Ohio Health Policy Review

Health Policy Review on hiatus for holidays

The Ohio Health Policy Review will be on hiatus through the holidays. The Review will resume both its daily reports, and twice-weekly electronic newsletters, on Thursday, January 3rd, 2008.

Report covers Ohio physician workforce data

The Association of American Medical Colleges has released its 2007 State Physician Workforce Data report (Note: PDF download). The report provides updated and expanded information on the active physician supply in each state, current medical school enrollment, physicians in graduate medical education programs, in-state retention rates, and more. The Ohio specific data finds that:

• Ohio ranks 17th among all states for active physicians per 100,000 population. In all, there were 28,904 active physicians in the state as of July 1, 2006, or 251.8 physicians per 100,000 people. (Source: State Physician Workforce Data, pages 5 and 6.)
• Ohio ranked 23rd for primary care physicians, with 10,244 total physicians practicing primary care or 89.2 physicians per 100,000 people. (Source: Ibid, page 10.)
• Ohio ranked 34th for the number of physicians who are 60 or older. 5,997 Ohio physicians, or 20.7% of all active physicians, are over age 60, while 6,026 or 20.8% are under age 40. (Souce: Ibid, page 16.)

SCHIP program extended, physician Medicare rate cuts delayed

Yesterday the House temporarily extended the State Children's Health Insurance Program (SCHIP). (Source: "Dems End the Year Without Health Victory," Associated Press, Dec. 19, 2007.) The extension, which the Senate approved on Tuesday, would fund SCHIP at current levels through March 2009. The Democratic leadership and many Republicans had been fighting for a $35 billion SCHIP expansion, but President Bush vetoed two previous expansion bills, saying they would move too many children from "private coverage to government-sponsored coverage." Despite the temporary extension, Congressional Democrats "promised that the (SCHIP) issue will be revisited many times next year."

The same health bill also gave physicians a 0.5% rate increase when they treat the elderly and disabled in Medicare. Physicians had been scheduled to take a 10% cut. The reprieve for doctors will last until June 30 and cost about $6 billion. "Lawmakers offset the expense in several ways, trimming a fund for certain private insurers by $1.5 billion, reducing payments to physicians for medications delivered at the doctor's office, and freezing payments for inpatient rehabilitation care."

Two NE Ohio doctors developing new way to screen for breast cancer

Two Northeast Ohio doctors may have found a better way to screen for breast cancer. (Source: "Doctors aim to improve breast cancer screening," Beacon Journal, Dec. 18, 2007.) Current breast screening methods are not overly precise, resulting in nearly eight out of every 10 breast cancer biopsies coming back as benign. But a new type of screening that relies on air pressure, lasers and digital imaging may reduce the need for some of these biopsies. Created by Dr. Richard Barr, a Youngstown radiologist and professor of radiology at the Northeastern Ohio Universities Colleges of Medicine and Pharmacology, and Dr. C. William Loughry, a retired Akron City Hospital surgeon, the procedure known as ultrasound elasticity imaging gauges "how much the breast tissue moves when pushed, and if a lump is present, how hard it is."  In about half the cases, the elasticity ultrasound may be able to say whether the lump is benign or cancerous. In the other cases, the women would still need a biopsy. Barr said this procedure won't replace mammography but "is another tool to use.'' The concept is being developed in conjunction with Siemens Medical Systems and the next step is an international study of the procedure.

Website aims to bring in new generation of physicians

A new website called MedShow aims to convince young people to follow careers in medicine. (Source: "Project seeks to find more family doctors," Columbus Dispatch, Dec. 17, 2007.) The brainchild of Dr. Linda Stone, associate dean for student affairs at Ohio State University's medical school, and Deb Miller, a marketing expert, the website is supported by Ohio State and the Ohio Academy of Family Physicians. Other universities have also expressed interest in the site. According to Stone, predictions show a shortage of 85,000 physicians by 2020, and family medicine and general internal medicine are being hit particularly hard.

Strickland says mental health drug preauthorization will proceed

In a follow-up to last week's story about the state Medicaid program requiring preauthorization for certain specialized mental health drugs, Gov. Strickland said he gave "extensive thought" to the decision and he still intends to implement the policy, despite a request from Senate Republicans to suspend the plan. (Source: Gongwer Report, Dec. 17, 2007.) "We would not want to deprive anyone from getting the medication they need," Strickland said, but added that the pharmaceutical industry "can be very creative in the way it markets medications and the way it looks after its profits, and I don’t want to be gullible when it comes to the use of limited resources."

