Ohio Health Policy Review

CMS OKs additional payment to Ohio hospitals for Medicaid expenses

After lobbying from Gov. Ted Strickland, officials at the federal Centers for Medicare & Medicaid Services have given the go-ahead to a state plan to pay hospitals an additional $87 million this year for the care they provide to low-income Ohioans on Medicaid (Source: “Feds OK plan to let hospitals recoup Medicaid expense,” Columbus Dispatch, July 15, 2010).

The bulk payment, which will be disbursed to hospitals by the end of this month, and a 5-percent increase in Medicaid reimbursement fees effective in October were included in last year's state budget to let hospitals recoup some of the money they were losing through a new state franchise fee.

The fee is projected to cost hospitals statewide $718 million over the two-year budget ending June 30, 2011. The two provisions aimed at offsetting that expense will let hospitals recoup $569 million, according to the Ohio Hospital Association.

Northeast Ohio health systems begin work developing ACO models

Two Northeast Ohio health systems — Summa Health System in Akron and University Hospitals in Cleveland — have begun working with  National group purchasing organization to create accountable care organizations aimed at improving coordination of care and reforming the way providers are paid (Source: “Alternative to HMOs coordinates treatment delivery,” Akron Beacon Journal, July 5, 2010).
 
Under the ACO concept, doctors and hospitals would get financial incentives to work together to keep patients healthy and out of the hospital. The partners would coordinate their care and then share in any savings if quality and cost goals are achieved. Federal health reform legislation allows for ACOs through Medicare, beginning in 2012 . Under the law, patients in traditional Medicare will be assigned to an ACO if their normal provider participates.

Northeast Ohio hospitals join national ACO collaborative

Cleveland-based University Hospitals and Akron-based Summa Health System are two of 20 health systems from across the country that have come together as part of a national accountable care organization collaborative program (Source: “University Hospitals, Summa among 20 health systems to join collaborative networks,” Crain’s Cleveland Business, May 21, 2010).

The 20 systems have formed two collaboratives that will work together to design ACOs that will promote better patient involvement and increased patient accountability for their own health care. The collaboratives are being organized by Premier, a performance improvement alliance of more than 2,300 U.S. hospitals and 67,000-plus other healthcare sites. The groups also will:

• Create medical homes for patients
• Explore new care delivery models for primary, speciality and hospital care
• Intergrate specialists, acinllary providers and hospitals
• Develop reimbursement models that emphasize value of care
• Create an HIT infrastructure that would allow medical personal to share patient information

The accountable care organizations developed by the 20 partner systems could be among the first to apply for new Medicare contracts in which providers would share Medicare cost savings. Those contracts will be available in 2012.

Ohio Supreme Court ruling may limit medical liability damages

A ruling by the Ohio Supreme Court earlier this month that is expected to limit damages in personal injury cases, including medical liability, is being characterized as a victory for physicians (Source: “Liability damages may be limited by Ohio ruling,” American Medical News, May 24, 2010).

The high court on May 4 ruled that defendants may submit evidence showing the amounts actually paid for a plaintiff’s medical bills, even when those costs are less than the amount originally billed. At issue is whether a defendant can request that damages be determined based on the actual amount paid by an insurance provider, which is often much lower than the total amount of the original medical bill. The difference between the two amounts is commonly know as write-offs.

"Write-offs are amounts not paid by third parties or anyone else, so permitting introduction of evidence of them allows the fact finder to determine the actual amount of medical expenses incurred as a result of the defendant's conduct," Justice Terrence O'Donnell wrote in the decision. "This result supports the traditional goal of compensatory damages -- making the plaintiff whole."

Ohio hospitals compelled by federal law to assist in Census, association reports

The American Hospital Association has released an advisory to its membership that federal laws require hospitals and health care facilities to cooperate in conducting the 2010 census (“Federal Law Requires Hospital Cooperation for 2010 Census,” Ohio Hospital Association Health e-News, March 18, 2010).
 
According to the American Hospital Association Regulatory Advisory, hospitals must work with census staff to identify hospital inpatients considered residents in the facility.

"While important, the 2010 Census must be conducted in a fashion that minimizes burden, avoids disrupting patient care and adheres to adequate confidentiality protections," the AHA advisory states.

Central Ohio hospital systems create ‘Columbus Fetal Medicine Collaborative’

The four major hospital systems in the Columbus area have formed one of the nation’s first fetal medicine collaboratives aimed at improving outcomes for high-risk expectant mothers, according to a news release from the hospitals.

Officials from Mount Carmel Health System, OhioHealth, The Ohio State University Medical Center and Nationwide Children’s Hospital announced this week that they have created the Columbus Fetal Medicine Collaborative.

Dr. Richard O’Shaughnessy, director of the fetal treatment program at Ohio State University Medical Center and professor of maternal fetal medicine, and Dr. Donna A. Caniano, surgeon-in-chief and chief of pediatric surgery at Nationwide Children's Hospital, co-chair the collaborative.

The collaborative has created a Web site at www.columbusfetalmedicine.org.

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’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.

Ohio hospitals listed among nation’s best for HIT quality

Health IT watchdog group Leapfrog has released its list of the 45 best hospitals in the nation for HIT quality, and it includes several from Ohio (Source: “Leapfrog names 45 best hospitals in country for 2009,” Healthcare IT News, Dec. 4, 2009).

Cincinnati Children’s Hospital was listed among the nation’s top pediatric hospitals, and both the Ohio State University Medical Center and its affiliated James Cancer Hospital and Solove Research Institute were listed among the top urban hospitals.

The rankings are based on Leapfrog’s Hospital Survey, which the organization touts as the only national, public comparison of hospitals on issues including mortality rates for certain common procedures, infection rates, safety practices, and measures of efficiency.