform debate,' said Goertz. 'We have never had that opportunity before, and to be there at the highest level of discussion is what we have worked so hard for.'

The AAFP is no longer sitting on the sidelines, said Goertz. 'We are an organization trying to advocate for who we are. Family medicine is part of the answer to improving the health care system.'

Goertz and the other AAFP leaders also met briefly with HHS Secretary Kathleen Sebelius and had a longer meeting with her staff members. According to Heim, they discussed physician payment, the PCMH model, regulation of health information technology and physician training issues.

'It was really a honed message to everybody tailored to their particular programs and very much around the same themes,' said Heim. 'We drove home the value of primary care and how primary care and family medicine are absolutely essential and central to any health care reform.'

Academy leaders also met with Mary Wakefield, R.N., Ph.D., administrator of the Health Resources and Services Administration, or HRSA. According to Heim, they discussed various HRSA programs, such as Title VII, Section 747, of the Public Health Service Act, which provides federal support for training family physicians. In addition, said Heim, they discussed the role of community health centers in providing care to the indigent and medically underserved.

AAFP Thanks AMA for Support

During a recent advocacy blitz in Washington, AAFP leaders took the opportunity to meet with AMA leaders to thank them for their support of primary care during the health care reform process.

'We had a very good discussion with them about where we were in synergy with health care reform and their support for the patient-centered medical home,' said AAFP President Lori Heim, M.D., of Vass, N.C.

Heim noted that the AAFP also thanked AMA leaders for supporting the primary care payment bonuses contained in the House and Senate health care reform bills.

U.S. Surgeon General and family physician Regina Benjamin, M.D., M.B.A., also received a visit from Academy leaders. According to Heim, Benjamin emphasized the Obama administration's commitment to fighting childhood obesity and also acknowledged the important role family physicians will play in the campaign against childhood obesity.

'As a family physician, Dr. Benjamin recognizes the need to not only focus on the child, but also to focus on the whole family,' said Heim. 'Part of our discussion was how we can work with the surgeon general's office to make sure that we have a message that targets children and also works through the family to get to the children.'

As part of additional advocacy efforts, AAFP leaders visited several Capitol Hill offices. They met with Rep. Chet Edwards, D-Texas, a member of the House Appropriations and Budget Committee, and Rep. Walt Minnick, D-Idaho. In addition, they met with staff members from the offices of Sen. Richard Burr, R-N.C.; Sen. Kay Hagan, D-N.C.; Sen. Patty Murray, D-Wash.; and Sen. Mike Enzi, R-Wyo. AAFP leaders also met with staff members from the Senate Finance Committee, which has jurisdiction over health care reform.

пятница, 5 октября 2012 г.

Super Tuesday Pork - AP Online

A small sampling of federal money recently sought by lawmakers for projects in states holding presidential nominating contests Tuesday.

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Alabama

_ $136,000 to the Bryan W. Whitfield Memorial Hospital in Demopolis for equipment and facilities.

_ $195,000 to the Alabama Institute for the Deaf and Blind in Talladega for an interpreter training program.

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Alaska

_ $146,000 to Alaska Addictions Rehabilitation Services Inc. in Wasilla for equipment and facilities.

_ $487,000 to the Galena City School District for a boarding school for low performing native students from remote villages across Western Alaska.

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Arizona

_ $390,000 to Chiricahua Community Health Centers Inc., for equipment and facilities for a community health center in Bisbee, and a medical and dental clinic in Douglas.

_ $146,000 to Apache County Schools in St. Johns for a teacher training initiative.

___

Arkansas

_ $73,000 to the Baptist Health Medical Center _ Heber Springs for equipment and facilities.

_ $679,150 to the Criminal Justice Institute of Little Rock for a law enforcement education and training program.

___

California

_ $341,000 to Adventist Health of Roseville for expansions to the clinical information system, including new equipment.

_ $438,000 to the Monterey County Probation Department in Salinas for the Silver Star gang prevention and intervention program.

___

Colorado

_ $312,000 for Avista Adventist Hospital in Louisville for health information systems.

_ $123,000 to Metropolitan State College in Denver for training and equipment.

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Connecticut

_ $292,000 to the Connecticut Hospice Inc. in Branford for health information systems.

_ $487,000 to the Community Foundation for Greater New Haven to support multidisciplinary intervention programs for families and children exposed to violence and trauma.

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Delaware

_ $414,000 to Christiana Care Health System in Wilmington for construction, renovation and equipment.

_ $390,000 to the Delaware Education Department for the Starting Stronger Early Learning initiative.

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Georgia

_ $48,000 to Community Health Works in Forsyth for rural health care outreach.

_ $146,000 to West Central Technical College in Waco for equipment.

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Idaho

_ $243,000 to the Franklin County Medical Center in Preston for construction, renovation and equipment.

_ $292,000 to the Lee Pesky Learning Center in Boise to provide educational materials for literacy programs.

___

Illinois

_ $146,000 to Bureau County Health Clinic in Princeton to expand rural health services, including new equipment.

_ $195,000 to Poder Learning Center in Chicago for immigrant neighborhood job development and education.

__

Kansas

_ $292,000 to the Atchison Hospital Association for renovation and equipment.

_ $312,000 to Kansas City Community College for work force training and placement in the retail and hospitality industries.

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Massachusetts

_ $235,000 for a weather buoy for Nantucket Sound.

_ $204,000 for program development and educational equipment for Barnstable youth and community center.

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Minnesota

_ $487,000 to Minnesota Humanities Commission in St. Paul to implement curricula and classroom resources on Native Americans.

_ $243,000 to Bemidji State University for a nurse training program.

