Ohio Health Policy Review

GOP Senate leaders leaning toward Medicaid reform, away from expansion

Republican Senate leaders are indicating that they are interested in pushing a series of reforms to Medicaid, but seem less likely to support Gov. Kasich’s plan to expand the program (Source: “Legislators mull Medicaid changes rather than expansion,” Columbus, Dispatch, May 17, 2013).

“It’s always better to create a path for short-term benefits with long-term incentives to become self-sufficient,” said Senate President Keith Faber, R-Celina, in a meeting with editors and reporters at the Columbus Dispatch.

Among ideas being considered by legislative leaders are time limits and work requirements for Medicaid enrollees, as well as the potential of moving thousands of pregnant women, disabled workers and children from Medicaid to coverage obtain through the health insurance exchange.

All of the material from the Ohio Medicaid Expansion Study, a partnership between HPIO, the Ohio State University, the Urban Institute and Regional Economic Models, Inc., as well as additional Medicaid resources from HPIO, is available at www.hpio.net/medicaid

Ohio House addresses error in new sports concussion law

State lawmakers moved this week to correct a new state law that inadvertently could allow coaches and referees in youth sports leagues to be criminally prosecuted for violating rules regarding players’ head injuries (Source: “Ohio bill would fix errors in sports safety law,” Associated Press via the Akron Beacon Journal, May 15, 2013).

The House voted unanimously Wednesday to fix the error in the law. The Senate passed an earlier version of the bill, though it will likely sign off on the legislation.

The new law requires coaches, volunteers and officials in youth sports organizations to have players who show concussion-like symptoms sit out games or practices until they’ve been checked and cleared in writing by a doctor or licensed health-care provider. Athletes can’t return to play on the same day they are removed.

A bill-writing error left open the door for coaches to face charges. The way the law is currently written, parents who volunteer at sporting events could be fined or face jail time if they haven’t received the proper concussion training, said state Rep. Jay Hottinger, R-Newark.

Hottinger said it wasn’t the law’s intent to “potentially turn volunteers and coaches and referees and officials into criminals.”

Ohio to expand background checks on home health workers

Ohio officials announced this week that they will use a $2.1 million federal grant to expand criminal background checks for health-care workers who provide home- and community-based services to Ohioans (Source: “Health care workers’ criminal checks to be expanded,” Columbus Dispatch, May 16, 2013).

“It is important that seniors and people with disabilities can trust the service providers that come into their homes, and this program will ensure that home-based services are of the highest quality,” said Greg Moody, director of Gov. John Kasich’s Office of Health Transformation.

Ohio will add $700,000 in state funds to the grant from the Centers for Medicare and Medicaid Services. The funds will extend the use of the Ohio attorney general’s Retained Applicant Fingerprint Database Information Exchange to the health workers. Long used by law enforcement, the system, which monitors criminal convictions, also is used for background checks on teachers. State officials can’t yet say when automated checks will begin.

Study: Medicaid ‘churn’ increases hospitalizations, costs

Researchers at George Washington University have found that Medicaid enrollees coming on and off of the program leads to more hospitalizations and higher costs for patients (Source: “Study: Medicaid 'churn' bad for patients,” The Hill, May 10, 2013).

According to the Association for Community Affiliated Plans study of Medicaid “churn” –- or when beneficiaries move on and off the rolls because of small variations in income –- a beneficiary enrolled consistently for 12 months pays $333 in medical bills per month, on average. Patients enrolled for six months paid $469 per month, and those enrolled for one month paid $625.

Statewide trauma system fails to reduce Ohio fatal injury rate

Despite the introduction of a new statewide trauma system aimed at reducing fatal injuries in Ohio, the rate of such deaths actually increased 44 percent between 2000 and 2011 (Source: “Trauma system to be vetted,” Columbus Dispatch, May 5, 2013).

“A well-functioning trauma system should result in a decrease in mortality. We definitely are not seeing that,” said Dr. Steve Steinberg, who is a trauma surgeon at Ohio State University’s Wexner Medical Center and a member of the state’s lead trauma agency — the Board of Emergency Medical Services.

The negative trend has fueled momentum for a possible overhaul of Ohio’s trauma system, with supporters of reform hoping for legislation this fall.

Kasich remains optimistic about Medicaid expansion deal

Gov. Kasich said this week that he would support a ballot initiative to expand Medicaid, although he is still holding out hope that the state legislature will pass an expansion bill first (Source: “Governor patient on Medicaid issue,” Toledo Blade, May 10, 2013).

