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Monday, January 30, 2006
Hospitals Can Now Request Waivers for Flu Beds
The Centers for Medicare & Medicaid Services (CMS) announced it will now allow individual hospitals to request waivers to use prospective payment system-exempt beds for flu by contacting CMS Region V directly. According to the Ohio Department of Health, CMS will accept individual requests until there is evidence of a statewide or regional problem, at which time the usual process of OHA requesting a statewide or regional waiver will be implemented. Hospitals are encouraged to keep OHA informed regarding regional or widespread issues they experience. For contact information for Region V, contact Rick Sites at ricks@ohanet.org or Carol Jacobson at carolj@ohanet.org or 614.221.7614.

The state legislature also continues discussing the flu, with the Senate Health Committee passing legislation this week that would require hospitals to offer certain patients flu and pneumonia vaccines. OHA opposed the original version of House Bill 257, sponsored by Rep. John Hagan (R-Alliance), because it conflicted with federal initiatives and did not provide the flexible system needed to protect against potentially deadly infectious disease outbreaks. An amendment accepted in the House addressed these concerns by requiring hospitals to follow vaccination guidelines issued by the Centers for Disease Control and Prevention. The language is consistent with hospitals’ current practices, and therefore OHA does not oppose the bill.

In the past week, Ohio was upgraded to an alert state on www.fluwatch.com, indicating that more flu cases are being reported. For more information on the current flu season, visit www.ohanet.org/flu/. (Carol Jacobson, carolj@ohanet.org; Rick Sites, ricks@ohanet.org)

Hospitals Required to Register with ODH
All Ohio hospitals have until March 1 to submit their annual registration form, which is required by Ohio statute and regulations. The data, which is submitted to the Ohio Department of Health (ODH), includes statistical information regarding admissions, services, number of beds and other important information. This year, the statistics take on even more importance as the state prepares for the possibility of pandemic flu and increased threats of bioterrorism. The form and instructions are available on ODH’s Web site at www.odh.ohio.gov/forms/formfinder.aspx by selecting “hospital registration.”

Hospitals Can Apply for H2E Awards
Hospitals active in recycling, eliminating mercury and implementing other environmental programs can apply for a Hospitals for a Healthy Environment (H2E) award until Feb. 10. The annual awards program recognizes environmental excellence in health care. For more information or to apply, visit www.h2e-online.org/awards/. H2E, a national initiative to improve environmental performance in health care, is a joint program of the American Hospital Association, Environmental Protection Agency, American Nurses Association and Health Care Without Harm. View a list of Ohio hospitals designated as H2E partners at www.h2e-online.org/programs/partner/p_mbrst.cfm?parmStateCode=oh. (Rick Sites, ricks@ohanet.org; Susan Zabo, susanz@ohanet.org)

Tuesday, January 31, 2006
Corporate Campaigns Could Deal Death Blows to Hospitals
After more than 30 years of union activity in health care organizations, changing labor union tactics now threaten the viability of Ohio’s hospitals, eating up vital time, resources and finances. Responding to declining membership, organized labor embraced a new strategy for exerting pressure on employers: the corporate campaign.

The corporate campaign represents a completely different strategy from traditional union efforts to build membership by focusing recruitment efforts directly on workers. Instead of targeting workers, the labor union aggressively attacks the reputation of a target employer, undermining public confidence and key stakeholder relationships until management decides it must yield to the union’s demands or risk the company’s financial well-being. One union leader described a corporate campaign as “death of a thousand cuts rather than a single blow.”Ultimately, the goal of the corporate campaign is to pressure an employer into agreeing to a “neutrality agreement,” requiring them to remain silent or neutral while the union organizes employees.