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Missouri

_ $341,000 to Central Methodist University in Fayette for science, math, engineering and technology teacher training program.

_ $412,000 to Boys and Girls Town of Missouri in St. James to expand services to abused and neglected children.

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Montana

_ $273,000 to the Community Medical Center in Missoula for construction, renovation and equipment.

_ $487,000 to Benefis Healthcare in Great Falls for equipment and facilities.

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New Jersey

_ $487,000 to the Bayonne Medical Center for health information technology.

_ $624,000 to Rutgers University Law School in Camden for student scholarships and loan repayment, internships and public interest programming.

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New Mexico

_ $82,000 to the Indian Health Center in Albuquerque for equipment and renovations.

_ $48,000 to ChildSight New Mexico in Gallup for a children's vision screening and eyeglass program.

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New York

_ $243,000 to A.O. Fox Memorial Hospital in Oneonta for equipment and facilities.

_ $243,000 to the Onondaga County Public Library in Syracuse for technology upgrades.

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North Dakota

_ $409,000 to Minot State University in Minot to monitor and treat those with autism spectrum disorder in rural areas with limited access to health professionals.

_ $390,000 to the Standing Rock Sioux Tribe in Fort Yates for a methamphetamine prevention program.

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Oklahoma

_ $97,000 to Eastern Oklahoma State College in Wilburton for health information systems and pharmacy technology programs.

_ $195,000 to Tulsa public schools for programming for students at risk of dropping out, including curriculum development.

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Tennessee

_ $146,000 to Blount Memorial Hospital in Maryville for equipment.

_ $4,875,000 to the University of Tennessee in Knoxville for the Baker Center for Public Policy.

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Utah

_ $48,000 to Beaver Valley Hospital for equipment and renovation.

_ $48,000 to Ogden city schools to enhance the aerospace, math and science curriculum.

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West Virginia

_ $121,000 to Alderson-Broaddus College in Philippi for equipment and facilities for the nursing program.

четверг, 4 октября 2012 г.

Proton Cancer Therapy Center: an entrepreneur's dilemma. - Entrepreneurship: Theory and Practice

This case deals with the dilemma faced by an entrepreneur named John Styles who was faced with the decision of whether or not to enter into a partnership with M.D. Anderson Cancer Center in Houston to build a Proton Cancer Therapy Center. The decision was clouded by the fact that most of the $100 million investment required for the venture would be invested in facilities and technology that could be used for nothing else if the project failed. In addition, the typical venture capitalists who would normally invest in such a venture would not find this deal enticing because of the long time lag to profitability.

Introduction

John Styles parked his car in the parking lot behind the office of his family business on Bellaire Boulevard in Houston and eschewing the elevator, walked slowly up the stairs pondering the unique opportunity afforded his company if he decided to accept it. It had all started with an offhand remark by his Sunday school teacher suggesting that Styles should meet a new member of their church who had also devoted his life to health care. Being one who seldom passed up an opportunity to meet someone else who made their living in health care, Styles agreed and soon was having lunch with Leon Leach, who turned out to be the executive vice president of The University of Texas M.D. Anderson Cancer Center (hereafter called Anderson) in Houston.

Over a long lunch, Leach gave Styles some interesting background on a proposed deal between Anderson and Tenet Healthcare to build a proton therapy cancer center in Houston. Unfortunately, the deal had fallen apart because Tenet had evaluated its corporate strategy and decided to refocus on its core managed health-care operations and sell its proton therapy subsidiary. One thing led to another, and soon, Leach and Styles discussed the possibility of The Styles Company answering a soon-to-be-released request for proposal (RFP). The company chosen in the RFP would be venturing into a partnership with Anderson to build the proton therapy center. Styles was excited and intrigued about the possibilities of such a venture but concerned about putting together a deal that would raise sufficient funds for the project.

It was now October of 2001, and Styles knew he needed to make a decision soon on whether or not he would undertake this project.

The Styles Company

John H. Styles, the senior member of the Styles Company, grew up in Seymour, Texas, and received a scholarship to play football at Baylor University in Waco, Texas. He had grown up under difficult economic circumstances with parents who worked hard to support the family. Styles often suggested to people that he could never have attended college if it had not been for the fact that Baylor offered him a scholarship. After completing a degree in Business Administration at the Hankamer School of Business at Baylor, Styles was offered a teaching/coaching job in his hometown. He took the job but was only able to coach and teach for 2 years on an emergency teaching certificate because he did not have certification in secondary education.

After a short stint in Wichita Falls, Styles went to work as the Controller/Chief Financial Officer for Providence Hospital (owned by the Catholic Church) in Waco, Texas, in 1966. It was during his time at Providence Hospital that he became aware of the payment provisions under the newly implemented Medicare law that would revolutionize the health care industry. It became clear to him that hospitals such as Providence, which had formerly operated at breakeven or a loss in the past, would now find themselves doing much better financially. One of the reasons for this was the guaranteed payments by the government for the elderly who were able to pay very little in the past.

Styles, secure in the knowledge that health care was the industry he was interested in, took a couple of other executive-level health-care jobs in Louisiana and Arkansas. In 1974, he moved to Houston, which, with the Texas Medical Center, was becoming a health-care mecca. Arriving in Houston, he became the Senior Operations Officer for LIFEMARK Corporation (previously Medenco, Inc.). This New York Stock Exchange company had grown from scratch and owned more than 50 hospitals and was sold in 1984 to American Medical International.

After the sale of LIFEMARK, Styles became a founding investor in HealthSouth Corporation and Founder/CEO of Outpatient Healthcare, Inc., and eventually, Mid-America Healthcare Group, which owned and managed numerous hospitals. Both Outpatient Healthcare and Mid-America were sold to Columbia/HCA in 1991 and 1995, respectively.

