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Monday, November 3, 2003
ODPS Evaluates Trauma Center Closure
The Ohio Department of Public Safety (ODPS) has developed an evaluation tool to examine the closure of trauma centers in Ohio in an effort to understand the factors influencing trauma center closure. If the evaluation tool is deemed successful, the American Trauma Society and Johns Hopkins School of Public Health will consider this model for the evaluation of trauma centers on a national level.

OHA has not endorsed this model, but has provided a copy of the evaluation tool to members in a bulletin as a reference document. The bulletin will also be available online at www.ohanet.org/bulletins/. (Bridget Gargan, bridgetg@ohanet.org)

Tuesday, November 4, 2003
CMS Releases 2004 Outpatient Final Rule
The Centers for Medicare & Medicaid Services (CMS) last week posted a final rule on the Medicare outpatient prospective payment system (OPPS) for 2004. Changes in the new regulation include:

· An increase in PPS payment rates of 4.5 percent, though payments remain significantly lower than costs.
· The application of “dampening rules” to protect certain Ambulatory Payment Classifications from significant losses.
· The creation of two outlier thresholds and payment pools, with one for outpatient hospitals services that would offer additional payment when the cost of service reaches a designated level.
· The reactivation of individual “C” codes for all device categories, though use of the codes will not be required or enforced.
· The reduction of the threshold determining when drugs are separately paid.

The regulation will be published in the Nov. 7 Federal Register and is online at www.cms.gov/regulations/hopps/2004f/. An OHA bulletin will be available this week at www.ohanet.org/bulletins/. (Charles Cataline, charlesc@ohanet.org)

Patient Safety Receiving Financial Boost
An initiative to improve patient safety in the Buckeye State just got some additional financial support. The Ohio Patient Safety Institute (OPSI) will receive a $186,000 grant from the Ohio Medical Quality Foundation to fund its operations, programming and new projects for 2004. The foundation and the OHIC Insurance Company have provided funding to OPSI the past year.

This next year OPSI plans educational programs on technology and patient safety, development of reporting methodologies in addition to the expansion of public awareness campaigns, such as medication brown bag events held around the state. Also in the works is the online Patient Safety Learning Library, a comprehensive resource center for the collection and dissemination of effective quality and patient safety practices. Hospitals are encouraged to submit their own practices to OPSI. Contact Rosalie Weakland or visit the OPSI Web site at www.ohiopatientsafety.org for more on the learning library and other OPSI initiatives. (Rosalie Weakland, rosaliew@ohanet.org)

Wednesday, November 5, 2003
IOM Report Calls for Shorter Hours to Improve Outcomes
The third in a series of reports on patient safety released yesterday by the Institute of Medicine (IOM) calls for transforming the environment in which hospital nurses work. Keeping Patients Safe: Transforming the Work Environment of Nurses calls for changes in how nurse staffing levels and mandatory limits on nurses' work hours are established claiming nurses' actions are directly related to better patient outcomes.

Though IOM acknowledges the current workforce shortage, the report urges state regulators to prohibit nurses from working more than 12 hours per day and more than 60 hours per week. In Ohio, the 2003 vacancy rate is 6.07 percent for registered nurses and 10.14 percent for licensed practical nurses, according to an annual OHA survey. IOM claims reformed staffing policies would aid in recruiting and retaining nurses, not add additional pressure to the already stressed workforce.

The report also encourages hospitals to allocate more financial resources to support continuing education for nurses. However, the report does not address how the current shaky economy and declining reimbursements to hospitals impact their bottom lines.

Two OHA-backed efforts in Ohio are other alternatives to ease the problems cited by the report. The Ohio Patient Safety Institute continues to work on improving patient safety through education of both health care providers and patients, alongside the FutureThink initiative, which strives to halt workforce shortages by utilizing available health care workers more efficiently. More about those initiatives is online at www.ohiopatientsafety.org and www.futurethink.org, respectively.

More information about the study, sponsored by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality, is online at www.iom.edu. (Jean Scholz, jeans@ohanet.org)

ASF/OHA Medicare Billing Seminars Scheduled
Registration materials are out for OHA and AdminaStar Federal’s (ASF) annual programs on Medicare billing and receivables management. OHA and ASF will come together to offer a general review of Medicare claims processing topics, including an update from provider relations and customer service, ASF Medical Review and the new Comprehensive Error Rate Testing (CERT) program, and national and regional Medicare Secondary Payer operations.

Dates and locations are:

n Nov. 10 - Holiday Inn French Quarter, Perrysburg
n Nov. 14 - Embassy Suites, Cincinnati
n Nov. 17 - Sheraton Suites, Cuyahoga Falls
n Nov. 21 - Radisson Airport Hotel, Columbus

Registration information is available on the OHA Web site at www.ohanet.org, or by calling the OHA Center for Education at 614.221.7614. (Charles Cataline, charlesc@ohanet.org)

Thursday, November 6, 2003
Congress Nears End on Medicare Prescription Drug Bill
A congressional conference committee is continuing negotiations on the niche hospital issue as one of the final unresolved pieces of the Medicare prescription drug bill. As work on the legislation nears completion, hospital leaders are being encouraged to urge their legislators to press for inclusion of the Breaux-Nickles amendment on niche providers in the final conference report. The issue focuses on the conflict of interest inherent when physicians own specialty hospitals and refer their patients to them. The Breaux-Nickles amendment closes the loophole in existing regulations. A proposed House measure calls only for a study.

