Ohio Health Policy Review

Ohio children’s hospitals rated high for infection rates

A new study by Consumer Reports found that Ohio children’s hospitals do a better-than-average job of reducing central-line bloodstream infections (Source: “Children’s hospitals reduce deadly infections,” Dayton Daily News, Jan. 26, 2012).

The children’s hospitals in Akron, Cincinnati, Columbus and Cleveland all received a score of 4 (out of a possible 5) for their infection rates. Because Ohio does not require hospitals to report infection rates to the state, the study relied on data voluntarily submitted to the Leapfrog group, a nonprofit that collects and analyzes hospital performance data (the Children’s Medical Center of Dayton and Toledo Children’s Hospital do not report data to LeapFrog and were, therefore, not included in the analysis).

Ohio officials taking varied approaches to ACA implementation

Nearly two years after passage of the Affordable Care Act, Ohio officials have moved ahead quickly with some provisions of the law while taking a more cautious approach on others (Source: “Ohio takes two-track approach to health reform,” Lancaster Eagle Gazette, Jan. 19, 2012).

While Lt. Gov. Mary Taylor, who also serves as the Director of the Ohio Department of Insurance, has repeatedly called for the complete repeal of the law, the Governor’s Office of Health Transformation has employed a more pragmatic approach, taking advantage of the provisions of the law that align with the governor’s priorities.

"All of this is more complicated than an easy yes or no," said OHT Director Greg Moody. "There are aspects of federal reform ... that picked up innovation on the state level. Those are things we were going to do with or without" the federal law.

Added HPIO President Amy Rohling McGee, “"The Kasich administration is generally inclined to innovating and exploring ways to better streamline care and provide better outcomes. Where there are these sorts of opportunities for innovation embedded in the Affordable Care Act ... our state is taking advantage of those."

Ohio hospital nursing shortage appears to be lessening

After several years of nursing shortages, new data shows that the vacancy rate for hospital nurses in Ohio continues to decrease (“Hospitals have lowest job openings for nurses in years,” Hamilton Journal-News, Jan. 26, 2012).

According to the Ohio Hospital Association, the statewide vacancy rate for nurses was 4 percent in 2010, the most recent year for which data is available. That compates to 6.2 percent in 2009 and double-digit rates in the preceeding years, according to OHA officials.

Two initiatives pushing for medical marijuana in Ohio

Two separate groups have been given the go-ahead by the state ballot board to begin collecting the signatures needed to put a constitutional amendment that would legalize medical marijuana on the November ballot (Source: “2 groups push medical marijuana,” Columbus Dispatch, Jan. 26, 2012).

The Ohio Medical Cannabis Amendment of 2012 is backed primarily by patients, advocates and business people and would leave most decisions on regulating the drug to a state commission.

The Ohio Alternative Treatment Amendment is backed primarily by the National Organization for the Reform of Marijuana Laws, which advocates nationally for the complete legalization of the drug, and includes much more detail about regulations on how much marijuana could be obtained, who could grow it and where it could be distributed.

Supporters of both amendments have indicated that they expect the two versions to be reconciled into a single amendment before being placed on the ballot.

Cincinnati organization files brief in Supreme Court ACA case

Citing uninsured rates in Cincinnati, the Health Foundation of Greater Cincinnati today files an Amicus Curiae (Friend of the Court Brief) with the United State Supreme Court in regards to its review of the Affordable Care Act (“The Health Foundation of Greater Cincinnati Files with U.S. Supreme Court,” Health Foundation of Greater Cincinnati news release, Jan. 13, 2012).

The brief  was filed “in support of neither party” and was submitted in an effort to shed light on health insurance affordability and how individuals’ decision on purchasing health insurance is impacted by their income.

“The Health Foundation supports reform in the health care system, and especially making health care available for as many people as possible,” said James Schwab, President and CEO of the Foundation, in a release. “The Foundation is not taking a position on the specifics of the Affordable Care Act.”

The Health Policy Institute of Ohio has created a special Supreme Court resource page on its website featuring news, analysis and resources related to the Supreme Court review of the ACA.

[Full disclosure: The Health Foundation of Greater Cincinnati provides financial support to the Health Policy Institute of Ohio.]

State announces rebidding of Medicaid managed care contracts

Just days after announcing plans to include quality standards in new contract language for Medicaid managed care plans, the Kasich administration announced that it was rebidding all of its MMC contracts (Source: “Kasich announces new contracts for Ohio's Medicaid program,” Columbus Dispatch, Jan. 11, 2012).

Using language adopted by Catalyst for Payment Reform, a non-profit organization of large private payers, the new managed care contracts will withhold a portion of payments until performance standards are met. Other significant changes to the managed care program announced by the Ohio Department of Job and Family Services, include Medicaid recipients having a choice or four plans, up from two or three currently. Also, , in an effort to increase competition and lower administrative costs, the state will reduce the number of service regions from eight to three and combines coverage for the Aged, Blind and Disabled (ABD) and Covered Families and Children (CFC) populations in each region. 