One of Styles's personal goals was to provide a good living for his family so that they would not have to face the scarcity that he had faced as a child, and if possible, he wanted to involve as many members of his family in the businesses that he started as wanted to be involved.

The success of the many health-care businesses that he founded gave him the capital and the personal motivation to continue to launch new enterprises. He developed a strategy of keeping his eyes open for promising ventures, assessing their potential value, and investing in those that showed the promise of providing the financial rewards that he needed as well as the satisfaction that he had helped others achieve a level of health care that they needed.

At the time of the proposal to work with Anderson, Styles had been actively involved in health-care-related business ventures for 35 years. Two of Styles's sons and one of his grandsons had also been involved all of their working lives with the health-care industry. John H. Styles, Jr. had more than 25 years of operational experience in hospital and health-care-related business. He had been involved in the design, construction, development, ownership, and management of businesses including acute care hospitals, rehabilitation hospitals, ambulatory surgery centers, medical office buildings, cancer treatment facilities, and cancer research facilities.

A younger son, Jason Styles, had been a cofounder and executive vice president of corporate affairs for Triumph Healthcare prior to its sale in 2004. He also had served as a corporate finance executive with Harris Webb & Garrison (precursor of Sanders Morris Harris, Inc.). At Harris Webb, he was involved in numerous transactions including private placements, valuations, equity and debt financings, and mergers and acquisitions. He assisted in the closing of more than $400 million in equity and debt offerings in various industries including health care. He also served in several capacities for Mid-America Healthcare Group prior to the sale of its assets to Columbia/HCA.

The Styles Company was formed as a vehicle to consolidate the management and operations of various investments of its principals--John Styles, Sr. and his sons. The investments were primarily involved in health care and real estate ventures. The Styles Company provided complete project development and management duties including the following:

* Feasibility studies

* Project financing

* Selection and management of architectural, engineering, and interior design

* Real estate acquisition

* Equipment procurement and oversight of installation

* Long-term management services.

Proton Cancer Treatment

The goal of all cancer therapies had been to selectively destroy cancer cells while sparing normal tissue. Some of the medical techniques that had been used for the treatment of cancer were surgery, chemotherapy, and radiation therapy. Proton therapy was just a newer form of radiation treatment.

The Proton Process

As early as 1946, the physicist Robert Wilson believed that protons could play a significant role in cancer treatment because of their advantageous dose distributions (Wilson, 1946). The process was such that when proton beams interacted with matter, they produced energy depositions that were characterized by a relatively low dose in the shallow regions of their path; however, near the end of the proton range, the dose rose sharply to a peak and then fell abruptly to zero. The result was that a high dosage of ionizing radiation could be delivered to a deep-seated tumor while not harming the surrounding normal tissues. Compared with an X-ray beam, a proton beam had a low 'entrance dose' (the dose delivered from the surface designed to cover the entire tumor) and no 'exit dose' beyond the tumor. See Figure 1 entitled 'Diagram of Proton Cancer Therapy' for a description of this process.

The outcome of this type of cancer treatment was so successful that by the year 2000, nearly 40,000 patients at 25 cancer centers around the world had received proton therapy treatment. One of the advantages of proton therapy was that this treatment had fewer side effects as compared with other types of cancer treatment.

Prospective Patients

Proton therapy was recommended for patients whose tumor: (1) was localized; (2) required high doses of radiation for control; and (3) was located near tissues or organs sensitive to radiation therapy. The types of tumors most often selected for proton therapy were cancers of the prostate, eye, lung, brain, head, and neck. Proton treatment had also been found to be useful in treating cancers in children.

[FIGURE 1 OMITTED]

Locations for Proton Therapy

In 2000, there were 19 proton therapy facilities around the world that had treated nearly 29,000 patients. Loma Linda University Medical Center was the first such center in the United States, and it opened in 1990. Other proton facilities were planned at Massachusetts General Hospital in Boston, Indiana University in Bloomington, the University of Florida in Jacksonville, and the University of Pennsylvania in Philadelphia. Table 1 describes the timeline for development of proton cancer therapy.

The M.D. Anderson Cancer Center

The M.D. Anderson Cancer Center was established in Houston in 1941 by a $1 million fund that was financed jointly by the State of Texas and the M.D. Anderson Foundation. The cancer center became a part of the University of Texas medical system. In 2000, Anderson was ranked as the number one cancer hospital in the United States by U.S. News & World Report primarily based on its reputation among board certified physicians and its low mortality rates. Since 1990, M.D. Anderson had been ranked among the nation's top two cancer hospitals. Statistics for the year 2000 indicated that during the past year, M.D. Anderson had treated 52,000 cancer patients and recorded over 448,000 outpatient office visits. Anderson also employed nearly 16,000 employees including 840 faculty members.

Patient Census Trends

From 1996 to 2000, M.D. Anderson's inpatient census increased by 16% while outpatient visits increased by 32%. In addition, over 43% of Anderson's patients were self-referred, which Anderson perceived to be reflective of the center's reputation and its marketing programs.

The Radiation Oncology ('RO') division was a leader within the M.D. Anderson system. The RO division employed over 350 professional faculty and staff in nonresearch positions, and in the year 2000, provided conventional radiation therapy to over 370 patients per day. The division projected net revenues of nearly $50 million and operating margins of 28% for 2001 and had experienced a 17% compounded annual growth rate in net revenues from 1996 to 2001. However, due to capacity constraints, over half of all Anderson patients who required radiation therapy used outside facilities such as community hospitals and freestanding oncology centers to obtain their radiation treatments.