Hospitals and other health care organizations are especially vulnerable to corporate campaigns, with fewer than 10 percent of the nation’s health care workers currently organized. This translates into six to seven million non-union health care workers whose anticipated dues would represent approximately $3 billion. In addition, there is little risk that the work of most health care employees will be transferred overseas, unlike with most manufacturing jobs. The campaigns redirect precious health care resources by forcing health care providers to defend themselves against union attacks instead of focusing on serving patients and improving their communities’ health. Unlike union efforts focused on benefiting employees, a corporate campaign is driven by the desire to increase membership at any cost—even the cost of putting a community’s health care at risk. View OHA’s January Healthbeat article at www.ohanet.org/healthbeat/ for more information. (Mary Gallagher, maryg@ohanet.org)

OHA Staffing Program Celebrates First Anniversary
OHA Solutions Staffing Program this week celebrates its one-year anniversary. Since filling its initial order one year ago today, the program has helped hospitals fill nearly 9,000 per diem shifts and long-term/travel vacancies in both the nursing and allied health care departments. Seventy-five Ohio hospitals currently take advantage of OHA Solutions’ services, which draw from over 80 staffing companies.

Rolling full-steam into its second year, OHA Solutions implemented four upgrades to the ShiftWise web-based program available to hospitals and introduced a platform to help hospitals use internal employee resources to help book open shifts, while also improving staff satisfaction. Later this spring, OHA Solutions will launch a health care jobs site to allow hospitals to post available positions—including part-time and full-time openings—and view the resumes of potential candidates. Look for more information on this exciting resource over the next several months.

For more information on OHA Solutions, visit www.ohasolutions.com/ or contact Nancy Melcher-Webb at nwebb@ohanet.org or Dan Paoletti at danp@ohanet.org or 614.221.7614.

What’s Up With Asthma?
That question will be answered by the Ohio Asthma Coalition in its first multi-state asthma conference, What’s Up With Asthma? An In-the-Trenches Approach, planned for March 10 at the Ohio State University Fawcett Center in Columbus. Physicians, nurses, respiratory therapists, social workers, pharmacists, health educators and others are invited to learn about a practice model for working with patients, new tools and other asthma-related topics. The registration deadline is Feb. 27. The cost is $65 if payment is received by Feb. 13 and $75 after that date. Visit www.ohiolung.org/OACwhatsupwithasthma.htm for more information and to register.

Wednesday, February 1, 2006
Court Ruling May Impact Hospital Labs
Recent news coverage of a case before the Ohio Supreme Court (State v. Mayl), in which a blood test taken by a hospital was found to be inadmissible in a lawsuit against a drunk driver accused of aggravated vehicular homicide, has raised questions about whether all hospitals should be required to have labs certified by the Ohio Department of Health (ODH) to conduct alcohol and drug testing for law-enforcement purposes. Currently, there are approximately 30 certified labs in Ohio. A small number of hospitals have certified labs.

Although OHA supports means to prevent driving while under the influence, OHA does not support mandated hospital participation in certified alcohol and drug testing. It would create staffing problems, disrupt the core business of patient care, and draw on valuable financial and staff resources. ODH certification standards mandate burdensome procedures that are common in criminal forensic labs but not used by hospitals for routine patient care. OHA maintains that alternative means are available and sufficient to provide valid evidence to law enforcement. Following State v. Mayl, ODH issued guidance to law enforcement on obtaining results of alcohol and drug tests as part of routine medical care from non-ODH-approved labs – the majority of hospitals.

The Ohio legislature sought feedback from OHA before pursuing legislation mandating hospital participation. OHA responded with its position paper on alcohol and drug testing, online at www.ohanet.org/advocacy/state/issues/resources/testing_position_paper.pdf. No legislation is currently pending to require lab certification, and OHA is not aware of any plans to introduce such a bill. Stay tuned for more information. (Rick Sites, ricks@ohanet.org; Bridget Gargan, bridgetg@ohanet.org)

Health Care Small Part of State of the Union
Focusing the majority of his speech on international matters, President George W. Bush did call for some changes in the nation’s health care system during last night’s State of Union. Bush called for greater use of electronic health records to enable providers to better share information with one another while reducing costs and errors. He also noted the need to address the rising cost of health care and help uninsured Americans find access to coverage. Again this year, Bush called on Congress to pass medical liability reform legislation, a feat that might prove difficult in an election year. Finally, Bush discussed greater use of Health Savings Accounts, an approach to health care financing that has received mixed reviews from providers, insurers and employers.

