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Tuesday, September 3, 2003
Ohio Rural Health Rep Goes National
OHA congratulates Heather Reed, Administrator of the Ohio State Office of Rural Health, for her recent election to the position of president-elect of the National Organization of State Offices of Rural Health. She will serve as the president-elect during 2004 and will assume the position of president in 2005.

Reed also has been appointed by U.S. Department of Health and Human Services Secretary Tommy Thompson as a member of the National Advisory Committee on Health and Human Services.

Wednesday, September 3, 2003
Physician Referral Bill Vote Delayed
The Ohio House Health and Family Services Committee postponed a scheduled vote Wednesday on House Bill 71 while OHA and other interested parties review a proposed compromise to the legislation originally intended to prohibit physician-investors from referring patients to their own hospitals.

OHA is awaiting legislative language outlining the latest proposal from Rep. Gregory Jolivette, R-Hamilton, the House health committee chair. The proposal will then be shared with Ohio hospitals statewide for member feedback. Broad points of the latest proposed compromise include the following:

Physician self-referral prohibition in temporary law, effective for 2 ½ years
Grandfather protection for existing and new physician-owned hospitals that have filed a notice of intent by Sept. 26, 2003, which is the day the requirement for filing a notice of intent for new construction is effectively repealed, pursuant to a provision in the state budget bill
A 2 ½ -year moratorium on new specialty hospital construction, applicable to not-for-profit as well as for- profit hospitals
A temporary prohibition, effective for 2 ½ years, on hospitals denying staff privileges to physicians solely on the basis of their investment in a for-profit hospital.

Regarding the physician credentialing provision, the Ohio State Medical Association has indicated it might seek introduction of separate legislation to propose even broader restrictions on hospital credentialing decisions. (Jeff Klingler, jeffk@ohanet.org)

Thursday, September 4, 2003
CMS Clarifies EMTALA Regulations
The Centers for Medicare & Medicaid Services (CMS) has issued a final rule clarifying hospitals’ obligations to patients under the Emergency Medical Treatment and Labor Act (EMTALA) of 1986.

Hospitals have advocated clarifications to EMTALA for more than a decade, and are lauding the rule as needed and practical guidance. The rule does not remove the obligation of hospital emergency departments to continue to screen and stabilize patients regardless of the patients’ ability to pay, but clarifies that EMTALA applies only to such emergency settings and cases. According to the rule, once a patient is admitted to the hospital, the hospitals’ EMTALA obligations will be deemed satisfied. After admission, inpatient care regulations will continue to apply.

The final rule continues hospitals' obligation to maintain an on-call list, but gives hospitals discretion for how best to do so given limited staffing resources. In situations of national emergency, hospitals will not be penalized if they are forced to transfer patients (due to overflow, etc.) in a way that would otherwise violate EMTALA

The rule is to be published in the Sept. 9 Federal Register and effective Nov. 10, 2003. See a draft of the rule at http://cms.hhs.gov/physicians/default.asp and also a CMS press release at http://cms.hhs.gov/media/press/release.asp?Counter=837. (Jonathan Archey, jonathana@ohanet.org)

ODH Cardiac Cath Pilot Moves Forward
Despite opposition by the OHA Board of Trustees, Ohio Department of Health (ODH) Director J. Nick Baird said the department plans to go ahead with its cardiac catheterization pilot program, first introduced in July.

The OHA Board directed staff to communicate a number of concerns with ODH about the program to allow adult diagnostic cardiac catheterizations on low-risk patients in a freestanding setting. Concerns include: 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.

Responding to OHA concerns in a letter, Baird stated, “…it is our position the department should facilitate the safe development of such services. We believe this pilot program is appropriate to monitor patient safety through the controlled development of this service.” OHA staff will discuss next steps with the OHA Board at its next meeting later this month. The letter is online at http://www.ohanet.org/advocacy/state/issues/letters/cardiaccath.pdf. (Bridget Gargan, bridgetg@ohanet.org; David Engler, davide@ohanet.org)

Friday, September 5, 2003
Medical Malpractice Dilemma Climbs Toward Boiling Point
The stewing health care liability pot nears eruption in Ohio and many other U.S. states, with insurance premiums increasing more than 500 percent nationally between 1975 and 2001 and continuing to rise. And the problem does not affect just hospitals and physicians, it threatens access to quality health care for all patients.

Ohio’s government has taken steps toward seeking a remedy to the medical malpractice situation, including the passage of tort reform legislation, Senate Bills 281, 120 and 179, earlier this year. Other groups are also taking action. OHA established a Sponsored Deductible Program (SDP) to help physicians finance large insurance deductible losses on their medical professional liability coverage and will proceed with the creation of a new medical malpractice insurance company to help stabilize the market for Ohio physicians and hospitals.

This fall, both Ohio’s General Assembly and U.S. Congress will face a new slate of tort reform legislation (www.ohanet.org/med-mal/legislation/) and the Ohio Supreme Court will also play a vital role, with the power to uphold legislation that addresses the medical malpractice insurance crisis and to prevent the expansion of tort liability that characterized the court during the 1990s.

Through programs designed to aid physicians and new legislation seeking to create a better system, Ohio is taking important steps to turn down the heat on the state’s medical malpractice situation. For more information, see OHA’s September Healthbeat at http://www.ohanet.org/healthbeat/2003/healthbeat0903.htm.

HIPAA Electronic Billing Seminars Offered
The Ohio HIPAA Implementation Organization (OHIO for EDI) is offering regional seminars to assist providers in meeting the October 16 HIPAA electronic transaction regulations. The day-long seminars will be held September 11 in Columbus, September 12 in Cleveland, and September 18 in Cincinnati. For registration information, go to www.ohiohipaa.org. (Rick Sites, ricks@ohanet.org)