This legislation, which is still a work in progress, is believed to already contain a number of important provisions and OHA supports provisions that are expected to: fully restore funding to the Medicaid Disproportionate Share Hospital (DSH) program; maintain the current “full market basket update” for inpatient Medicare services; improve Medicare reimbursements to small and rural hospitals and make permanent the current equalization of the standardized base rate; bolster the Indirect Medical Education (IME) adjustment; and provide regulatory relief and protections to hospitals under Medicare rules. (Jonathan Archey, jonathana@ohanet.org)

Medicare Offers Financial Help For Flu Shots
With health care providers providing flu shots to many Ohioans, this year’s increase in Medicare reimbursement rates for influenza, pneumococcal and Hepatitis B vaccinations work to reduce the financial burden of offering these services. Effective March 1, 2003, Medicare payment rates increased 94 percent over the 2002 rates, ranging from $5.34 to $10.98 depending on geographic location-the payment rate for Ohio is $7.30. For more information, visit http://cms.hhs.gov/preventiveservices/2.asp.

Causing more than 3,000 deaths in Ohio each year, pneumonia is the most common complication from the flu. The Ohio Department of Health and OHA encourage Ohioans, especially those over 65 and the medically high-risk, to receive vaccines. OHA, the Foundation for Healthy Communities and National City Bank also worked together to offer flu shots in Columbus this week, vaccinating 48 people in one morning. Thanks to those who contributed to this effort. (Rick Sites, ricks@ohanet.org)

CORRECTION:
OHA this week received a correction from the American Hospital Association (AHA) regarding changes to the Medicare cost report that would require hospitals to report information on uncompensated care provided. OHA last week reported that these changes would apply to cost reports beginning on or after April 30, 2003, but based on AHA’s correction they will apply to cost reports ending on or after April 30, 2003. Stay tuned for additional information from OHA on this issue.

Friday, November 7, 2003
Uninsured/Underinsured Motorist Law Reversed
Justice Maureen O'Connor, writing the majority opinion for the Ohio Supreme Court, this week substantially limited the Scott-Pontzer line of cases that turned Ohio's uninsured/underinsured motorist law on its head. Separately, the court disposed of over 100 pending cases raising similar legal issues, including one in which OHA made an amicus appearance urging reversal of Scott-Pontzer.

The Scott-Pontzer line of cases began in 1999 when four justices ruled that liability insurance policies intended to protect business interests could be tapped by persons injured in automobile accidents who were not employees of the company, who were not on company business at the time of the accident, and who were not in company vehicles. The Ohio legislature quickly enacted legislation overriding the Scott-Pontzer cases, but it could not affect hundreds of cases involving accidents prior to the effective date of the bill.

O'Connor wrote that a policy of insurance naming a corporation as the insured covers an employee of the corporation only if the loss occurs within the course and scope of employment. The ruling brings Ohio in line with most other states.

O'Connor was joined by Chief Justice Thomas J. Moyer, Justice Evelyn Lundberg Stratton, and Judge Mary DeGenaro sitting for Justice Deborah L. Cook, recently appointed to the federal bench. Dissents were filed by three justices originally responsible for the Scott-Pontzer cases: Alice Robie Resnick, Paul E. Pfeifer, and Francis E. Sweeney. (Rick Sites, ricks@ohanet.org)

OHA Opposes OIG “Usual Charge” Definition
OHA this week sent a letter to the Office of Inspector General (OIG), U.S. Department of Health and Human Services, opposing proposed amendments to OIG exclusion regulations that redefine the terms “substantially in excess” and “usual charges” as outlined in the Sept. 15 Federal Register. OHA contends that OIG’s proposed methodology would be difficult and expensive for hospitals, outweighing in cost and time any benefit to the Medicare program.

The proposed rule would break down “usual charges,” requiring every hospital to establish an average charge for each of thousands of individual items and services. Several hospitals would be unable to meet this requirement, as many of the qualified employees are busy working to implement the data management changes required by the Health Insurance Portability and Accountability Act (HIPAA). Other hospitals would face the significant costs of managing and auditing this data on an ongoing basis. OHA discouraged OIG from pursuing the proposed amendments and will keep members apprised on the issue. (Charles Cataline, charlesc@ohanet.org)

Grassroots Advocacy With One Click
Communication with your legislators just joined the digital age. This week, OHA kicks off an online grassroots advocacy tool available at http://capwiz.com/ohanet. Individuals from member hospitals can contact state and federal lawmakers on top health care issues by submitting their own letters or utilizing OHA-created templates. Letters will be sent directly to legislators via fax or e-mail, or members can print and mail their letters. The sender will not need to look up the e-mail address or fax number-or even know the elected official to which the letter should be addressed-OHA's new Web site will do all the work.

Individuals who are members of the OHA Advocacy Network, a free service to employees of OHA member hospitals, will receive Action Alerts calling for communications with state or federal lawmakers on a pending issue. Sign up to join the Advocacy Network online at www.ohanet.org/advocacy/state/network or by contacting Stacey Walton at staceyw@ohanet.org.

OHA's new grassroots Web site also will allow individuals to find the names, addresses and phone numbers of their elected officials, and includes information on state and federal legislators, agencies and departments and local government.

Also improving hospitals’ grassroots efforts is the updated-now interactive-OHA legislative tracking system. Find links to bill text and additional resources on OHA-tracked legislation, legislator bios, standing committee lists and OHA staff contact information. The OHA legislative tracking system is online at www.ohanet.org/advocacy/state/issues/status125.doc. (Stacey Walton, staceyw@ohanet.org)