Ohio Health Policy Review

Study: Public health care spending to top private spending by 2012

A new study from the Centers for Medicare & Medicaid Services projects that, for the first time ever,  government spending is poised to eclipse private health care spending (Source: “Government moving into central role in health care, with or without Obama plan,” Associated Press via Cleveland Plain Dealer, Feb. 4, 2010).

The study, “Health Spending Projections Through 2019: The Recession’s Impact Continues,” was published in the latest edition of the journal Health Affairs.

Analysis from the CMS Office of the Actuary predicts that federal and state programs will account for slightly more than half of all U.S. health spending by 2012. The shift, which has been anticipated for some time, was accelerated by aging Baby Boomers becoming Medicare eligible and more Americans enrolling in Medicaid because of the economic recession.

"This does mark a pretty stark jump in the data," said Christopher Truffer of Medicare's Office of the Actuary, which prepared the analysis.

Kaiser Health News has created an interactive graphic (Java plug-in required) that details the historical levels of public and private health care spending.

Budget cuts mean state trauma registry not being analyzed

State officials say that because of budget cuts, Ohio’s trauma registry is so underfunded that staff is unable to analyze the data for people critically injured in car crashes, fires and shootings (Source: “State's trauma registry can't be analyzed,” Columbus Dispatch, Feb. 1, 2010).

The number of state employees working on the 11-year-old registry, which is housed at the state Emergency Medical Services division, has been cut from three to two, at the same time that the number of records has increased from 24,000 a year to 40,000. 

"When the legislation was written they simply didn't imagine the work entailed in getting the data back out and using it appropriately," said Tim Erskine, state trauma coordinator.

Hospitals say observation units can cut costs

Ohio hospitals are joining a national trend of expanded use of observation units, a practice they say can cut billing by a third (Source: “Hospital observation units prove efficient, cost-effective,” Columbus Dispatch, Feb. 3, 2010).

More hospitals are creating units where patients can be observed for up to 23 hours in most cases.

"A lot of patients are on the bubble -- not well enough to go home, but not sick enough for inpatient," said Janet Susi, the OSU Medical Center observation unit's clinical nurse director. "If patients don't get turned around in 23 hours, we admit them."

Added Kelly McGivern, president of insurance industy trade association the Ohio Association of Health Plans, "Being admitted is a higher standard of care than in observation; prices are higher in an admission."

Ohio Medicaid institutes drug co-pay plan

In a move aimed at saving the state about $243 million, about 1.5 million Ohioans enrolled in Medicaid managed care plans saw their prescription drug coverage altered on Feb. 1 (Source: “Ohio Medicaid changes to prescription drug coverage take effect today,” Cleveland Plain Dealer, Feb. 1, 2010).

Although all Ohioans enrolled in a Medicaid managed care plan were sent new cards over the past few weeks, perhaps the biggest change will affect about 400,000 enrollees who will now be responsible for drug co-pays of $3 for drugs that require prior authorization from Ohio Medicaid and $2 for trade-name drugs. There's no cost for generics. In some cases, beneficiaries may also be required to switch to generic drugs.

Prescriptions are expected to continue uninterrupted, according to state officials.

ODI: Liability closed claims down 40 percent since tort reform passed

A new report from the Ohio Department of Insurance has found that the number of medical liability closed claims has dropped 40 percent since tort reform was enacted in 2005 (Source: “Tort reforms cited in Ohio’s medical claims decline,” Dayton Daily News, Feb. 3, 2010).

The annual Ohio Medical Liability Closed Claim Report is mandated as part of the tort reform legislation. Among the provision in the tort reform law is capping noneconomic damages at $350,000 and limitations on claims. According to the Ohio State Medical Association, which was a strong supporter of the legislation, premiums have decreased by an average of 22 percent since the bill was passed.

State reforms to individual insurance market take effect

State reforms to the individual insurance market that cap the cost of policies for people with pre-existing conditions went into effect with the start of the new year(Source: “Ohio caps health-coverage cost,” Columbus Dispatch, Jan. 4, 2010).

The new regulations require insuraners to charge no more than twice the lowest rate the company charges a person of similar age and gender.

