OHA Advocacy Network

Advocacy Report • Friday, May 25, 2007

STATE

OHA’s Top Advocacy Agenda Items: State Budget, 24/7 ED Bill

As the state’s $52.9 billion biennial budget and legislation mandating all hospitals have a 24/7 ED near crucial votes, OHA is boosting its advocacy efforts on both proposals.

OHA Hosts Legislative Receptions, Holds First-Ever Media Briefing

Over the past few weeks, OHA, in partnership with the regional allied hospital associations, have hosted legislative receptions in Akron, Cincinnati, Cleveland and Dayton, providing hospital representatives with an opportunity to meet with their legislators to discuss pertinent legislative issues including those being considered in the state budget. The receptions in all areas of the state have generated positive feedback from both hospital representatives and elected officials.

This week, OHA took a new approach at advocacy around the state budget by hosting a media briefing for the Statehouse press corps. Hospital administrators and trauma surgeons outlined the need for supplemental Medicaid payments for trauma centers, rural obstetrics and critical access hospitals at the briefing, where Issue Briefs on each supplemental payment request were provided and outlined.

Issue Brief #1: Trauma Centers

OHA is calling for the creation of a special state fund to help preserve verified trauma centers in Ohio. Maintaining access to trauma care is vitally important and hospitals are heavily subsidizing these unites. This fund will provide some financial relief to these hospitals. OHA estimates at least $4 million in state dollars for each year of the biennium is needed for supplemental payments to Ohio’s trauma centers.

Calling on the legislature to help Ohio avoid a collapsed trauma system as happened in Los Angeles, Mary C. McMarthy, M.D. FACS, director of trauma services for Miami Valley Hospital in Dayton and Professor of Surgery for Wright State University School of Medicine, noted the vital need for expensive, but critical trauma care in Ohio’s hospitals. F. Barry Knotts, M.D., Ph.D., medical director, trauma care with St. Vincent Mercy Medical Center in Toledo, echoed McCarthy saying “no money, no mission” in reference to the hospital’s mission and ability to provide care to the underserved.

Issue Brief #2: Critical Access Hospitals

OHA is working to preserve access to care in medically-underserved areas by promoting Medicaid

cost-based reimbursement for critical access hospitals. Ohio has 34 hospitals classified as “critical

access hospitals” in communities throughout the state. Medicare reimburses these facilities based

upon reasonable cost verses an inpatient DRG or outpatient fee schedule formula. If Medicaid would reimburse critical access hospitals on a reasonable and allowable cost basis, the state could assist

these hospitals in providing services to the communities they serve. OHA estimates this amendment

will cost $8 million in state dollars each year of the biennium.

Saying that additional state funds would bolster the number two and three biggest employers in the region – University Hospitals Geneva Medical Center and Conneaut Medical Center – Laura Delago, president, noted the high percentage of Medicaid patients combined with increasing charity care are a financial threat to the two critical access hospitals without adequate reimbursement.

Issue Brief #3: Rural OB

OHA supports the creation of a special state fund, $6 million in state dollars for each year of the biennium, to make supplemental payments to rural hospitals that provide obstetrical (OB) services. These essential rural hospitals are incurring significant losses providing OB services and some of these facilities are on the verge of closing their units. This amendment will help to keep these units open and available to all pregnant women.

Speaking on the need for access to obstetrics care in rural hospitals, William D. Watkins, chief administrative officer of Bluffton Hospital, said the hospital lost on average $2,000 per Medicaid OB patient because Medicaid pays the hospital below its cost to provide that vital care. Medicaid payments to the hospital in 2006 fell short of costs by $800,000, Watkins said.

The inclusion of these vital service programs in the state budget will allow hospitals to draw down a combined total of $55.8 million in federal funds.

OHA continues to encourage hospitals to contact their state senator, particularly those that sit on Senate Finance & Financial Institutions Committee, to urge their support of the Medicaid inpatient update, targeted increases for vulnerable service and Medicaid coverage expansions. Template letters can be found at http://capwiz.com/ohanet/state/main/?state=OH.

The Senate is expected to wrap up action by June 12. After the Senate approves its version of the budget, a House and Senate conference committee will then reconcile differences between the two versions and pass it along to the Governor for final approval by June 30. For additional resources on the state budget, visit the OHA State Budget Web page. (Bridget Gargan, bridgetg@ohanet.org)

OHA Testifies in Support of 24/7 ED Legislation, Seeks Committee Vote June 6

SB 120 received another hearing last week in the Senate Health, Human Services and Aging Committee. OHA Senior Vice President Reed Fraley testified in support of the legislation that he said would establish a basic standard for all hospitals in Ohio by requiring them to operate 24/7 emergency departments (ED). He gave a brief overview on the problem of for-profit facilities and the effect they have on neighboring non-profit facilities. He also addressed comments that were made at previous hearings including: what facilities would be required to have an ED; the impact this legislation would have on critical access hospitals; in what type of institutions innovative approaches to clinical practice would best be obtained; and for-profit facilities reduced amount of care to the uninsured.