Paperwork issues surround prescription assistance programs

A new Plain Dealer article explores the paperwork required for the prescription assistance programs  offered by the major drug companies. (Source: "Drug plans for needy are helpful, but paperwork a headache," Dec. 16, 2007.) While the programs do offer free prescription drugs to those who qualify, "clinics catering to the poor and uninsured have found themselves shouldering the expense of filing the reams of paperwork required on behalf of clients." For example, Free Clinic of Greater Cleveland hired a second pharmacy technician two years ago to handle the paperwork load of about 500 applications a week. The clinic obtained about $3.5 million worth of medications last year and expects an even higher volume this year.

Part of the paperwork problem results from each drugmaker requiring different forms, while "some companies want recent pay stubs; others will accept last year's tax return, a bank statement or a letter from the Social Security Administration confirming the patient is disabled. At least one pharmaceutical company keeps its guidelines a secret. People send in the forms and hope for the best, according to Kris Gualtier, a pharmacy technician at the Free Clinic. Some pharmaceutical companies want the documents mailed in; others prefer faxes. None allow electronic filing. Some require people to requalify for the programs every 90 days, while others wait a year before verifying if a patient still meets income guidelines."

According to Ken Johnson, senior vice president for communications and public affairs for the Pharmaceutical Research and Manufacturers of America, federal antitrust laws prevent companies from using a standard form.

Quality comparisons of Ohio hospitals

Dr. Alvin D. Jackson, director of the Ohio Department of Health, hopes to soon provide quality comparison measures on state hospitals in a user-friendly online format. (Source: "Public to get more Ohio hospital comparisons," Plain Dealer, Dec. 17, 2007.) Since 2001, Ohio hospitals have provide some data to the ODH, including information on organ transplants, births, open-heart surgeries, and length of patient stays. While this information is available to the public, it is not easy to access and doesn't allow for a complete quality comparison of hospitals. ODH's new reporting requirements will "piggyback on what hospitals already report, such as the reams of information to Medicare." Representatives of the Ohio Hospital Association say that "hospitals are already required to report a great deal of information" and don't want to shoulder another burden if it doesn't provide important information for the public.

The Plain Dealer article also highlighted several already existing quality comparisons of Ohio hospitals, including the Employers Health Coalition of Ohio's "A Consumer Guide to Ohio Hospital Quality." The article also says Jackson "ultimately wants to have a data center that people can use to look up, by ZIP code or census tract, information on childhood immunization compliance, obesity rates, lead levels and other data that would help policy makers decide where to put scarce tax dollars to improve public health."

Physicians worry about planned Medicare payment cut

Doctors are worried about a planned 10% cut in Medicare payments set to take effect Jan. 1. (Source: "Doctors see red if Medicare cuts stand," Columbus Dispatch, Dec. 16, 2007.) If Congress doesn't override the cut, there are concerns that many physicians might stop accepting Medicare patients. Dr. Elena A. Christofides, a Columbus diabetes specialist, said that in order to pay her staff a living wage and benefits, if the cut takes effect she will "charge all her patients a fee to recoup her costs, which have risen while Medicare payments have remained flat since 2002."

This is the sixth straight year in which Medicare has proposed cutting payments to physicians, although Congress has passed legislation each year to instead freeze payments. U.S. Rep. Pat Tiberi said he expects the House to do the same this time. However, he doubts that the Senate will follow suit. Spokesmen for Senators George V. Voinovich and Sherrod Brown said the lawmakers are against cutting payments to doctors. The cuts result from a formula passed by Congress "that ties physician payments to the nation's economy. When it's good, payments can rise. When it's bad, payments can be frozen or cut."

Civil Rights Commission to take collaborative approach with maternity leave proposal

Ohio Civil Rights Commission member Leonard Hubert, who is now the Commission's designated point man on the stalled maternity leave effort, says he will take a collaborative approach to move the proposal forward. "We’re going to reach out and talk to the business community and we’re going to reach out and talk with the Governor's Office," Hubert said in an interview. (Source: Gongwer News, Dec. 13, 2007.) The OCRC is working to revise the proposed rule's fiscal impact analysis in accordance with a decision handed down against the leave plan by the Joint Committee on Agency Rule Review.