Cancer Trends and Capacity Issues

The second leading cause of death in the United States in 2000 was cancer. Only heart disease claimed more lives than cancer. In fact, one in four deaths in the United States in the beginning of the twenty-first century was caused by cancer.

In the 10 years from 1990 to 2000, nearly 15 million new cancer cases had been diagnosed in the United States. Over half of all new cancer cases were located in the following four sites: lung, prostate, breast, and colorectal. The annual cost for cancer treatment in 2000 was $107 billion--$37 billion of which was devoted to direct medical costs, $11 billion for lost productivity due to the illness, and $59 billion for lost productivity due to premature death (Sanders Morris Harris, 2001).

Although the incidence of cancer in the population was expected to increase in the twenty-first century due to population growth and the aging of the population in general, cancer diagnosis rates were also rising because of better diagnostic tools. The earlier detection of cancer would increase the need for therapies designed to treat the newly diagnosed cases.

Since proton therapy was a type of radiation therapy, the question arose as to the ability of M.D. Anderson Cancer Center to handle the capacity needs of a growing population of cancer patients. Table 2 indicates the radiation oncology capacity surplus or deficit projections through the year 2006.

If a proton cancer therapy center were to be built in Houston, M.D. Anderson and the University of Texas System owned four acres of land near the Texas Medical Center in Houston where the facility could be located. The University of Texas System had suggested that arrangements could be made to offer a 60-year lease to the Center for its operations. The rationale for that was that M.D. Anderson was regularly identified as the top cancer hospital in the nation, and it made sense to locate this cutting-edge cancer technology nearby.

The Styles Company and Anderson had estimated that approximately 92,500 square feet would be needed for the facility, which would include state-of-the-art equipment, four patient treatment rooms, and a particle-accelerator-based proton system. In addition, the space would provide for research and patient support services to be offered. Calculations on the project concluded that the total cost of the facility would be $100 million, and construction would take around 3 years to complete. Anderson agreed to provide all clinical services and nonexecutive staffing for the facility, and the executive management would be directed by the Styles Company and Sanders Morris Harris.

A site drawing for the proposed facility was developed by Tsoi/Kobus & Associates Facility Design and Architecture firm. This firm had received national recognition and several awards. Five of these were AIA/Modern Healthcare design awards.

A proposed deal for funding the center would be put together by Sanders Morris Harris, an equity capital firm in which the Styles Company had an interest. The center would include several treatment rooms with a treatment couch framed by a 35-foot, 196-ton wheel that is known as a 'gantry.' The gantry rotates around the patient to direct the proton beam at the tumor. Dr. James Cox, head of Anderson's Division of Radiation Oncology, suggested, 'With this new technology, we will be able to increase doses of radiation, preserve healthy tissue and treat patients much more successfully.'

Proposed Equipment for the Center

Hitachi had been selected as the manufacturer to provide the proton equipment. The product they had developed for possible use in the facility was called PROBEAT. This medical technology was designed to deliver a proton beam to localized tumors and other conditions susceptible to treatment by radiation. The equipment had two main components. One was a beam delivery system whose primary responsibility was to ensure that the prescription parameters were properly delivered. The other was the equipment necessary to generate the proton beam and direct it to the beam delivery system.

The equipment was under review by the Federal Drug Administration and was expected to be approved by the time the facility opened. Hitachi had agreed to make a $50 million equipment loan for the project.

Reimbursement for Proton Therapy

The Medicare Program, which was the largest payer for health-care services in the United States, was considered at the beginning of the twenty-first century to be the 'gold standard' for payment and coverage issues related to health care. To distinguish between these two issues, 'coverage' referred to the procedure by which Medicare made a determination of whether a service was 'necessary and reasonable.' In addition, coverage did not necessarily guarantee payment, although payment could not be made to a provider unless it was a covered service. Therefore, Medicare had to approve coverage of a service before payment could be made (Particles Newsletter, 2000).

Medicare coverage decisions could be made at both the national and local level. At the national level, decisions such as this were made by advisory panels. At the local level, Medicare coverage decisions were made by a local Medicare contractor who worked with the Medicare Program to administer benefits in a particular geographic region.

In accordance with the Balanced Budget Act of 1997, the Health Care Financing Administration (which administered Medicare) agreed upon the following payment rates and coinsurance amounts on May 4, 2001.

* Proton treatment delivery, simple $414.49

* Proton treatment delivery, intermediate $906.85.

The difference between 'proton treatment delivery, simple' and 'proton treatment delivery, intermediate' was described as follows:

Proton Treatment Delivery, Simple: Proton beam delivery to a single treatment area, single port, custom block, with or without compensation, with treatment set-up and verification images.

Proton Treatment Delivery, Intermediate: Proton beam treatment to one or two treatment areas, two or more ports, two or more custom blocks, and two or more compensators, with treatment set-up and verification images (American Medical Association, 1999).

At the beginning of the twenty-first century, proton beam therapy was covered for most clinical indications by Medicare and was therefore routinely paid by insurance companies. Proton therapy itself had been recognized by the Health Care Financing Administration (the organization charged with the responsibility for setting payment policies for Medicare) as a standard therapy--rather than an investigational therapy--and enjoyed favorable reimbursement rates from Medicare carriers and other sources of reimbursement. By 2000, the reimbursement for this treatment was almost twice as much as the rate for the most advanced conventional radiotherapy such as Intensity-Modulated Radiation Therapy (Sanders Morris Harris, 2001).

