Wednesday, February 13, 2008
Executive Order Could Improve Regulatory Challenges Faced by
Hospitals
Gov. Ted
Strickland yesterday signed an executive order to implement a new
“common sense” business regulation that he hopes will provide clear
guidelines and create a more efficient and effective regulatory
environment in Ohio. Hospitals often face challenges with
regulations that are out of date or slow to change – issues the
executive order could improve. For example, alcohol hand rubs
mounted in hospital corridors were identified several years ago as
effective infection control strategies with minimal fire risks, but
Ohio continued to prohibit such devices for some time after the
International Fire Code permitted them. In addition, hospitals spend
tens of millions of dollars each year complying with infectious
waste regulations that are based on overly-prescriptive statutes
enacted during the AIDS crisis of the 1980s. Infection control and
infectious disease experts say the statutes and regulations are
based on fear and not science, plus the recordkeeping requirements
in those provisions do not recognize modern computer and internet
technology.
Among other
requirements, the order calls for:
► Agency rules to
impose the least burden and costs to business, including
paperwork and other compliance costs, necessary to achieve the
underlying regulatory objective.
►
State agencies to review existing rules and
processes, amending or rescinding those that impose unneeded
restrictions or carry unintended consequences
► Certain cabinet agencies to designate an ombudsman to act as a
liaison between the agency and those affected by the regulatory
rules and processes.
► The use of easy-to-understand language in all future
administrative rules submitted to the Joint Committee on Agency
Rule Review.
► The creation of a system to allow interested parties to
receive communications about rules of interest to them.
View the
Executive Order at
http://governor.ohio.gov/Default.aspx?tabid=868. (Bridget
Gargan,
bridgetg@ohanet.org; Rick Sites,
ricks@ohanet.org)
Thursday, February 14,
2008
EMS Board Seeks Hospital Comments on Changes to Geriatric Triage
Rules
The state Emergency Medical Service Board’s (EMS) Trauma Committee
created a task force to determine at what age a person should be
considered a ‘geriatric trauma patient’ and to ascertain what EMS
and emergency department personnel should look for to decide if an
injured older person should be treated at a trauma center. Based on
these findings, the EMS Board has proposed adding
new criteria to the geriatric triage
rules authorized in HB 138, a 2000 law designed to implement a
statewide trauma system.
The task force
examined data from the Ohio Trauma Registry, which collects
information on all injured patients admitted to hospitals in Ohio
but does not include patients treated and released in less than 48
hours. The task force found that, for the purposes of trauma care,
age 70 is the age when a trauma patient should be treated as a
geriatric trauma patient. It also found several indicators for EMS
and emergency department personnel to use in deciding if the injured
geriatric patient should be sent to a trauma center for treatment.
The EMS Office of Research and Analysis estimated the
effects
of the new geriatric trauma triage criteria on hospitalizations of
geriatric trauma patients. Based on 2006 data, 946 of the 3,127
patients in the study population would have been triaged to a trauma
center (30%). The study also showed that 83 non-trauma center
hospitals admitted geriatric trauma patients from this population,
so the non-trauma hospitals in Ohio could see an average reduction
of 11.3 admissions of severely injured patients annually.
Based on these
findings, the EMS Board has added new geriatric criteria to the
protocols used to decide where an injured person should be treated.
Before the change is adopted, the Trauma Committee will draft and
approve suggested changes and refer them to the EMS Board for
consideration at its March meeting. That meeting begins a 75-day
process that includes a public hearing on the proposed changes and
submission to and review by the Joint Committee on Agency Rule
Review.
OHA is seeking
feedback on the
proposed changes from
member hospitals. Please share suggested changes and letters of
support or opposition with Bridget Gargan at
bridgetg@ohanet.org.
Friday,
February 15, 2008
OHA, OCHA Join to Testify Against Medicaid Freeze
In a public hearing
today, OHA and the Ohio Children’s Hospital Association (OCHA) issued
joint testimony opposing the two-year Medicaid inpatient hospital rate
freeze proposed by the Ohio Department of Job and Family Services. While
both organizations applauded the recent decisions to restore dental
benefits for adults enrolled in Medicaid, to restore a desperately
needed Medicaid payment rate increase for physicians, and to cancel
plans to recalibrate inpatient payment rates, OHA and OCHA testified
that a two-year freeze on inpatient rates would increase the shortfalls
hospitals are forced to accept when treating patients enrolled in
Medicaid. In state fiscal year 2006, the most recent year for which
complete data is available, Medicaid payments fell $305.7 million short
of covering the costs of the services hospitals provided to patients
enrolled in Medicaid. OHA has estimated that if Medicaid managed care
contracts are tied to fee-for-service rates, the impact of the proposed
freeze could be nearly $160 million over the two calendar years, 2008
and 2009, for which the freeze would be effective.
Beyond a general
opposition to the proposed rate freeze, OHA and OCHA gave three
suggestions to the department:
-
To reduce the
freeze from two years to one year, and have the department
reevaluate the state’s finances before deciding to freeze rates
in 2009;
-
To study and
implement an employed-physician upper payment limit program
(Physician UPL) for public hospitals;
-
To bolster
Medicaid payments to hospitals using funds from the recently
reported class-action settlement with Merck;
In addition, OHA
suggested:
-
To develop
methodology for estimating the impact of this and future
policies on both the fee-for-service and managed care arenas.
View a copy of the
full testimony. OHA and OCHA hope to continue a productive
dialogue with the department and the administration on ways to
address the growing Medicaid payment shortfalls. OHA will keep its
members informed of any response from the department, as well as the
status of the rate freeze rule over the coming weeks. (Nick Lashutka,
nlashutka@ohiochildrenshospitals.org; Ryan Biles,
ryanb@ohanet.org)
Hospital Reporting Obligations Under Ohio
Statutes and Regulations
OHA today issued a Member Bulletin outlining hospital reporting
obligations under Ohio statutes and regulations. The bulletin
summarizes the reporting obligations and directs readers to
controlling statutory or regulatory provisions. The bulletin is
available to OHA members at
www.ohanet.org/Bulletins/2008/08-001.htm. (Rick Sites,
ricks@ohanet.org)