The cap will be reduces to 1 ½ times the lowest rate by 2013. According to the Ohio Department of Insurance, the cap should reduce premiums by 50 percent to 70 percent for people who buy individual policies, and should make coverage more affordable for 52,000 uninsured Ohioans.

And in the first week in which the cap has been in place, one insurer has already been suspended for violating the law (Source: “Insurer suspended under new rate cap,” Business First of Columbus, Jan. 6, 2010).

ODI officials announced this week that Texas-based Chesapeake Life Insurance Co. has been suspended from soliciting business or selling new or renewal health or life policies in Ohio. The company was the only one of more than two dozen companies selling individual policies in Ohio that did not meet the Jan. 1 deadline to submit forms to ODI describing the plans offered and their premiums.

New state law aims to attract more advanced practice nurses to Ohio

New legislation that is set to take effect this year is expected to make Ohio more attractive for advance practice nurses looking to relocate (Source: “New Ohio law to help advanced practice nurses move into the Buckeye State,” Cleveland Plain Dealer, Jan. 4, 2010).

Senate Bill 89 permits out-of-state nurses who already have received training and are authorized to write prescriptions for some drugs to do the same in Ohio without completing and additional training here. The bill was sponsored by Democratic State Sen. Sue Morano, a registered nurse from Lorain, and was unanimously approved by the Senate and was signed by Gov. Strickland last week.

In November, the Health Policy Institute of Ohio released a white paper, The Future of the Nursing Workforce in Ohio (pdf, 24 pages), that outlines the nursing shortage anticipated in Ohio by 2020. With a projected shortage of 29 percent, or 32,000 nurses, Ohio is one of three states — along with California and Texas – that has the largest gaps and needs for nurses and nursing students, according to a study by Cleveland-based Center for Health Affairs.

Tobacco fund fight heading to Ohio Supreme Court

The fight over whether the state can spend its $258 million tobacco settlement funds for other state programs is heading to the Ohio Supreme Court (Source: “$258M from tobacco settlement for Ohio held pending court,” Toledo Blade, Jan. 7, 2010).

Washington-based anti-smoking organization American Legacy Foundation is seeking to appeal last week’s court ruling that the state was free to use the money for other purposes.

The money was set aside nearly 10 years ago for smoking treatment and cessation programs. The state is planning to use it instead to fund county adult and child protective services, optional Medicaid programs such as adult dental care, and expanded health-care coverage for children.

Ohio’s Hospital Compare site goes live

The Ohio Department of Health this month launched a new Web site that lets users look up outcomes, patient satisfaction and other performance measures for hospitals across the state (Source: “State launches new Web site to compare hospitals,” Akron Beacon-Journal, Jan. 4, 2010).

The free Ohio Hospital Compare tool includes more than 100 measures in a dozen categories: heart attack care, heart failure care, heart surgery, stroke care, pneumonia care, surgical care, hospital-acquired infections, infection prevention measures, patient safety, patient satisfaction, children's asthma care and pregnancy/delivery.

The majority of the data available online is based on patient care delivered in 2008. Although about 65 percent of the information is obtainable from other sources, primarily from the online hospital compare tool run by the U.S. Centers for Medicare & Medicaid Services, information about stroke care, heart surgery, patient safety, infection prevention measures and pregnancy care at hospitals previously wasn't easily accessible for Ohio patients, according to ODH officials.

Cincinnati NAACP: Hospital closure weakens safety net

The Cincinnati NAACP charged last week that Mercy Health Partners’ plans to close two urban hospitals and replace them with one in a more suburban location would weaken safety net services for low-income patients in the area  (Source: “NAACP: Hospital closings hurt poor,” Cincinnati Enquirer, Jan. 4, 2009).

"What is currently unfolding before our eyes is Mercy Health system's urban divestment strategy, weakening safety net services to the poor," wrote local NAACP President Christopher Smitherman to Mercy officials. "The NAACP does not support weakening safety net health care services to the poor, nor should you."

Mercy officials say the new hospital is located about five miles away from the two that are being shuttered and will still serve the area’s residents.

The decision by Mercy is the latest in a string of developments that some say will negatively impact safety net services in the Cincinnati area. With the Health Alliance of Greater Cincinnati on the verge of breaking up, there is fear by some city leaders that University Hospital will be left solely responsible for serving the area’s poor.