Considering the Deal

John Styles had put together many health-care deals in his lifetime, but this deal was unique and required much more thought. In all of the projects he had undertaken before, he had learned that there are a number of risks factors that are inherent in the deal (Monroy & Folger, 1993). He considered the following the most important: market risk, people risk, technology risk, and money risk.

Market Risk

Most investors are concerned about the market opportunity of a new venture. If the idea does not involve a sizeable market, the investors and the equity capital firm will not be able to make the rate of return on the investment that they require.

Regarding proton cancer therapy, the statistics verified the fact that the incidence of cancer was growing as a threat in the United States and was the second leading cause of death in the United States.

People Risk

Andrew Carnegie, the famous American industrialist, once said:

Take away my factories, my plants; take away my railroads, my ships, my transportation; take away my money; strip me of all these, but leave me my people, and in two or three years I will have them all back again (Mason & Harrison, 1996).

In deciding whether to put money into a new venture, an investor will want to be assured that the people who will be running the company know what they are doing. A saying among equity capitalists is, 'A 'B' business plan with an 'A' entrepreneur is preferred to an 'A' business plan with a 'B' entrepreneur.' John Styles had proven his ability to generate the financing, construction, and management of health-care facilities in the past, and Anderson was often ranked as the number one cancer hospital in the United States.

Technology Risk

In today's high-tech world, being on the cutting edge of an industry's technology is extremely important (Roberts, 1991). Especially in the health-care industry, the latest technology, treatments, and medication for treating diseases with the highest mortality rates are a given for a start-up company. This risk was the most prominent one for Styles regarding his decision of whether or not to undertake this project. The equipment to be used in the center had not yet been approved by the Federal Drug Administration. In addition, past history indicated that new medical equipment normally had a limited life span before it was replaced with even more efficient technology.

Styles speculated, 'A question many investors would have would be: 'Is there a silver bullet out there that may be discovered in the future that would make this technology obsolete?' The answer to that is 'no' because this technology has been around since the 1940s, and it has only been at this time that computers were developed that could direct the proton beam during the treatment.' However, he did worry, 'If the equipment didn't work, we would have nothing but a hole in the ground with a building that could only be used for a very specific purpose.'

Money Risk

One of the greatest concerns for a new business venture is that it will run out of cash for operations before it becomes profitable. For the investor, an important consideration is the likelihood that the company will be able to go public in the near term so that the investors can cash out and invest their money in other attractive ventures. For this particular venture, the capital needs were high and the possibility of raising $100 million given the long amount of time to payout was troublesome.

Styles had undertaken projects just as large in the past, but they had involved multiple hospitals. He reflected, 'If one hospital did not do well, you knew you were spreading the risk over several hospitals. Here there is a single hospital and a new technology that would bear all of the risk.' In addition he suggested, 'Not many deals involve an investment of over $60 million in equipment. The MRI equipment was the most expensive I had dealt with, and the cost of that equipment was in millions--not tens of millions.' He also worried that if the investors lost their money, it would make his company and M.D. Anderson look bad. Not only that, but the University of Texas system had to approve this, and the people on the board had to trust that the Styles Company and M.D. Anderson knew what they were doing.

All of these risks rolled around in Styles's head as he considered undertaking the deal. He suggested, 'Another way of reducing the risk is by bringing qualified people onto your team. Our team would be the Styles Company, the investment bankers, the equipment people, and the medical care specialists at M.D. Anderson. When you have a team that is seeking all the answers to the right questions, it greatly reduces the risk of the deal.'

The Crucial Decision

John Styles, reflecting on the proton center deal, pondered what he had learned in his many years in the health-care industry about putting a deal together. He reflected, 'First of all, you have to structure the deal so that all of the parties can buy into it. Then you have to come up with a good story about the project that has sizzle-that catches people's attention. Then you must select the most appropriate target investors for the deal and develop a successful pitch designed especially for them.' Styles speculated that putting a deal together with M.D. Anderson would be a great capstone to his career.

Unfortunately, an early conversation that Styles had with a potential supplier of equity capital caused him to rethink his story and the target investor market. The friend had said, 'John, this sounds like a great deal for someone, but the time horizon is longer than our charter allows. We try to get in and out in five years, and it will take you five years to get this built.' Styles suddenly realized the traditional suppliers of equity capital he had worked with in the past wouldn't be interested in this deal. He knew they would have to find some sources of funds that had a much longer time horizon.

In assessing the risks involved, Styles often used the seasoned gambler as an example. 'A gambler often seems to be throwing his money away; but if he has played the game long enough, he knows the odds. He knows when to play and when to fold. That is similar to an entrepreneur doing a deal. If you've done enough deals in that industry (and for me it is health care), you know when to play and when to sit it out.'

Styles thought about his own characteristics as an entrepreneur, his background in health care, and the environment surrounding the deal and wondered how these factors affected his decision-making process.

As he sat down at his desk and stared out the window at the heavy traffic on Bellaire Boulevard, Styles took out a yellow legal pad from his desk, made two columns on the pad entitled 'Pros' and 'Cons' and began to reflect on whether or not he should undertake this deal. If so, he wondered how he could structure the deal to appeal to the unique set of investors that would be required.

Note to Instructors

John Styles, founder of the Styles Company, was afforded an opportunity by the CFO of M.D. Anderson Cancer Center in Houston, Texas, to partner with Anderson in financing, constructing, and managing a proton cancer therapy center in that city. The primary reasons for considering the construction of the center were that Anderson could not handle the high demand for radiation therapy that they were experiencing in the early years of the twenty-first century, and additionally, proton therapy was a much more refined and effective method of treating some types of cancer than other traditional radiation therapies.

