From: AMC/NOMA Staff
SUBJECT: AMC/NOMA Notables
Date: February 11, 2002
AMC/NOMA provides print materials through fax blasts, our magazine
– The Cleveland Physician, fact sheets, mailers and through our Web site at www.amcnoma.org. Periodically
the physician members with email addresses will receive the AMC/NOMA Notables.
Ohio Health
Care Provider Joint Negotiation Act receives proponent hearing
The Academy of Medicine of
Cleveland/Northern Ohio Medical Association’s President, Ronald A. Savrin, M.D. was first to give proponent
testimony supporting House Bill 325, the Ohio Health Care Provider Joint Negotiation Act. Representative Jim Trakas (R- Independence), the
bill’s sponsor, provided sponsor testimony on the bill in early January to the House
Insurance Committee. Rep. Trakas emphasized
that the public would benefit from this legislation as it would allow medical experts to
determine what coverage would be medically necessary rather than the health insurers.
Dr. Savrin testified that “(health) plans present physicians with non-negotiable contract terms that a reasonable business person would never agree to” and that “as health plans continue to merge and consolidate, the decision-making authority over the health care of our patients will be controlled by a small group of managers.”
Dr. Savrin also noted that managed care
plans “impose many unfair utilization procedures and transfer all patient care
liability to the physician” and that “some insurance plans require physicians to
agree to insure against any and all claims - and certain policies extend liabilities to
persons outside the physician’s own practice.”
While conceding that, in some cases, managed care has encouraged physicians and
hospitals to look for cost cutting opportunities, he also feels that the majority of their
influence has been unfavorable.
Also providing proponent testimony
was State Representative William Seitz, an antitrust attorney from Cincinnati, Ohio. Rep. Seitz stated that “passage of the bill
is necessary to level a very unlevel playing field that exists between our medical
provider community and dominant managed care/insurer power buyers who have their own
federal antitrust exemption.”
The bill is designed to provide a pro-active, market-driven solution to the imbalance of power in the health care market by waiving anti-trust laws and allowing medical providers to jointly negotiate patient care issues with insurance companies and HMOs. The bill, which is modeled after legislation already in place in Texas, will represent the broad and common interests of physicians and patients on issues that affect access, quality and the cost of health care. The bill will also allow for independent health care providers to join together to negotiate non-fee related contract terms with insurers. Some of these terms include definition of medical necessity, patient referral standards and procedures, utilization review criteria, and payment methods and timing.
The passage of this type of legislation has become a necessity in recent years due to the consolidation of insurance companies. In the last six years, the number of insurance companies has dropped from 18 to six, creating an imbalance of power between health care providers and the insurance entities. It has also been reported that more than 27,000 of the 140,000 bills introduced in state legislatures across the nation have been in response to the current state of the health care industry
At a request
by Governor Bob Taft to look into the professional liability insurance situation, the Ohio
Department of Insurance found the market in Ohio to be adequate and competitive and
believes premium rates will continue to increase over the next year. Governor Bob Taft has requested the Department to
continue to gather additional information on the market, factors influencing the market,
and the consequences of various types of governmental intervention. At the current time, no legislation has been
introduced to directly address the liability insurance problem; however, some tort reform
bills are pending before the Ohio General Assembly.
Many believe
that tort reform will assist in keeping
professional liability premiums lower; however, this cannot take place unless there is a
change in the present composition of the Ohio
Supreme Court. The current justices have
handed down a number of decisions that have had a negative impact on the practice of
medicine in Ohio. Thanks to the Ohio Supreme
Court, the comprehensive tort reform package that was effective in January, 1997 was ruled
unconstitutional in August, 1999.
The Ohio
electorate will have one more chance this year to change the composition of the Ohio
Supreme Court. Under the current Supreme
Court, Justices Alice Robie Resnick, Andrew Douglas, Francis Sweeney and Paul Pfeifer have
a judicial philosophy of “making law”; while Justices Thomas Moyer, Deborah
Cook, and Eve Stratton have the philosophy that justices should “interpret the
law”. Many physicians and businesses
believe Ohio needs to get back to the traditional philosophy of having the courts
“interpret the law” written by the Ohio General Assembly.
