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Monday,
August 9, 2004
OHA’s Foundation for Healthy Communities last week announced it will award approximately $1.25 million in grant funding to 72 hospitals, distributing over $540,000 to 46 pulmonary rehabilitation programs and nearly $700,000 to 26 programs targeting uninsured pregnant women and children. These grants will be administered between now and June 2006, contingent on release of the Ohio Public Health Priorities Trust Fund monies. To learn more about the grants or to see a complete list of recipients, go to www.ohanet.org/HealthyCommunities/newsletter/2004/fall.htm.
The foundation also received approximately 50 proposals for the Hospitals as the Healthiest Workplaces in Ohio! grants. OHA staff and hospital volunteers will review the proposals in the coming weeks before they receive final approval by the Foundation’s Board of Directors. Grant recipients will be announced by mid-September. (Lynne Ayres, lynnea@ohanet.org)
Tuesday, August 10, 2004
Medical Savings Insurance Company has entered into a consent order with the Ohio Department of Insurance (ODI) that requires the company to cease issuing restrictive-endorsement checks to health care providers in Ohio.
ODI has been investigating Medical Savings since at least March 2003 and several OHA member hospitals have filed complaints with ODI over Medical Savings' business practices. Medical Savings employed a practice of marking checks to hospitals "payment in full" even though the hospitals' total bills were not paid. Ohio Administrative Code Sec. 3901-1-60(D)(2) prohibits insurers from indicating a payment is "final" or a "release of claim" unless the benefit plan or contract limit has been met or the provider or beneficiary has agreed to a compromise settlement. Although Medical Savings denies it is in violation of any Ohio insurance law, Medical Savings is involved in litigation with several health care providers in Ohio and other states.
The consent order requires Medical Savings to revise its current practices and procedures and to no longer issue restrictively-endorsed benefit checks to Ohio medical providers. Also, by the end of August, Medical Savings must reissue any outstanding benefit checks that had been issued to providers with the restrictive endorsements and have not been negotiated. (Mary Gallagher, maryg@ohanet.org)
Campaign Seeks to Reduce Health Care Gaps
The third annual Take a Loved One to the Doctor Day campaign kicked off
this summer, encouraging minorities to visit or make appointments to see
a health professional on Sept. 21. Take a Loved One to the Doctor Day is
one element of a larger effort by the U.S. Department of Health and
Human Services (HHS) to reduce health disparities affecting racial and
ethnic minorities by encouraging preventive health screenings. HHS
kicked off its long-term Closing the Health Gap campaign in 2001.
Interested organizations are encouraged to organize screenings, health fairs and other events promoting health and well and wellness in conjunction with Take a Loved One to the Doctor Day. In 2003, 500 national and local organizations participated as partners. For more information and materials, including a tool kit to help communities organize local health events, call 800.444.6472 or visit www.healthgap.omhrc.gov.
Wednesday,
August 11, 2004
The OHA Finance Committee and the Bureau of Workers’ Compensation (BWC) recently agreed on a restructured hospital payment system for the Health Partnership Program (HPP), the BWC’s managed health care plan for state-fund injured workers, that is scheduled to start the beginning of next year.
The new agreement maintains the BWC’s percent-of-charges system for three calendar years, with caps on payment increases in 2006 and 2007. After the three-year period, the BWC reserves the right to convert to another payment system if overall HPP hospital payments continue to increase beyond what it considers acceptable. The BWC is reducing the inpatient percent-of-charges rate to 70 percent, effective Jan. 1, 2005, but will keep the outpatient rate at 60 percent.
The agreement was reached after the BWC asked stakeholders, including OHA, for help controlling what it called unacceptable increases in medical costs. OHA acknowledged hospital payments likely increased because of higher billed charges. However, OHA data show the payment increase is also due to a rise in the number of BWC admissions and outpatient encounters and a corresponding rise in severity of the illness and injuries of the workers. Although the BWC this week announced HPP payments dropped $80 million in state fiscal year 2004, it will still have to seek long-term solutions to stabilize provider payments. More information about the revised HPP Payment Methodology will be available in OHA’s Aug. 13 ABC Bulletin. (Charles Cataline, charlesc@ohanet.org)
ODJFS Director Withdraws Retirement
After announcing his retirement last week, Ohio Department of Job and
Family Services (ODJFS) Director Tom Hayes has agreed to stay on at
ODJFS indefinitely to help solve a county accounting problem and prepare
the next two-year budget. In his role, Hayes oversees such programs as
unemployment and Medicaid.