With senators continuing to commit support, OHA is working with bill sponsor Sen. David Goodman (R-Columbus) to obtain a committee vote on June 6. OHA will be activating an Advocacy Alert on May 30 asking hospitals to contact their senators, particularly those that sit on Senate Health, Human Services and Aging Committee, asking them to support the legislation.

OHA this week published its May HealthBeat article, “Protecting Hospital Emergency Departments Helps Ensure Healthy Ohioans”. For more information on SB 120, or to track its progress, visit http://www.ohanet.org/advocacy/state/issues/limitedservicehospitals.htm. (Bridget Gargan, bridgetg@ohanet.org; Reed Fraley, reedf@ohanet.org)

Hospital Reps Speak with New House Committee on Improving Health Care Access and Affordability
The Ohio House Healthcare Access & Affordability Committee last week heard testimony from OHA and three hospital representatives in response to the committee's questions on health care costs, delivery coordination, technology, ways to improve access, affordability and the health care delivery system. The committee is intended to be a vehicle for health care reform.

Gus Kious, M.D., CEO of Huron Hospital, shared the perspective of the Cleveland Clinic on Medicaid, charity care and the potential for cost savings in hospital services. Dr. Kious stressed the costliness of emergency room care for the hospital, state and patient. He expressed his support of the proposed Medicaid expansion in the state budget which he stated would “encourage individuals to manage their health rather than waiting till there is a crisis that requires an emergency department”. Dr. Kious’ other recommendations included: support of 24/7 emergency rooms; support of preventative medicine for chronic illness; and more effective and expanded use of mid-level practitioners.

Tom Urban, president and CEO of Mercy Health Partners, provided information on hospital provider services and the health system’s experiences related to the growing number of uninsured. He outlined two public-private initiatives currently underway in Toledo and Cincinnati which are working to positively impact access and affordability for the uninsured in those areas of that state. Mercy Health Partners has partnered with area healthcare organizations for these initiatives. He also spoke in support of comprehensive chronic care management programs, stating that they would slow the growth of state Medicaid spending, improve healthcare access and improve the quality of patient care.

Heidi Gartland, vice president of government relations for University Hospitals, spoke on behalf of the Ohio Children’s Hospital Association, sharing the challenges that Ohio’s children’s hospitals face, particularly their high reliance on Medicaid payments. She also spoke on the efforts of the state’s children’s hospitals working together with other area providers, serving as centers of excellence for their regions and eliminating the need to duplicate expensive pediatric care in each and every facility.

Bridget Gargan, OHA's vice president of state policy & advocacy, submitted written testimony responding to the specific questions previously posed by the committee including information on: the cause of rising health care costs; efforts to coordinate with other health care delivery systems; the use and future of information technology in health care; the role the state can play to promote both access and affordability in health care in Ohio; and suggestions on hospital collaboration to improve the health care system.

FEDERAL

CMS Proposes Reduced Medicare Payments, United Hospital Response Needed
OHA is working closely with the American Hospital Association (AHA) to fight the reductions in Medicare inpatient payments to hospitals proposed by the Centers for Medicare & Medicaid (CMS). Hospital CEOs and advocates can help TODAY by contacting their federal lawmakers and urging them to sign on to letters being circulated in the US House and Senate. The bipartisan letters, authored in the US House by Reps. John Lewis (D-GA) and Jerry Weller (R-IL) and by Sens. Ken Salazar (D-CO) and Pat Roberts (R-KS) in the US Senate, demand CMS remove these onerous and unwarranted provisions from the final version of the Inpatient Prospective Payment System rule.

View background information on AHA's Web site or access the AHA Action Alert. To be connected to your lawmakers, call the Coalition to Protect America's Healthcare automated hotline 1-866-887-CARE (2273). Be sure to ask lawmakers to sign on to the Lewis/Weller and Salazar/Roberts letters. (Jonathan Archey, jonathana@ohanet.org)

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Visit us on the Web at: www.ohanet.org

Direct questions on OHA’s advocacy agenda to:

Bridget Gargan, Vice President, State Policy & Advocacy (bridgetg@ohanet.org)

Jeff Klingler, Director, State Policy & Advocacy (jeffk@ohanet.org)

Jean Scholz, RN, Director, Health Policy (jeans@ohanet.org)

Rick Sites, General Counsel (ricks@ohanet.org)

Stacey Conrad, Specialist, State Policy & Advocacy (staceyc@ohanet.org)

Jonathan Archey, Manager, Federal Relations (jonathana@ohanet.org)

Laura Landis, Executive Assistant, State Policy & Advocacy (laural@ohanet.org)