While leadership in both the Ohio House and Senate have indicated that it is unlikely that expansion language will be reinserted into the state budget plan, both chambers are convening subcommittees to examine potential Medicaid reform that could include expanding eligibility.

Speaking at the first meeting Tuesday of The Healthier Ohio Working Group, the Ohio House subcommittee formed to discuss Medicaid reforms and possible options for expanding the program, the Governor’s Office of Health Transformation Diretor Greg Moody and Medicaid Director John McCarthy said reforms to Ohio’s Medicaid system in recent years have saved the state millions of dollars, but failing to expand the program could put that progress at risk (Source: "Officials: Medicaid reforms at risk if program isn't expanded," Cincinnati Enquirer, May 8, 2013).

Meanwhile, the Obama administration appears close to approving Arkansas-style Medicaid expansion in which at least a portion of the newly eligible Medicaid population would receive coverage through private plans on the health insurance exchange, an option that has been mentioned as a possibility in Ohio (Source: “Obama Administration Poised to Approve Arkansas-style Medicaid Expansions,” Pew Stateline, May 6, 2013). 

Wide variation seen in Medicare charges across Ohio

Newly released federal data on hospital charges shows dramatic variation in costs throughout Ohio (Source: “Medical charges vary widely across Ohio,” Newark Advocate, May 9, 2013).

The Centers for Medicare and Medicaid Services made public this week the average charges for the 100 most frequently billed services in fiscal year 2011 paid by Medicare. The data covers 3,201 U.S. hospitals, including 131 in Ohio, and allows users to compare costs between facilities.

One example of the variation in Ohio is that the discharges from Wooster Community Hospital for patients with a heart attack averaged $9,631, the lowest in the state. Meanwhile, at the Ohio State University’s Wexner Medical Center, the bill submitted to Medicare would be a state-high $92,976, on average.

The Cleveland Plain Dealer has posted an online tool that allows users to explore the database to see average costs charged by hospitals. 

Cincinnati study: Pediatric nurse ratios impact readmission rates

Researchers at the Cincinnati Children’s Hospital Medical Center have found that pediatric nurse staffing ratios are significantly associated with hospital readmission for children with common medical and surgical conditions (Source: “Nursing staff ratios directly impact pediatric hospital readmissions,” Fierce Healthcare, May 8, 2013).

The study, which was published in the journal BMJ Quality & Safety and is believed to be the first to examine the extent of the association between hospital nurse staffing levels and pediatric readmissions, found that an increase of only one patient in a hospital's average staffing ratio raised the likelihood of a medical patient's readmission within 15-30 days by 11 percent. And the odds of readmission for surgical patients increased by 48 percent.

Children treated in hospitals meeting a staffing benchmark of no more than four patients per nurse were significantly less likely to be readmitted within 15-30 days. Nursing staffing ratios had no effect on readmissions within the first 14 days after discharge.

Feds to give community health centers $150 million for ACA outreach

Responding to criticism that not enough money has been allocated to educating consumers about enrolling in health exchanges, the Obama administration announced Thursday that community health centers across the country will get $150 million to help uninsured Americans sign up for health insurance coverage under the ACA (Source: “Health centers get $150 million to help the uninsured navigate new coverage options,” Associated Press via Washington Post, May 9, 2013).

The announcement comes a month after the administration made $54 million available to states and private groups so that they could hire new health insurance “navigators.” The same concept is being applied to the nation’s 1,200 community health centers, which serve about 21 million patients each year, many of them without health insurance.

Studies: Health spending slowed in recent years

Two new studies published this week in the journal Health Affairs indicate a significant slowdown in national health spending in recent years (“Health Care Cost Growth May Be Slowing Long-Term, New Studies Show” Forbes, May 7, 2013).

In one study, Harvard researchers found that between 2009 and 2011, health care spending grew about 3 percent a year, compared to 5.9 percent annual growth in the decade before. Researchers concluded that the slowdown was created by more factors than just the recession, giving them optimism that the trend may continue. A companion study by Harvard economists concludes that if that trend holds through 2022, the federal government would spend as much as $770 billion less than has been anticipated.

In analysis also published in Health Affairs, Harvard professor David Cutler said the slowdown in health spending was caused in part by the recession, by also by slower advances in medical technology and the growth of health plans that shift more costs to consumers.