Fellows Wanted for Agricultural Safety Program
Great Lakes Center For Agricultural Safety and Health (GLCASH) invites
individuals to join its new Fellows Program, a three-year initiative
aimed at increasing the level of evaluation for impact of
agricultural/rural safety and health outreach and educational programs.
Fellows will participate in a 20-month Web-based education program and
will receive up to $500 to evaluate an existing safety or health program
in their community. More information and an application are available at
www.glcfellows.osu.edu/. Applications must be received by Oct. 1.
Thursday,
August 12, 2004
The Centers for Medicare & Medicaid Services (CMS) this week released its 2005 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule, including proposed changes to payments for outpatient services required by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003.
According to CMS, the proposed HOPPS changes will increase projected Medicare payments to hospitals for outpatient services to $24.2 billion compared to projected payments of $22.7 billion in 2004 -- a 6.6 percent increase in total payments. Other MMA changes include the continuation into 2005 of the two-year extension of “hold harmless” payments for small rural hospitals having fewer than 100 beds and sole community hospitals in rural areas, and a mandated “Welcome to Medicare” routine physical for new beneficiaries. CMS is also proposing a new fixed dollar threshold in addition to the current outlier threshold for outlier payments in outpatient settings.
OHA will review the proposed rule and keep members apprised of further details. The proposed rule will also be published in the Aug. 16 Federal Register with information on how to send comments, accepted until Oct. 8. The final rule is expected by Nov. 1. The proposed rule is online at www.cmc.hhs.gov/providers/hopps/. (Charles Cataline, charlesc@ohanet.org)
Briefing Covers Impact of Potential 2006-07 Budget Cuts
The Universal Health Care Action Network of Ohio (UHCAN) and the
Campaign to Protect Ohio’s Future will hold a public briefing, “Ohio’s
Current and Upcoming Budget: Vulnerable Populations Still at Serious
Risk,” Friday, Sept. 10 in Columbus. The briefing will focus on the
fiscal year 2006-2007 budget and actions steps for preventing possible
cuts that could impact many areas, including the health care of 1.7
million low-income Ohioans. It is free and open to concerned citizens
and those affiliated with education, higher education, health care,
social service organizations, libraries, local and state government,
business, the faith community and the media.
The briefing will be held 10 a.m. to noon at the YWCA of Columbus, Huntington Hall, 65 South Fourth Street. RSVP by Tuesday, Sept. 8 to Erin Sherwood Wright at 614.221.4336 ext. 23, or e-mail Erin_oashf@ameritech.net. To learn more about UHCAN, visit www.uhcanohio.org, and for more information on the Campaign to Protect Ohio’s Future, visit www.protectohio.org. (Bridget Gargan, bridgetg@ohanet.org)
Friday,
August 13, 2004
The Ohio Department of Job and Family Services (ODJFS) has resolved outstanding assessment issues from the 2002 and 2003 Hospital Care Assurance Program (HCAP). As a result, ODJFS is processing additional payments to eligible hospitals in amounts totaling $1,241,722.70 for the 2002 program and $979,718.10 for the 2003 program. Payments should arrive by the end of this week. Data regarding these additional payments will be online at www.ohanet.org/hcap/ by Tuesday, Aug. 17.
CEOs on the Move
Steven Swart
returns to his hometown as the new president and CEO of Doctors
Hospital of Nelsonville. He will assume CEO responsibilities in late
September from current CEO Joel Kaiser, who previously announced his
intention to return to the director of nursing position.
LaMar Wyse, president and CEO of Holzer Medical Center, Gallipolis, and vice-president of operations for Holzer Consolidated Health Systems, this month announced he will leave his current positions to accept a new role as president and CEO of Galion Community Hospital. Wyse will remain at Holzer until October.
Chad Patrick has been appointed CEO of Mercy Franciscan Hospital Western Hills, Cincinnati.