Looking to the future stresses the baby boomer generation will put on the health care delivery system, Bush proposed a commission to study the long-term effects of that generation will have on Medicare, Medicaid and Social Security. The president’s address is online at www.whitehouse.gov/news/releases/2002/01/20020129-11.html#. (Jonathan Archey, jonathana@ohanet.org)

2006 Federal Poverty Income Guidelines Released
The U.S. Department of Health and Human Services (HHS) released the federal poverty income guidelines for 2006 in the Jan. 24 Federal Register. A copy of the notice is available at www.access.gpo.gov/su_docs/fedreg/a060124c.html, under the “HHS” section.

The 2006 poverty income guidelines, which went into effect Jan. 24, are:

Family Size	Income Guideline
1	$9,800
2	13,200
3	16,600
4	20,000
5	23,400
6	26,800
7	30,200
8	33,600

Add $3,400 for each additional person if the family unit has more than eight members.

Calculate eligibility for free care related to Ohio’s Hospital Care Assurance Program beginning with admissions or services delivered on or after Jan 24. This may result in the need to split any outpatient series claim for repetitive services that crosses Jan 24. Hospitals are also reminded to update their free care notices to self-pay patients. (Charles Cataline, charlesc@ohanet.org; Ryan Biles, ryanb@ohanet.org)

Thursday, February 2, 2006
Ohio Delegate Named U.S. House Majority Leader, Federal Budget Finalized
After a second-ballot victory this afternoon, Rep. John Boehner (R-Ohio) will become the next majority leader of the U.S. House of Representatives. The position is one of the most influential in the House, second only to that of the Speaker. Boehner, chairman of the Education and Workforce Committee, will replace Rep. Roy Blunt (R-Mo.) who stepped to the plate temporarily after Rep. Tom DeLay (R-Texas) left the post last fall. Central Ohio Congresswoman Deborah Pryce, the fourth-highest ranking person in the House, has chaired the House Republican Conference since 2004, and Boehner’s victory gives Ohio additional influence over the U.S House’s leadership team and the national legislative agenda.

In other big news from the Hill, the House yesterday passed the fiscal year 2006 budget reconciliation bill, finalizing this year’s federal budget. The approved legislation contains the following provisions that impact hospitals:

Full updates for Medicare inpatient and outpatient payment rates.
A moratorium on new limited service specialty hospitals for up to eight months as the U.S Department of Health and Human Services develops policy suggestions to Congress regarding physician investment, charity care, and other guidelines for such facilities.
Cuts to ambulatory surgical centers, bringing their payments in line with hospital outpatient departments.
A second year phase-in at 60 percent to the Rehabilitation 75% Rule before continuing to 65 percent in 2007 and 75 percent in 2008.
For rural facilities: An extension of the outpatient hold harmless provision for three years, at 95 percent the first year, 90 percent the second and 85 percent the third year; a provision to rebase and extend the Medicare Dependent Hospital program until 2011.
Allowing children’s hospitals to participate in the 340B program to purchase drugs at a discount.
A freeze in Medicare physician payments for one year, rather than allowing a scheduled 4.4% cut.
An overall Medicaid net cut of $4.7 billion over five years, significantly less than proposals made by fiscal conservatives earlier this year.

Despite hospital lobbying efforts, the package retained a provision regulating the rate out-of-network hospitals and their emergency departments are paid by Medicaid managed care plans and some cost-sharing for Medicaid enrollees. Effective in FY 2007, the bill also expands quality reporting requirements and increases the penalty to Market Basket minus 2.0 for hospitals not reporting all required categories. (Jonathan Archey, jonathana@ohanet.org)

Natural Gas Prices Fall
Last week, the nation experienced a dramatic decrease in the futures prices of natural gas, with prices falling to nearly half what they were in early December. The surplus of natural gas is significantly higher than one-year ago as well as above the five-year average. A drop in crude prices precipitated the erosion in the New York Mercantile Exchange (NYMEX), but lack of cold weather is a major cause of the decline as 18 percent of the gulf production remains offline. Look for this trend of lower prices to continue, but hospitals are encouraged not to wait until prices have an opportunity to bounce back up before locking in for the summer, where prices are in the mid to high eight dollar range. For more information, visit OHA’s energy issues Web site at www.ohanet.org/energy/. (Rick Sites, ricks@ohanet.org)

Hospitals’ Heartbeat
A 2005 nominee for the Albert E. Dyckes Health Care Worker of the Year Award

