While the Senate bill contains a full Medicare inpatient update, the House legislation includes a reduction in the update, lowering the market basket update by .4 percent. OHA is advocating strongly against this reduction, voicing hospitals’ need for a full update regardless of other provisions for hospitals the final legislation may include. 

Proponents of the bill testified it is the best solution to a growing problem of physicians investing in and referring patients to limited-service hospitals focusing on more profitable health care services, including cardiac and orthopedic care. Four witnesses urged passage of the bill, including OHA Board Member Joe Calvaruso, president and CEO of the Mount Carmel Health System, and Mary Jo Welker, MD, chair of the Ohio State University Department of Family Medicine.

Proponents testified the very design of physician-owned, limited-service specialty hospitals - which are not equipped to handle patients with complications - require those more complex and expensive cases to go to full-service community hospitals. With reimbursement for care based on average costs, that means specialty hospitals gain profits by cherry-picking healthy patients while community hospitals’ ability to offer a full range of needed services is crippled.

Even the two opponents testifying noted the issue is attracting federal attention. They suggested state legislators wait for federal officials to act. However, Mary Gallagher, OHA vice president and general counsel, argued both state and federal legislation is needed to address physician self-referral for all types of patients, those covered by Medicare and Medicaid as well as those who have private insurance. Testimony and a letter to Ohio members of Congress is available on the OHA Web site at www.ohanet.org/advocacy/state/issues/default.htm#conflict. (Jeff Klingler, jeffk@ohanet.org)

Thursday, June 26, 2003
State Budget Finalized on High Note for Hospitals
Gov. Bob Taft signed off on the 2004-2005 biennial budget today, retaining vital eligibility and funding provisions for Ohio’s hospitals. In large part due to OHA and Ohio hospital advocacy efforts, HB 95 restores full coverage for more than 50,000 low-income working Ohioans and provides a $9 million Medicaid outpatient update for adult hospitals over the next two years, which will result in $20 million in state and federal matching dollars. The Ohio Children's Hospital Association led a successful grassroots advocacy effort, resulting in a full inflationary inpatient update for Ohio’s children’s hospitals. The funding increases were allocated despite some legislators’ efforts to slash Medicaid spending.

Taft did make a line-item veto dealing with Medicaid care management, removing language that restricted the Ohio Department of Job and Family Services’ ability to implement managed care and prohibited managed care for aged, blind and disabled children. However, OHA was successful in deleting the most problematic managed care provision: language requiring that hospitals treat patients enrolled in HMOs with which they have no contract and accept 95 percent fee-for-service as full payment. Taft also vetoed the supplemental dental, podiatric and vision services for Medicaid, placing restrictions on these services. OHA is evaluating the language pertaining to this item and will provide additional information as well as a summary of all budget items with hospital impact.

U.S. House May Restore Medicaid DSH Funding
As the House Medicare reform legislation moves toward completion, with a full House vote expected late tonight, legislators have added additional provisions for hospitals. Despite concerns with key aspects of House Resolution 1, hospital advocates applaud provisions to restore full disproportionate share program (DSH) funding for hospitals starting in fiscal year (FY) 2004, to grant aid for rural hospitals and to offer regulatory relief.

Primarily through the efforts of Rep. Deborah Pryce (R-OH), H.R. 1 provides that DSH allotments administered under the Hospital Care Assurance Program (HCAP) will be increased 120 percent in FY 2004, with annual inflationary adjustments thereafter. Though Ohio hospitals will still need to cope with the $50 million reduction for FY 2003, the provision restores Ohio’s HCAP to nearly the levels maintained before the reduction.

H.R. 1 also contains many benefits for rural hospitals, raising their base Medicare reimbursement rates to that of urban-area hospitals and strengthening the Critical Access Hospital program, among other provisions. The legislation also goes far to reduce the regulatory burdens hospitals face.

OHA will continue to work with Congress to improve this historic legislation. We commend Rep. Pryce’s leadership in securing DSH funding for Ohio’s hospitals and sent a letter to House leaders applauding the above provisions. To view the letter, visit www.ohanet.org/advocacy/federal/HR1letter062603.pdf. (Jonathan Archey, jonathana@ohanet.org)

Friday, June 27, 2003
Physician Self-Referral Bill Gains Momentum
An OHA-backed bill to close a physician self-referral loophole will receive additional hearings this summer before the Ohio House Health and Family Services Committee. Following bipartisan support expressed by committee members during a hearing on Wednesday, Chair Greg Jolivette, R-Hamilton, announced Thursday he will continue work on House Bill 71 with a possible vote at the end of August. Jolivette added he sees potential for compromise.

Guarding Against the Missing Link: Patient Safety Efforts in Ohio
In the ongoing effort to improve their patients’ safety, Ohio’s hospitals recognize that the health care chain is only as strong as its weakest link: facilities not prepared to transition to error-reducing technology, physicians who do not feel safe reporting their errors or patients who change doctors or pharmacists without providing a copy of current medications. Hospitals, the Ohio Patient Safety Institute (OPSI), and Ohioans FiR_xst are all working to increase patient safety by strengthening each of these links.

On the federal front, legislation regarding the voluntary reporting of errors was passed by the House and is currently working its way through the Senate with support from the American Hospital Association and OHA. The Joint Commission on Accreditation of Healthcare Organizations also requires hospitals to meet national patient safety goals as of January 2003, and the Federal Drug Administration plans to require bar coding on medication, which would reduce medical errors by 50-80 percent.

Within Ohio, hospitals are working to evolve from paper to handheld technology and electronic medical records and physicians, pharmacists, nurses and other health care workers have accepted the challenge of increasing patient safety. Informing patients, and engaging them in protecting their own safety, also remain vital to the state’s patient safety efforts.

Patient safety remains a high priority in Ohio and with the continued support of legislators, hospitals, health care workers and patients Ohio will be a leader on this important issue. For more, see OHA's June Healthbeat at www.ohanet.org/healthbeat/2003/healthbeat0603.htm.