State officials expect to announce preliminary contract awards in April and finalize contracts by the end of the year.

Effort attempts to add Ohio data to national EMS database

The state emergency medical services board is pushing the General Assemebly to repeal a 1992 law that prohibits the state from sending information to a federal database of EMS runs (Source: “Ohio not part of federal database on EMS runs,” Columbus Dispatch, Jan. 4, 2012).

The Ohio Hospital Association lobbied for the law 20 years ago, citing concerns about keeping individual names of providers confidential in the public trauma registry. A repeal would likely stipulate that individual hospital names would not be included in the database, but would identify ambulance agencies agencies for accurate groupings and to compare services within the state and against other states, though the names would be kept confidential. OHA officals have indicated that if individual hospitals were not named, it would not oppose repeal legislation.

“Ohio has been [and EMS] leader for years and wants to submit data, but their statute prohibits them,” said Karen Jacobson, director of the national information system.

As part of its recently adopted three-year strategic plan, HPIO has identified four strategic objectives, one of which is developing tools for improved Ohio health system data transparency. To learn more about the Institute's work with data transparency, please visit www.hpio.net/transparency.

Ohio Medicaid to begin paying for quality, value in new managed care contracts

The Ohio Medicaid program announced yesterday that Ohio will be the first state in the nationa to work with a large private payer organization to develop contract language that ties managed care payment to quality outcomes (Source: “Ohio begins value-based measure for Medicaid,” Dayton Daily News, Jan. 9, 2012).

As Medicaid begins the rebidding process this month for 2013 contracts with managed care plans, it will be using language developed by Catalyst for Payment Reform to set some payments based on the value of care received by patients. CPR is a San Francisco-based nonprofit organization of large employers/health care purchasers such as General Electric Co., Walmart Corp. and The Dow Chemical Company.

The partnership with CPR will not cost the state any money and officials say they are still working to develop the quality and savings goals that will be used to measure managed care plans. 

In November, HPIO hosted CPR Executive Director Suzanne Delbanco and a panel of public and private purchases for a forum on opportunities for purchasers to drive health care value. HPIO also partnered with CPR to field test its Market Assessment Tool in Columbus. Columbus was one of three cities in the nation selected to test the tool, which is designed to gauge the readiness of a particular market for payment reform.

“We are encouraged that Ohio Medicaid is moving forward with efforts to tie payment to quality outcomes and value. This will encourage other public and private purchasers to leverage their ability to improve outcomes and lower costs,” said HPIO President Amy Rohling McGee. 

“Medicaid’s decision affirms the interest from public and private stakeholders that we heard both at our forum and in working with CPR on their assessment of the Columbus marketplace,” McGee added.  “HPIO looks forward to working with Ohio Medicaid and OPERS in discussions focused on aligning public and private payment with better health quality outcomes.”

HPIO adopted payment reform as one of its four strategic objectives in 2011 and is currently engaging public and private stakeholders in an ongoing payment reform collaborative. As part of this collaborative, this month HPIO will be hosting small groups of providers, purchasers, payers and consumer representatives to help move forward a collective agenda around payment reform.

Cleveland sues state over city's trans fat ban

Cleveland Mayor Frank Jackson filed a lawsuit last week claiming that a state law that forbids municipalities from regulating ingredients in prepared foods infringes on the city’s home rule rights (Source: “Cleveland files in court to keep its ban on trans fats,” Cleveland Plain Dealer, Jan. 3, 2012).

At issue is a law passed by Cleveland City Council in April that bans restaurants from using cooking oils containing trans fats. However, the Ohio Senate, at the request of restaurant lobbyists, amended the state budget to ban municipalities from regulating ingredients.

"The health and well-being of Cleveland is the responsibility of the City of Cleveland, and we are taking proactive steps to help make everyone in Cleveland healthier," Jackson said at the news conference.

Jarrod Clabaugh, spokesman for Ohio Restaurant Association's, countered that this city’s ban  " would have made it extremely difficult for existing restaurants to grow their business and would have made our state less attractive to outside economic investment.”

State Dems introduce exchange legislation

Democratic state legislators introduced a bill in both chambers last week that would create the infrastructure for a state-run insurance exchange for individuals and small businesses (Source: “Dems try again to force Ohio’s hand in creating insurance exchange,” (Columbus) Business First, Jan. 5, 2012).

The legislation is sponsored by Rep. John Patrick Carney (D-Columbus) and Rep. Nickie Antonio (D-Lakewood) in the House and Sen. Michael Skindell (D-Lakewood) in the Senate. The bill would establish separate individual and small business markets, with oversight provided by a board of state health and a board made up of state health and insurance officials and appointees representing unions, consumers and small business, plus economic and benefits experts. 

In order to pass, the legislation would have to win support from Republicans, who control both chambers. Republican leaders indicated last week, through their spokesmen, that they needed to review the bill before commenting.  

Last September the Health Policy of Ohio released a policy brief titled “Federal rules for establishing health insurance exchanges” (pdf, 12 pages) that provides background on the issue.