The site plan for the proton cancer therapy center estimated that approximately 92,000 square feet would be needed for the facility to house state-of-the-art equipment that had not yet been approved by the Federal Drug Administration. The cost of the project was estimated to be $100 million, and the primary constraint in raising money was the fact that it would take several years to complete the deal and build the center. Therefore, payback on the investment would not begin until patients were treated in the facility--which would be as long as five or more years.

REFERENCES

American Medical Association. (1999). CPT Manual. Chicago: American Medical Association.

Mason, C.M. & Harrison, R.T. (1996). Informal venture capital: A study of the investment process, the post-investment experience and investment performance. Entrepreneurship and Regional Development, 4, 105-126.

Monroy, T. & Folger, R. (1993). A typology of entrepreneurial styles: Beyond economic rationality. Journal of Private Enterprise, IX(2), 64-79.

Naffziger, D.W., Hornsby, J.S., & Kuratko, D.F. (1994). A proposed research model of entrepreneurial motivation. Entrepreneurship Theory and Practice, 18, 29-42.

Particles Newsletter. (2000, January). The newsletter of Proton Therapy Cooperative Group. Issue Number 25.

Roberts, E.B. (1991). Entrepreneurs in high technology: Lessons from MIT and beyond. New York: Oxford University Press.

Sanders Morris Harris. (2001, October). Information memorandum for the proposed proton therapy center at the University of Texas M.D. Anderson Cancer Center, 4.

Wilson, R.R. (1946). Radiological use of fast photons. Cambridge, MA: Harvard University Research Laboratory of Physics.

Marlene Mints Reed is Visiting Professor of Entrepreneurship at the Department of Management & Entrepreneurship, Hankamer School of Business, Baylor University, Waco, TX, USA.

Rochelle Reed Brunson is Lecturer in Family & Consumer Education at the Department of Family & Consumer Education, Baylor University, Waco, TX, USA.

Please send correspondence to: Marlene Mints Reed, tel.: (254) 710-4868; e-mail: marlene_reed@baylor.edu and to Rochelle Reed Brunson at rochelle_brunson@baylor.edu.

среда, 3 октября 2012 г.

Coast physicians rebuilding and caring for patients - The Mississippi Business Journal

Imagine losing your home and medical office in Hurricane Katrina, and then learning that most of the community thinks that you are dead.

Dr. Ben Kitchens and his wife lost their home in Katrina, and it wasn't the first time the Kitchens have had to start over. They also had major damages to their home in Hurricane Camille in 1969, but at least had enough of the house left to rebuild. After Katrina, they came back to only a slab. Ditto for the office; the only thing left was a slab.

Adding insult to injury, it was reported far and wide that Kitchens and his wife died.

'It is a funny thing,' Kitchens said. 'The media reported both of us dead. It said we had drowned in the storm. Our bodies were identified and we were certified dead. This went throughout the whole Coast and beyond. A lot of my patients were disturbed by that. They felt they had not just lost things in the storm, but their family doctor. Fortunately, that proved to be false.'

Kitchens, who has been a family practitioner for 47 years, left on Saturday afternoon before the storm hit. He and his wife were staying in Waco, Texas, they thought safely out of harm's way. Then Hurricane Rita came, and hurricane force winds were predicted in Waco. The storm dodged Waco, and the Kitchens family was okay. But dodging the false rumors of their demise was harder.

Despite the challenges of Katrina, rebuilding a home and a practice, Kitchens wouldn't dream of leaving or retiring now when his community needs him the most - especially since his small town doesn't have that many doctors. He and his wife have found a home in Long Beach they are remodeling, and a temporary office has been set up at the Long Beach Community Church while he continues to look for new permanent quarters.

After his fifth week back in practice, Kitchens is seeing a lot of patients with upper respiratory problems, but nothing beyond what he considers normal for this time of year. He is also listening to his patients, helping them process their losses.

'Most of the patients I see have a horror story of going through the storm,' Kitchens said. 'They may have been in water up to their neck for several hours. Quite a few of them are depressed and anxious. They are somewhat disoriented, but not to the point of not functioning. They are just stunned. When feeling comes back, it hurts. Many people are fighting over insurance coverage, and are frustrated with how slow things are moving. But most have a very positive attitude. They plan to rebuild and start over. I have been impressed that most of the people have a very good outlook.'

'I consider my patients my friends. I have been here long enough that we have more than a professional relationship. I have a friendship with my patients, and feel a real obligation and desire to keep going and take care of them. People ask why I don't just retire. I don't want to retire, and certainly not at this time when the community is in such dire need of help.'

Another Coast physician who lost his home is Dr. Mahmoud H. Zayed, a cardiologist with the Southern Mississippi Heart Center, PA. He and his family lived in his medical offices on Bienville Boulevard until they could make other arrangements.

Still, Zayed said he was lucky because with a few exceptions most of his office staff survived without serious damage to their homes.

'The effects on our practice were to some extent minimized by the support of family members, as well as office staff,' Zayed said. 'Luckily, we have a very dedicated office staff who returned to the office within 10 days after the hurricane in order to be available for patient's needs such as refilling prescriptions and also calling drug reps to obtain samples for patients unable to get their medications from pharmacies because of damage and distribution problems. We knew it was going to be difficult for patients to get medicines for a while because of the circumstance.'

From the standpoint of practicing medicine, Zayed said the main challenge is to have patients refocus again on health problems. Unfortunately, a lot of patients with horrendous losses seem to neglect their health.

'It becomes less of a priority,' he said. 'We have been trying to motivate patients to take control of their health issues and adhere to a healthy lifestyle. I think we have unmasked quite a lot of coronary artery diseases from people going out trying to clear the yard and remove debris. This has actually led to a lot of patients experiencing symptoms such as shortness of breath or chest pain. They came for checkups and that led to a diagnosis of coronary artery disease that was undiagnosed in the past due to limited activity levels.'

