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Monday, November 17, 2003
Medicare Reform Bill Poised for Passage
After much advocacy from OHA and other hospital representatives, Congress has reached a tentative agreement on Medicare reform legislation that, if passed, would mean hundreds of millions of dollars for hospitals over the next several years. The bill may go to the House and Senate floors for votes as early as this week.

Key provisions for hospitals include:

Full market basket update for the inpatient prospective payment system for 2004, and a full update in 2005-2007 for hospitals participating in the American Hospital Association’s Quality Initiative. Non-participating hospitals would receive a market basket minus .4 percent increase.
Standardization of base payments for Medicare, permanently bringing all Ohio hospitals to the large urban rate.
Reduction in the labor related share of the wage index, a help for rural hospitals.
Improvements in the reductions planned for indirect medical education, granting more funds to teaching hospitals.
A 16 percent increase in the Disproportionate Share Hospital program, approximately $45 million, to help restore 2003 reductions to the Hospital Care Assurance Program.
Significant improvements to the physician fee schedule.
Language prohibiting physicians from referring patients to new specialty hospitals in which they have an ownership interest under Medicare for 18 months while more study of the issue is conducted. Existing facilities would be grandfathered and could add up to the greater of five beds or 50 percent of their current capacity on existing campuses during the 18-month period.
A requirement that Medicare pay for dual-eligible patients, helping to reduce the financial burden of Medicaid on the states.
Numerous regulatory relief changes under Medicare.

Supportive of the many positive improvements this bill holds for hospitals, OHA will continue to report on any changes to or votes on the legislation. (Jonathan Archey, jonathana@ohanet.org)

OHA Offers Prep for Revised Surveys
With new changes in industry standards and the survey process for 2004 rapidly approaching, the OHA Center for Education is sponsoring Preparing Your Diagnostic Imaging Department for JCAHO Survey. This conference, Dec. 9 at the Wyndham Hotel in Dublin, will offer information on how to succeed with the revised Joint Commission on Accreditation of Healthcare Organizations (JCAHO) survey format, including: what policies are reviewed, what questions are asked of staff and managers, what practices are observed, what surveyors look for in staff files, patient records and environmental and infection control issues. For more information and to register, visit www.ohanet.org/education/education_programs.asp.

Tuesday, November 18, 2003
Bill Would Expand Physician Assistants’ Scope
Legislation to expand the responsibilities of physician assistants (PA) was introduced earlier this month. Senate Bill 147, sponsored by Sen. Lynn Wachtmann (R-Napoleon), maintains physician assistants’ status as dependent practitioners under the direction of their supervising physician, but would require more education and training to expand their scope.

The bill would require PAs to obtain a master’s degree to practice in Ohio, to take effect in 2008, with a grandfather clause exempting currently practicing PAs. It would also allow physicians to delegate prescriptive privileges to qualified PAs for certain drugs.

Also, SB 147 would not require a supervising physician’s countersignature to allow other caregivers to execute medical orders written by a physician assistant. PAs practicing within a health care facility would be subject to that facility’s credentialing policies. Finally, on-site supervision would be eliminated for PAs whose supervising physician’s normal scope of practice is outside the emergency room. The exemption does not apply to PAs who routinely practice in an emergency room.

OHA staff has discussed initial drafts of the legislation with the OHA Quality Assurance and Accreditation Committee, which raised no serious concerns with the bill. OHA will discuss the bill as it was introduced with the committee next month. (Jeff Klingler, jeffk@ohanet.org)

ODI Outlines Risks With Captive Insurers
The Ohio Department of Insurance (ODI) cautioned providers to know the risks associated with captive medical malpractice insurance companies in a memo sent this week to Ohio health care providers. Captive insurers allow individuals or companies to self-insure certain risks by relying on their own resources to pay claims, rather than relying on a licensed insurance company to pay claims.

ODI suggests providers consider several factors before purchasing insurance through a captive, first warning that captives may not be regulated by ODI. Thus, these companies are not subject to the solvency requirements of Ohio law, which require insurers to have a minimum capital and surplus of $5 million or more. Captives, however, are not required to have that level of surplus, possibly placing individual’s personal assets at risk if the captive becomes insolvent. Largely because of this risk, some hospitals may not accept medical malpractice coverage provided by captives.

Additionally, captives are not covered by the Ohio Insurance Guaranty Association, which offers protection for medical malpractice coverage offered by Ohio licensed insurance companies. Finally, some captives have minimal reporting requirements, according to ODI. The complete memo is online at www.ohanet.org/med-mal/resources/ODIbulletin.pdf.

Both OHA and Columbus law firm Bricker & Eckler, LLP, have issued guidance on captive insurers, available at www.ohanet.org/med-mal/resources/. OHA continues to tackle Ohio’s medical malpractice insurance crisis and is currently awaiting ODI’s approval to create a new medical malpractice insurance company to increase stability in the market. For more, visit www.ohanet.org/med-mal/. (Rick Sites, ricks@ohanet.org)

Wednesday, November 19, 2003
Hospital Help Needed to Fend Off Flu
Officials are warning this year's flu season appears to have arrived early and is hitting hard. The Centers for Disease Prevention and Control (CDC) is urging Americans to get a flu shot as early as possible, citing early indications of the most severe flu season in several years.

Ohio is currently on watch status, according to the National Flu Surveillance Network. However, CDC predicts this year's virus is circulating at a higher level than usual for this time of the year. In addition, this year's flu vaccine is taken from a related, but different, strain of influenza than the strain circulating the nation, which may limit its effectiveness.