As part of
the 2002-2003 Biennium Budget Bill, a Health Care Workforce Shortage Task Force was
created to study the shortage of health care professionals and workers in Ohio. The Task Force, which is Chaired by J. Nick Baird,
MD, Director of the Ohio Department of Health, is to propose a statewide plan to address
this problem. The Task Force consists of
twenty-one members, and is primarily made up of physicians, nurses and other health care
professionals. Also serving on the Task Force
are State Representative Sally Conway Kilbane ( R – Rocky River ) and State Senator
Tim Ryan ( D – Niles ). The group has
been meeting monthly since August of 2001 and is scheduled to continue meeting through
June of 2002.
To address licensure standards and barriers in the current scope of practice, the Task Force is considering
the option of a centralized and standardized licensure system, which would attempt to
streamline a portion of the administrative burden of the licensure boards. A centralized and standardized system would create
fiscal efficiency for the state in licensing health care professionals in their role to
protect the public. Items being considered by
this system include: a comprehensive
healthcare workforce licensure database; citizen complaints; alternatives to discipline
for chemical dependency /practice problems; and educational program accreditation. The Task Force is also exploring
opportunities to improve the current system of educating students for careers in health
care by building a better educational system. The group is also looking at creating opportunities
for demonstration projects that maximize
technology and reduce the human resource demand, which may address the predicted shortage
of health care workers once the baby boom generation begins to age. Such projects may include: paperless charting
(links to large databases); mechanized beds and monitoring equipment; use of robotics in
pharmacy; and a “safe harbor” from licensing requirements, with assurances for
patient safety. The Task Force is also
considering roles the State of Ohio could play in the recruitment and retention of health
care workers.
The Advanced
Practice Nursing Formulary, as drafted by the Committee on Prescriptive Governance (CPG),
is posted on the Ohio Board of Nursing’s website at www.state.oh.us/nur. This draft document of the formulary incorporates
the CPG recommendations through November 19, 2001. A
revised formulary should be posted by March, 2002. The
implementation of the nurses prescriptive authority began February 1, 2002, when the State
Nursing Board’s rules became effective; however, as yet, no certificates to prescribe
have been issued. The CPG Committee will meet
periodically throughout 2002 and will continually establish, maintain, and revise the
formulary.
CMS:
Beneficiary Complaint Program to be revised
The
Center for Medicare and Medicaid Services has released plans to overhaul the Beneficiary
Complaint Program. Objectives of the new program will include: satisfaction
among 80% of complainants; recommendation of quality improvement plans in an as yet
undetermined percentage of complaints; resolution of communication issues in a percentage
of complaints; completion of reviews within accepted timeframes in 90% of cases; and a
minimum threshold of reliability in case review.
New strategies for the program will also include case managers to improve beneficiaries'
understanding of the process and the use of mediation to resolve disputes between
beneficiaries and providers. Case managers will also offer the complainant a single
point of accountability, explain the complaint process, and update the complainant on the
status of the complaint.
CMS plans to help prepare for changes in the complaint program by providing support and
networking opportunities. Testing for the new process will begin this spring, using
pilots for case manager implementation, improved letters to beneficiaries and providers,
and surveys of beneficiary satisfaction.
HIV/AIDS
reporting rule may change
The Ohio Department of Health is proposing a change to its rules on reporting HIV/AIDS and
is meant to protect physicians who provide information on HIV/AIDS cases. Physicians
are currently required to report AIDS cases since the early 1980s, and laboratories are
required to report tests indicating HIV infection since 1990. The proposed ODH rule
change will require physicians to submit reports on HIV patients to the Department.
The following two new reporting requirements are also included.
*
Cases of CD4 and T lymphocyte counts below 200 cells per microliter or a CD4 + lymphocyte
percentage of less than 14 when an HIV infection has not been ruled out as the cause.
*Cases
of perinatal exposure to HIV and any subsequent test results on every exposed newborn
infant or child until such time that either an HIV infection or a seroreversion status
that is negative is confirmed.
The CD4 T lymphocyte reporting will improve the completeness of AIDS case reporting and
laboratories will be required to report low CD4 and T lymphocyte counts. ODH staff
will contact that physician of any person not previously reported as an AIDS case to
determine if the person is HIV infected. If the person is HIV infected, the
physician will be asked to complete an AIDS case report. Case reporting of
perinatal exposure to HIV will allow ODH to follow children until the child is either HIV
infected or at a seroreversion status that is negative is
confirmed. The ODH proposed rule changes must be approved by the
Public Health Council which will hold a public hearing addressing the proposal later this
month. The rules will then be forwarded to the Joint Committee on Agency Rule Review
for consideration.
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do not have any editorial or other control over those web sites. Additional information on these topics may be
available on our web site at www.amcnoma.org.