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Monday, August 18, 2003
OHA Urges ODJFS to Pull Re-Bill Rule
OHA last week testified against a proposed rule of the Ohio Department of Job and Family Services (ODJFS) that would ban hospitals from re-billing selected outpatient services when an inpatient admission has been denied for medical necessity-a potential financial burden on hospitals since the claims would not be covered at all. OHA testified that Permedion, ODJFS’ outside review entity, is not questioning whether the care in these cases was medically necessary, but rather if the services could have been delivered on an outpatient, rather than inpatient, basis.

ODJFS states it is amending the rule because the re-billing process is too costly. However, ODJFS’ current process is not electronic, but a labor-intensive hard copy process. OHA recommended ODJFS delay any change in payment policy until it has examined the procedures in place to process re-billing and utilize electronic claims processing if possible. OHA further recommended that ODJFS continue the Centers for Medicare and Medicaid Services’ practice in which hospitals are permitted to re-bill selected services as if they were delivered in an outpatient setting.

ODJFS is considering OHA’s recommendations to drop the proposed rule. If ODJFS does not pull the rule, OHA will take its concerns to a Joint Committee on Agency Rule Review meeting in September. (Charles Cataline, charlesc@ohanet.org)

Grants Help Strengthen Rural Health Care
The Department of Health and Human Services (HHS) has awarded more than $30 million in grants nationwide for the maintenance and upgrade of rural hospitals, the coordination of rural health activities and the recruitment and retention of health care providers. The grants are a national effort to strengthen rural hospital networks and support State Offices of Rural Health.

Ohio will receive one of 45 Rural Hospital Flexibility Grants, and the $600,000 awarded to the state will go to help hospitals with 25 or fewer beds qualify as Critical Access Hospitals (CAH). Ohio currently has 20 CAHs, listed at www.ohanet.org/about_oha/cah.asp. HHS awarded nearly $22.6 million nationwide to support hospitals seeking this designation. In addition, Ohio will receive $140,831 of the $7.2 million allocated nationwide for State Offices of Rural Health to use in rural health activities and recruitment efforts. (David Hendershot, davidh@ohanet.org)

Tuesday, August 19, 2003
OHIC Loosens Ties to Parent Company
After a recent A.M. Best downgrade from a B++ to a B rating, OHIC Insurance Company’s parent organization no longer participates as an OHIC reinsurer. As of Aug. 11 the New York-based Medical Liability Mutual Insurance Company (MLMIC) fully funded the reinsurance trust account to cover its reinsurance obligations to OHIC. New OHIC reinsurers are Hanover, Converium and PMA Re, all rated A- or better.

Creation of the trust fund sets aside all potential payouts with funds to be used to cover potential claims from 1998-2002, when MLMIC served as a reinsurer of OHIC. According to OHIC, the change is specifically geared to satisfying the concerns of those insured through the company, demonstrating OHIC’s stability, and alleviating concerns that MLMIC’s financial problems might negatively impact OHIC.

In an informal OHA survey of Ohio hospitals, 30 of 31 respondents indicated their hospital continued accepting OHIC professional liability insurance for its physicians as meeting hospital bylaw requirements, most of which require a B+ or better rating for medical liability insurers. Based on diligent efforts to examine various medical malpractice insurance options for Ohio hospitals and physicians, OHA had recommended caution in responding to OHIC’s downgrade. (Rick Sites, ricks@ohanet.org)

Trustee Advocacy Day Scheduled
On Tuesday, Sept. 16, the American Hospital Association (AHA) will host a Trustee Advocacy Day in Washington, D.C. September is a critical time of year for hospitals to maintain maximum visibility as Medicare conferees continue their work with the Medicare Prescription Drug Benefit and before U.S. Congress adjourns for the year. AHA will be asking legislators to eliminate cuts in the hospital inpatient prospective payment system payments, to restore funding for Indirect Medical Education, to include Medicaid DSH relief, to protect Senate niche provider language, and to maintain and strengthen rural provisions.

The day will begin at Loews L’Enfant Plaza Hotel with a political and legislative briefing from AHA staff. Then, trustees will visit their respective legislators.

If you would like more information, or if your hospital’s trustees would like to attend the lobbying day, please contact Jonathan Archey, OHA’s federal relations manager. (Jonathan Archey, jonathana@ohanet.org)

Wednesday, August 20, 2003
2003 HCAP Model Available
The final version of the 2003 Hospital Care Assurance Program (HCAP) model is now available on OHA’s Web site at www.ohanet.org/hcap/. Also online is a summary and explanation of the 2003 model. Final assessment notices will soon be mailed to hospitals by the Ohio Department of Job and Family Services. The full assessment and payment schedule will be available on OHA’s HCAP Web page as soon as it is available. Watch for an upcoming OHA Bulletin for more information. (Ryan Biles, ryanb@ohanet.org)

Hospitals Lead the Way
OHA congratulates the accomplishments of Ohio hospitals and health care leaders recognized for their leadership in quality, end-of-life care, community health, engineering and medical transport.

Lutheran Hospital, Cleveland, scored 100 in its latest Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accreditation survey, a feat accomplished by only one out of every 500 hospitals surveyed by JCAHO.

Mercy Health Partners-Southwest Ohio, Cincinnati, was awarded a Citation of Honor from the American Hospital Association as part of its national Circle of Life recognition program. Mercy’s holistic Palliative Care Program in Cincinnati was one of seven programs to receive a citation. For more, visit www.hospitalconnect.com/aha/awards-events/circle_of_life/.