Veronica Sumodi, CCRN, MSN, CNS
Congestive Heart Failure Center
Hillcrest Hospital, Mayfield Heights
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A look inside Veronica’s nomination –
Ronnie has a special gift of combining quality, consistent care as a clinician with the leadership and administrative skills to achieve organizational excellence. Her strong leadership, clinical and teaching skills made her instrumental in developing the foundation of Hillcrest Hospital’s Congestive Heart Failure Center in 1999. Ronnie developed the center’s processes and procedures, including billing, and created the patients’ educational materials. The model was a success and was benchmarked throughout the East and Western Region of the Cleveland Clinic Health System. Today she continues to play a key role in the growing center’s daily operations, and in collaboration with the center’s medical director, carries an independent patient practice with prescriptive authority. She also teaches and mentors Clinical Nurse Specialist candidates at Kent State University.

Don’t forget to make your nomination for 2006! The deadline is Feb. 17.
Visit www.ohanet.org/annualmeeting/Awards/ to download nomination materials.

Friday, February 3, 2006
Medicaid Co-Pay Procedures Still Unclear; Feds yet to Weigh In
Hospitals continue waiting for billing instructions from the Ohio Department of Job and Family Services (ODJFS) on the new Medicaid patient co-pay policy, which applies the inappropriate use of a hospital emergency department (ED). The requirement went into effect for services delivered on and after Jan. 1.

As it stands, hospital personnel are required to identify Medicaid patients who are using the ED for non-emergencies, collect $3 from them for each inappropriate encounter and inform ODJFS in the “Remarks” section of the hardcopy or electronic Medicaid bills. ODJFS will reduce the hospital payment for each non-emergency encounter by $3. According to Ohio law, hospitals are not permitted to delay care to collect a co-pay, refuse services because a patient is not able to pay the $3 co-pay or waive the co-pay amount after the fact. If the patient is not able to pay the co-pay at the point of service, the hospital is expected to bill and follow up on the patient account, as normal.

OHA strongly objected to the section of the law and rule that forbids a hospital from waiving the $3, stating most hospital computer systems will not produce a bill for such a small amount, and that the cost to collect would greatly exceed any co-pay recovered. OHA was initially overruled by the Ohio General Assembly in last year’s state budget debate, but in the coming month the association will encourage lawmakers to reconsider.

OHA encourages hospitals to be aware of the requirement, create an internal policy to manage it and begin to educate staff. But hospitals may want to wait on full implementation until instructions are final. (Charles Cataline, charlesc@ohanet.org)

Program Offers New Information on Cancer Care
The Ohio State University’s James Cancer Hospital and Solove Research Institute will present Cancer Care Across the Continuum: New Discoveries, New Modalities March 2-3 at the Fawcett Conference Center in Columbus. Program faculty will share timely information about innovative models of cancer care, key treatment issues and quality of survivorship needs along the continuum of care. All health care professionals working in oncology care, rehabilitation, home health, hospice, mental health and other allied health care professions are invited to attend. Continuing education units will be provided for nursing, social work, dieticians, physical and occupational therapists. For more information or to register, visit www.jamesline.com/go/education or call 614.293.6428.

Hospitals’ Heartbeat
A 2005 nominee for the Albert E. Dyckes Health Care Worker of the Year Award

Nancy Brubaker Childs, RN, BSN, CIC
Director of Infection Control and Employee Health
Holzer Medical Center, Gallipolis
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A look inside Nancy’s nomination –
Nancy Brubaker Childs is the Director of Infection Control and Employee Health at Holzer Medical Center. Nancy is very dedicated to her job and to the health of over 1200 employees at HMC. Nancy’s love of her community is reflected through her participation in many community programs. She participates in the local cultural art center, leads a weekly Grief Group at her church, as well as serving as a resource in giving lectures on infection control. Professionally, Nancy is the Secretary of the Ohio Chapter of the Association for Professionals in Infection Control and Epidemiology. We are very proud of Nancy as we select her as our candidate for the honor of 2005 Ohio Healthcare Worker of the Year.

Don’t forget to make your nomination for 2006! The deadline is Feb. 17.
Visit www.ohanet.org/annualmeeting/Awards/ to download nomination materials.