After a natural disaster like this, substance abuse increases. People drink more, and tend not to cut back to pre-disaster drinking levels after recovery from the disaster. Zayed reminds his patients that going back to smoking and drinking is not going to help fix the problem.

He also encourages his patients to keep their faith, and remember what is most important.

'Our health is the most important gift from God, and as long as we are healthy, we can always rebuild and bounce back from these major disasters,' Zayed said. 'I am amazed at how people are pulling together. I see patients who are in their 80s ready to rebuild their homes on the water. We do have a very resilient community in South Mississippi, and I think we will ultimately overcome this major challenge and prosper.'

Many Coast residents are facing the most difficult times they have ever experienced.

'What I see in practice is a lot of people are depressed,' said Dr. Don LaGrone, Gulf Coast Children's Clinic, which has offices in Biloxi and Ocean Springs. 'Most people are still waiting to hear from insurance companies, so they are in financial limbo. A lot of people are still struggling with primitive living conditions. There are traffic snarls and prolonged difficulties getting across town. Everything takes more time and is more difficult.'

Physicians aren't immune from the problems. Many are suffering the same problems as patients in terms of anxiety and depression.

'Half the people I know, their homes were either completely destroyed or damaged by the storm,' LaGrone said. 'Outside of their practices, physicians are having to struggle with the same problems that everyone else does.'

LaGrone's office in Ocean Springs flooded, and he didn't have flood insurance because it was out of the designated flood zone. He and his staff did most of the repairs themselves in order to reopen two weeks after the storm. His office in Biloxi opened a week after the storm.

Another problem: many patients have left the area. For example, about 15% of Ocean Springs High School students relocated out of the area after Katrina.

'Many of our patients are no longer in the area, so initially our patient flow was very slow,' LaGrone said. 'We kept all employees on full salary through the storm and aftermath. So, it has been a little difficult with cash flow problems.'

Thus far the Gulf Coast Children Clinic's patient shortfall has been made up because Kessler Air Force's medical facilities have been closed due to hurricane damages. Military dependents have been going to private physicians.

'When Keesler comes back online and takes the business back from the community, it is going to put a lot of stress back on us,' LaGrone said.

The current concern is some of casino employees are losing their health insurance and there is no interim coverage in place. LaGrone is concerned families will leave the area because there is no health coverage, as well as no jobs.

Many of the casinos gave employees 90 days pay and medical benefits after the storm, but that has now run out. Some of the casinos are considering an interim agreement to provide coverage for casino employees who want to remain in the community during the period while the casinos are being replaced. An independent practice association of 75 Coast doctors has offered to see casino employees and their dependents at a discounted rate during the interim period while the casinos are closed. Details are still being worked out.

Like most people, after the devastation of Katrina, LaGrone and his family questioned if they should stay, having lost their home and everything they owned.

вторник, 2 октября 2012 г.

TMA Physicians and Legislators: 'Patients Have a Right to Know'. - Managed Care Weekly Digest

The Texas Medical Association (TMA) joined with state legislators to launch initiatives today that would make using health insurance better and much easier for Texas patients (see also Health Insurance).

The problem: Too often patients do not understand their health insurance information and cannot easily find the answers.

'We believe our patients have the right to know what's covered in their insurance,' said Josie R. Williams, M.D., TMA's president. 'Our patients also have the right to know which doctors and hospitals are in their network, how much extra they will have to pay for the health care services they receive, and why they have to keep paying more for health insurance.'

That is why TMA launched its grassroots outreach campaign, Patients' Right to Know. The goal of the campaign is to engage Texas patients in the effort to pass legislation that would reform health insurance.

Several state lawmakers have introduced important legislation that will ensure that patients have the right to accurate and current information on copays, deductibles, and health plan networks to make good health care decisions.

Health Insurance Code of Conduct Act of 2009

The first piece of legislation to bring needed improvements to the health insurance industry is the Health Insurance Code of Conduct Act of 2009. The measure was filed by Sen. Kip Averitt (R-Waco) and Rep. Craig Eiland (D-Galveston) in the Senate and the House as Senate Bill 1257 and House Bill 2750, respectively.

'We think it's about time health insurance companies treated our patients like valued customers, and keep the promises they make,' added Dr. Williams.

Health Insurance 'Soup Can Label' Bill

For many people, understanding which insurance to buy is difficult. So physicians wonder, what if patients could understand what's in their health insurance policy as easily as they can see what's in a can of soup? What if patients could compare two different health plans as easily as they can compare the calories in two different jars of peanut butter?

TMA's health insurance label plan, filed by Sen. Kirk Watson (D-Austin) and Rep. Senfronia Thompson (D-Houston), would do just that. SB 815 and HB 1932 would require a standardized format for health plan marketing materials that allows an 'apples-to-apples' comparison of health insurance coverage.

'Buying health insurance today is very complicated,' said Dr. Williams. She added that big insurance companies offer dozens of different plans, and cover different things. Patients' out-of-pocket costs can vary wildly. 'It is almost impossible to compare what each plan might mean to patients, their family, or business owners' employees, and we think it's time big insurance makes this simpler for patients.'

The Patients' Right to Know campaign calls on patients and physicians to help make health insurance more accessible and transparent. Among other tools, TMA created www.meandmydoctor.com, a Web site with a grassroots action center where patients can write their legislators in support of health insurance reform bills. Educational materials will be displayed in physician offices to inform and engage patients.

TMA is the largest state medical society in the nation, representing nearly 44,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA's key objective since 1853 is to improve the health of all Texans.