St. Rita’s YMCA Healthy Lifestyle Center at the Lima Mall, a program of St. Rita's Medical Center, Lima, was selected as a 2003 finalist for the American Hospital Association’s NOVA Award. For more, visit
www.hospitalconnect.com/aha/awards-events/awards/novaaward.html.

Receiving individual recognition, Stephen Blum, Shriners Hospital for Children, Cincinnati, was among 10 facilities management officials nationwide to receive an American Society for Healthcare Engineering’s Emerging Leaders award, which recognizes leadership in health care engineering, facilities management and related fields.

Alliance Medical Transport Service, part of the Health Alliance, Cincinnati, is the second transport service in the nation to receive accreditation in four levels of medical transport from the Commission on Accreditation of Medical Transports Systems. For more, see a Health Alliance news release at www.health-alliance.com/pressroom.

CORRECTION: In the most recent Hospitals Lead the Way feature, OHA erroneously excluded the following Ohio hospitals recognized in the annual U.S. News & World Report “America’s Best Hospitals” list: CHP Hospital and Surgical Center, Lorain, Children’s Hospital Medical Center, Cincinnati, Fairview Hospital, Cleveland, Grandview Hospital and Medical Center, Dayton, Grant Medical Center, Columbus, Mercy Medical Center, Canton, Rainbow Babies and Children’s Hospital, Cleveland, Riverside Methodist Hospital, Columbus, and St. Vincent Medical Center, Toledo. A complete list of hospitals is available online at www.usnews.com. (Mary Yost, maryy@ohanet.org)

Thursday, August 21, 2003
OHA Board OKs Creation of New Med Mal Company
The OHA Board of Trustees voted at its monthly meeting last week to proceed with creation of a new medical malpractice insurance company to help stabilize the market for Ohio physicians and hospitals.

The goal is to be ready to sell insurance by December in order to offer an alternative to physicians with coverage that expires in January. OHA would provide initial capital and Ohio hospitals will be invited to buy stock to fund additional capital. An offering circular is being prepared for distribution and regional meetings are being scheduled throughout the state in September to provide details to member hospitals.

In other action, the Board voted to endorse the participation of Ohio hospitals in the Quality Initiative for voluntary public reporting of quality data. The national initiative is sponsored by the American Hospital Association, the Federation of American Hospitals and the Association of American Medical Colleges.

However, the Board voted to oppose two state measures - a proposal by the Ohio Department of Health (ODH) to allow freestanding cardiac catheterization labs to operate in Ohio and legislation to mandate hospitals provide charity care equal to 4 percent of gross patient revenue.

The Board directed staff to communicate a number of concerns with ODH regarding its proposal for a pilot program of freestanding cath labs, including: the project’s impact on the entire health care delivery system, specifically cardiac care services in Ohio; the impact on utilization, quality, safety and cost; and the proposed 60-minute transfer guideline.

The proposed charity care measure, House Bill 248, was rejected as unnecessary and difficult to calculate. It was also noted hospitals provide a broad range of services in addition to charity care as part of their community benefit.

The Board also approved a dues formula for 2004 that continues a discount for early payment of dues. The discount for calendar year 2004 will be 5 percent.

Finally, the Board received a slate of candidates from the Nominating Committee. To be recommended to the OHA membership in the fall for election to the OHA Board in 2004 are: Gregory Nowak, administrator of Coshocton County Memorial Hospital; Stanley Korducki, president of Wood County Hospital, Bowling Green; David Meckstroth, president and CEO of Upper Valley Medical Center, Troy; James Meyer, president of MedCentral Health System, Mansfield; Alan Bleyer, president of Akron General Medical Center. Recommended as secretary/treasurer of the Board is Cathleen Nelson, president and CEO of St. Charles Mercy Hospital, Oregon. (Jim Castle, jimc@ohanet.org)

Friday, August 22, 2003
OHA Voices Support for Quality Initiative
The OHA Board of Trustees this month voted to endorse The Quality Initiative: A Public Resource on Hospital Performance, a voluntary national effort to publicly report certain hospital data. Sponsored by the American Hospital Association (AHA), the Federation of American Hospitals (FAH) and the Association of American Medical Colleges, this initiative seeks to reduce the need for mandatory reporting of quality measures. It is an effort to publicly report a subset of quality measures from the JCAHO core measures and the Centers for Medicare and Medicaid Services (CMS) 7th Scope of Work for heart attack, heart failure and pneumonia.

The initiative offers Ohio hospitals an opportunity to demonstrate the high level of quality of care they provide to their communities and continue performance improvement efforts. In addition, it takes a step toward developing an informed public and encouraging Ohioans to become actively involved in their care.

Hospitals choosing to participate must submit a pledge of participation to AHA (www.hospitalconnect.com/aha/key_issues/patient_safety/advocacy/quality_initiative.html) and sign up for the Qnet through Ohio KePRO, the Quality Improvement Organization for Ohio hospitals (216.447.9604). For additional information, contact Rosalie Weakland at rosaliew@ohanet.org or 614.221.7614.

GDAHA President Goes West
Joseph M. Krella, President of the Greater Dayton Area Hospital Association (GDAHA), has announced his resignation effective mid-September 2003. Krella will take the reigns as President and CEO of the Utah Hospital and Health Systems Association (UHA). A statewide organization, UHA represents 47 hospitals, 10 health systems and 27 affiliated professional societies.

Krella served as president of GDAHA for 12 years and the organization has seen successful collaboration and advocacy during his tenure. A tribute to this collaboration, GDAHA recently received the Ernest A. Codman Award for Quality Improvement from the Joint Commission on Accreditation of Healthcare Organizations. OHA offers best wishes to Mr. Krella in his new position.