Hospitals are encouraged to vaccinate patients at discharge, particularly those in a high-risk group: those 50 and older, those with chronic diseases or weakened immune systems, children and teenagers on long-term aspirin therapy, pregnant women and health care workers. For real time flu updates, visit www.fluwatch.com or www.cdc.gov/ncidod/diseases/flu/weekly.htm. (Rick Sites, ricks@ohanet.org)

Working Wonders
Nursing Rewards, a new statewide public education campaign encouraging nursing as a career, kicked off today with a media event at the Statehouse in Columbus. The campaign will feature a comprehensive Web site, television Public Service Announcements, billboards, radio and paper ads in an effort to educate the public on the benefits of a career in nursing. The campaign also seeks to increase public awareness of nursing as a fulfilling and challenging career for both men and women. Several Ohio nurses spoke at the campaign unveiling on why they enjoy their careers. Other speakers noted the importance of a strong health care system to Ohio's economy and that the strength of Ohio's health care system relies on a strong workforce, specifically a strong nursing workforce.

The campaign is sponsored by the Ohio Board of Nursing, in conjunction with the Ohio Health Care Association, OHA, the Association of Ohio Philanthropic Homes and Housing for the Aging, the Ohio Council for Home Care and the Ohio League for Nursing, are leading this campaign. For more information on this campaign, or on a career in nursing, visit www.NursingRewards.org.

Ohio hospitals are also making other efforts to recruit and retain talented associates and strengthen the Ohio health care system. On behalf of the Franklin County hospitals, the Columbus Chamber of Commerce last week held Think Healthcare Careers, sharing information about the many careers in health care with high school career advisors and students. For more information on the current health care workforce or other workforce-related issues, visit OHA’s Hospital Workforce Forum at www.ohanet.org/workforce/. (Jean Scholz, jeans@ohanet.org)

Thursday, November 20, 2003
OPSI Convenes Wrong Site Surgery Symposium
The Ohio Patient Safety Institute (OPSI), in conjunction with the Patient Safety Discussion Forum (PSDF), this week convened a meeting of Ohio health care professionals to discuss implementation of the Joint Commission on Accreditation of Healthcare Organizations’ (JCAHO) wrong site surgery protocol. As organizations move forward to meet the new JCAHO requirements, OPSI and PSDF are working to develop a standardized implementation process across all facilities. Aligning principles from the onset will encourage and enhance patient safety as physicians and health care professionals practicing in multiple settings apply universal wrong site surgery protocol principles to all of their affiliated organizations. The principles produced at this week’s symposium will be distributed early next year.

Patient safety continues to receive attention in various arenas, with the United States Pharmacopeia releasing its annual report on medication errors in U.S. hospitals this week and the Institute of Medicine publishing Patient Safety: Achieving a New Standard for Care this week. This week’s symposium and the resulting principles are among the many ways Ohio health care organizations continue striving to improve the safety of both their patients and associates. (Rosalie Weakland, rosaliew@ohanet.org)

IOM Calls for Electronic Health Information Network
The National Academies’ Institute of Medicine today released a new report, Patient Safety: Achieving a New Standard for Care, outlining the need for electronic medical records and other information technology systems in the quest to improve patient safety nationwide. The report promotes the creation, over a 10-year period, of a national network of health information that would be available to all health care organizations and governed by consistent standards. It charges the government with leading the way in this initiative and providing some of the necessary funding. To view a press release regarding the report, visit www.nationalacademies.org/.

Ohio health care organizations currently have multiple initiatives focused on improving patient safety through technology and information sharing, such as OHA’s work with the National Alliance for Health Information Technology to use bar coding to prevent medication errors and standardize health information systems to communicate between one another. The Ohio Patient Safety Institute (OPSI) recently launched an online Learning Library, allowing hospitals to share patient safety lessons learned, and is currently organizing a workshop on navigating the possibilities of information technology for early next year. In addition OPSI is piloting a process using existing data to identify errors for opportunities to improve patient safety processes. For more information, visit www.ohiopatientsafety.org/. (Rosalie Weakland, rosaliew@ohanet.org)

Friday, November 21 2003
Voice Support for Medicare Reform Bill
As the Medicare reform bill heads to the House and Senate floors, OHA urges hospital advocates to contact their members of Congress to vote yes on the bill. If passed, this legislation could mean hundreds of millions of dollars, regulatory relief and many other positive improvements for hospitals over the next several years. For more information, view a PowerPoint presentation outlining the provisions of the bill affecting hospitals at www.ohanet.org/advocacy/federal/. To find the phone number of your local member of Congress, call 1.800.826.9658 or visit www.ohanet.org/advocacy/federal/resources/congressional_delegation.asp. (Jonathan Archey, jonathana@ohanet.org)

Hospital Input Makes a Difference
Due to the response of Ohio’s hospitals and OHA, as well as other organizations across the nation, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will not institute proposed standards language barring hospitals from including in their governing body or medical staff bylaws any language asserting authority to unilaterally amend medical staff bylaws. Instead, JCAHO will work to re-define the respective responsibilities of hospital management, the governing body and the medical staff. It will establish new expectations regarding conflict resolution and collective responsibility that reflect the common goal of the groups to provide excellent care to the patients and communities they serve.

The Standards and Survey Procedures Committee of the Board of Commissioners instructed this course of action after discussing the field review’s strong responses both in favor of and opposed to the proposed standards. JCAHO views the project as an opportunity to better connect hospital leaders in their common goals and the commission plans to solicit input from the leadership groups as well as pertinent professional societies and associations. (Rosalie Weakland, rosaliew@ohanet.org)