In September 2002, a team of researchers from The Center for Studying Health System Change – which is funded by the Robert Wood Johnson Foundation, came to Cleveland to study our health system, how it is changing and the effects of those changes on consumers. Cleveland is one of 12 communities that HSC tracks through site visits every two years. The HSC researchers interviewed more than 100 leaders in the Cleveland health care market, including the president of the AMC/NOMA. The recently published report begins by noting that since the mid-1990s, Cleveland hospitals have consolidated into two major health systems, and goes on to state that unlike many communities, there is no strong countervailing force from health plans or employers to check the systems’ power, which has contributed to rising costs. The report also discusses the two major hospital systems having pressured physicians to admit patients to either CCHS or UHHS hospitals but not both, rising malpractice insurance premiums that are causing some physicians to close practices or reduce care to high-risk patients, and the Cleveland health care safety net. For more information or a copy of the report go to the Center for Studying Health system Change at www.hschange.org.
Dr. Kevin T. Geraci was invited to present an AARP group in Mayfield Hts., on February 10, 2003. Dr. Geraci’s remarks centered on the issue of the medical liability crisis and how it can impact access to care as well as quality of care. He mentioned that fact that the cost of running a practice as well as the hassles of responding to managed care inquiries are becoming problematic for many physicians in the Northeastern Ohio area. Dr. Geraci noted that when you add to this burden the escalating costs of medical liability coverage and the burden becomes even more untenable. He noted that there are still physicians leaving the practice of medicine and that the insurance market has still not stabilized enough to eliminate the liability crisis in the Cleveland area. Dr. Geraci outlined the provisions contained in Senate Bill 281. He indicated that the bill did not contain all of the points that organized medicine wanted in the legislation, but it was a start. One of the participants from the audience indicated that he felt that there should be a review board place to review medical liability cases to determine if there is any merit before it can be filed. Dr. Geraci noted that there are provisions in the bill for a patient to sign a form agreeing to arbitration, however, the patient can cancel that agreement during a certain timeframe. Overall, the participants at the AARP program were in favor of the medical liability legislation and many of the participants are still concerned about access to care issues.
Executive Director of the State Medical Board of Ohio, Tom Dilling was in attendance at the AMC/NOMA’s Board of Directors’ Meeting on January 21, 2003. Mr. Dilling provided an outline of the agency goals, as well as a written Board overview.
During the medical liability debate, the AMC/NOMA contacted the State Board because continually there were comments made that physicians are not appropriately disciplined in Ohio and that this was a part of the problem. Mr. Dilling noted that Ohio citizens should be made aware of the fact that the Board receives 3,000 complaints per year and takes 150 disciplinary actions against licensees each year. The Federation of State Medical Boards of the United States ranked Ohio second in terms of disciplinary sanctions imposed by medical licensing boards with a minimum of 15,000 in-state (physician) licensees. Public Citizen Health Research Group, a national consumer advocacy organization, ranked Ohio first among the states responsible for regulating large physician populations. The Ohio Medical Board has ranked in the Public Citizen’s top 10 each year since 1995.
Mr. Dilling also mentioned the Quality Intervention Program (QIP), which was designed and adopted into law in 1996 to address quality of care complaints that do not appear to warrant intervention via formal disciplinary action. QIP focuses on cases in which poor practice patterns are beginning to emerge or the licensee has failed to keep up with changes in practice standards.
Mr. Dilling also discussed administrative rules. Over the last few years, they have seen a number of groups that seek help from the legislature to become licensed or be allowed to practice a form of medicine. Examples include recent dissension between nutritionists and dieticians’ scope of practice, or relocated practitioners who have had a greater scope of practice than the state of Ohio allows such as psychologists who’ve had previous prescriptive authority. All of this is done outside of the formal school process – it is done through legislation. Medical groups have to have a solid stance on these issues and come to some type of agreement as organizations.
Two issues under review at this time are the anesthesiologist assistant rules and the office-based surgery rules. The question remains, to what extent are the rules needed? Mr. Dilling noted that there has been a lot of testimony on the rules, and he indicated that it is very rare that the Board would not review the rules after testimony. Both sets of rules, AAs and office-based surgeries will be under discussion at the board meeting in February. This information can be obtained on the State Board’s web site at www.state.oh.us/med.
Mr. Dilling indicated that if physicians wanted to contribute to the process they may do so and the Board welcomes physicians’ input on the decisions it makes. The Board will review the rules and make changes as necessary, but physicians should note that the Board is first and foremost a protector of the public.
Mr. Dilling noted that in terms of the most recent legislation on tort reform and medical liability reform there has been some positive press for the board. He did note that physician-profiling issues would probably surface again with the passage of this legislation. Currently, the State Board does not have medical malpractice or hospital actions on their web site as some states already do. Mr. Dilling believes that physician profiling will now be pushed to the forefront. Mr. Dilling noted that people would like to view the state medical board as the “better business bureau” for physicians. The members of the AMC/NOMA board asked Mr. Dilling to keep the AMC/NOMA apprised on this issue since the AMC/NOMA leadership would definitely provide input on any legislation intended to create a physician profiling mechanism in the state of Ohio. The members of the AMC/NOMA board asked Mr. Dilling to keep us apprised on this issue and indicated that the AMC/NOMA would definitely provide input n any legislation intended to create physician profiles.
AMC/NOMA physician members are encouraged to bring any questions or comments to the AMC/NOMA executive vice president/CEO, Ms. Elayne R. Biddlestone to be relayed to Mr. Dilling at the State Medical Board of Ohio.