Keywords: Health Insurance, Managed Care, Texas Medical Association.

понедельник, 1 октября 2012 г.

BAYLOR UNIVERSITY ANNOUNCES TOP TEXAS FAMILY BUSINESSES OF 2010.(Awards list) - States News Service

Waco, Texas -- The following information was released by Baylor University:

Baylor University's Institute for Family Business will honor the 2010 Texas Family Business of the Year award winners and finalists at an awards banquet on Thursday, Nov. 4, at Baylor's Bill Daniel Student Center.

The Texas Family Business of the Year awards program recognizes outstanding firms whose families demonstrate a commitment to each other and to business continuity, and who are responsive to the needs of their employees, communities and industries.

'Starting, owning and operating a family business is the foundation of the American Dream,' said J. David Allen, director of the John F. Baugh Center for Entrepreneurship at Baylor's Hankamer School of Business. 'It is our privilege to honor the dedicated, hard-working risk-takers in the state of Texas who contribute so much to our economic and social well-being.'

This year's winners are:

Small Family Business of the Year - DTAC - Midlothian and First Place Foods - Garland

Medium Family Business of the Year - Natural Bridge Caverns - Natural Bridge Caverns

Large Family Business of the Year - Associated Supply Company (ASCO Equipment) - Lubbock

Family Values Award - Southwest Sealants - Georgetown

Well-Managed Award - Total Office Solutions - Dallas

Community Commitment Award - Birkman International - Houston

Fastest Growing Award - American Servoil - Fulshear

Founders Award - Chacon Autos - Dallas

Heritage Award - Hobbs Bonded Fibers - Waco

Finalists in the competition are: Barney Holland Oil Co., Fort Worth; Insurance Network of Texas, Giddings; Metallic Products Corp., Houston; Sabine Pipe, Kilgore; Studio Gallery, Waco; Texas Air Composites, Desoto; The Lawton Group, McKinney; and Wilkirson-Hatch-Bailey Funeral Home, Waco.

Through the Texas Family Business of the Year program and other activities, the Institute for Family Business fulfills its mission to provide a forum for the development and dissemination of information relevant to the health and continuity of family businesses. Other educational and planning programs available to family business owners through the Institute include special interest seminars and entrepreneurship training classes.

воскресенье, 30 сентября 2012 г.

BAYLOR UNIVERSITY HONORS TOP TEXAS FAMILY BUSINESSES.(Awards list) - States News Service

Waco, Texas -- The following information was released by Baylor University:

Baylor University's Institute for Family Business will honor the 2012 Texas Family Business of the Year award winners and finalists at an awards banquet on Thursday, Nov. 8 at the University's Bill Daniel Student Center.

The program recognizes outstanding firms whose families demonstrate a commitment to each other and to business continuity, and who are responsive to the needs of their employees, communities and industries. Entries are judged on the following criteria: family involvement, community and industry involvement, and business success and succession.

'Considering all the recent pressures which have fallen upon business owners - economic downturn, the new healthcare expense issues and enormous regulatory restraints, it is really difficult to operate profitable businesses these days,' said J. David Allen, director of the John F. Baugh Center for Entrepreneurship at Baylor's Hankamer School of Business.

'When family issues are added to the mix great skill and judgment are required to remain successful. We really value, respect and honor family businesses that can balance all the issues, business and family, and continue to operate successful businesses. They are truly remarkable,' he said.

This year's winners are:

Small Family Business of the Year - All-Star Martial Arts and Fitness, Inc. - Cypress

Medium Family Business of the Year - Claffey Pools, Inc. - Southlake

Large Family Business of the Year - Johnson Roofing, Inc. - Waco

Community Commitment Award - The Dwyer Group - Waco

Family Values Award - Sabine Pipe, Inc. - Kilgore

Fastest Growing Award - Image Hospitality - Frisco

Well-Managed Award - DW Distribution, Inc. - Desoto

Founders Award - O'Day Drilling Company, Inc. - Rosharon

Heritage Award - Pendery's Taste Merchants - Dallas/Fort Worth

Finalists in the competition are: Advanced Chemical Logistics, Ltd., Richland Hills; Alloy Metals and Tubes International, Inc., Houston; Auto Exam, Inc., Houston; Billy's Automotive Service, Fort Worth; Brasher Motor Company of Weimar, Inc., Weimar; Broome Welding Company, Inc., Galveston; Hakim Sons Films, Inc., Dallas; Modern Method Gunite, Inc., Houston; Texas Disposal Systems, Austin; White and Associates Real Estate Services, Grand Prairie.

Through the Texas Family Business of the Year program and other activities, the Institute for Family Business fulfills its mission to provide a forum for the development and dissemination of information relevant to the health and continuity of family businesses. Other educational and planning programs available to family business owners through the Institute include special interest seminars and entrepreneurship training classes.

ABOUT BAYLOR UNIVERSITY

Baylor University is a private Christian university and a nationally ranked research institution, characterized as having 'high research activity' by the Carnegie Foundation for the Advancement of Teaching. The university provides a vibrant campus community for approximately 15,000 students by blending interdisciplinary research with an international reputation for educational excellence and a faculty commitment to teaching and scholarship. Chartered in 1845 by the Republic of Texas through the efforts of Baptist pioneers, Baylor is the oldest continually operating university in Texas. Located in Waco, Baylor welcomes students from all 50 states and more than 80 countries to study a broad range of degrees among its 11 nationally recognized academic divisions. Baylor sponsors 19 varsity athletic teams and is a founding member of the Big 12 Conference.

ABOUT HANKAMER SCHOOL OF BUSINESS