Ohio Health Policy News

Healthcare representatives from across the United States are urging Congress to halt cuts to funding that funds hospital care for uninsured or low-income patients who rely on Medicaid (Source: “Hospitals plead with Congress to avert $8 billion in cuts in Medicaid funding,” Ohio Capital Journal, Sept. 18).

More than 250 hospitals and health systems appealed to House and Senate leadership in a letter asking the lawmakers to avert or delay a forthcoming $8 billion cut to “America’s health care safety net.”

The reduction to the Medicaid disproportionate share hospital funding is scheduled for Oct. 1, as mandated under the Patient Protection and Affordable Care Act. The deadline comes as Congress faces partisan roadblocks to fund the government and renew a number of expiring federal programs by the end of the fiscal year, or Sept. 30.

The fund compensates hospitals that treat a disproportionate number of uninsured patients or low-income patients whose government-provided Medicaid coverage pays a lower rate than private insurance or Medicare. The ACA provision, written under the premise that rates of uninsured people would continue to decrease, requires $8 billion per year in cuts from 2024 to 2027.

The nation’s most thinly staffed nursing homes would be required to hire more workers under new rules proposed last week by the Biden administration, the greatest change to federal nursing home regulations in three decades (Source: “Federal Officials Propose New Nursing Home Standards to Increase Staffing,” New York Times, Sept. 1).

The proposed standard was prompted by the industry’s troubled performance earlier in the coronavirus pandemic, when 200,000 nursing home residents died. But the proposal falls far short of what both the industry and patient advocates believe is needed to improve care for most of the 1.2 million Americans in nursing homes.

The proposal, by the Centers for Medicare and Medicaid Services (CMS), would require all facilities to increase staff up to certain minimum levels, but it included no money for nursing homes to pay for the new hires. CMS estimated that three-quarters of the nation’s 15,000 homes would need to add staff members. But the increases at many of those facilities would be minor, as the average nursing home already employs nurses and aides at, or very close to, the proposed levels.

More than a dozen states have considered or passed legislation to better define the community benefit provided by non-profit hospitals in exchange for tax breaks, to increase transparency about the benefits hospitals provide, or, in some cases, to set minimum financial thresholds for charitable help to their communities (Source: “As Nonprofit Hospitals Reap Big Tax Breaks, States Scrutinize Their Required Charity Spending,” Kaiser Health News, July 11).

A congressional committee in April heard testimony on the issue.

“States have a general interest in understanding how much is being spent on community benefit and, increasingly, understanding what those expenditures are targeted at,” said Maureen Hensley-Quinn, a senior director at the National Academy for State Health Policy. “It’s not a blue or red state issue. It really is across the board that we’ve been seeing inquiries on this.”

Even the highest-performing hospitals see racial health disparities in adverse patient safety events, according to a new report (Source: “Even At Top Hospitals, Racial Health Disparities in Patient Safety Are Steep,” Patient Engagement HIT, June 7).
 
The report from the Leapfrog Group and Urban Institute showing that, regardless of a hospital’s rating in the Leapfrog Group’s scorecard, white patients were less likely to experience an adverse patient safety event than their Black and Hispanic peers.
 
The consistency of health disparities across all hospital rating grades indicates that the Leapfrog Group reports “cannot be used to convey information on the underlying disparity in safe inpatient care,” the researchers said. That means patients who fall into the groups facing more adverse events may need additional tools to help with care access decision-making.

The Health Policy Institute of Ohio has released the latest edition of its biennial Health Value Dashboard, which found that Ohio ranks 44 on heath value compared to other states and D.C. (as displayed in the graphic above).

That means that Ohioans are living less healthy lives and spending more on health care than people in most other states.

The Dashboard is designed for policymakers and other public- and private-sector leaders to examine Ohio’s performance relative to other states, track change over time and identify and explore health disparities and inequities in Ohio. The report also highlights evidence-informed strategies that can be implemented to improve Ohio’s performance.

With more than 100 data metrics, the report can be a valuable tool as Ohio’s leaders continue to develop the state’s biennial budget over the next two months.

In the fifth edition of the Dashboard, HPIO identified three specific areas of strengths on which Ohio can build to create opportunities for improved health value in the state:

• Strengthen Ohio’s workforce: Ohio can build upon recent success in attracting employers in high-growth industries to strengthen the workforce and reduce poverty
• Foster mental well-being: Ohio can build upon expertise with, and community response to, the addiction crisis to become a national leader in behavioral health
• Improve healthcare effectiveness: Ohio can build upon strengths in access to care to reinvigorate approaches to improving outcomes and controlling healthcare spending

Three years after the COVID-19 pandemic began, the healthcare field in Ohio and across the country continues to be challenged by worker shortages, which threaten the quality of care (Source: “3 years since COVID got here, health care remains changed,” Dayton Daily News, March 12).

Even prior to the pandemic, shortages of medical staff were linked to the quality of patient of care, medical errors and increased risks of dying, according to the American Association of Colleges of Nursing.

In response to the shortage, Ohio hospitals are working to address employee burnout, attract new talent and fill gaps by other means, including innovation with telehealth options. The American Hospital Association said their members also contract with outside agencies to fill gaps, but they say prices with those agencies have risen dramatically from what they were prior to the pandemic.

Research by the federal Office of the National Coordinator for Health IT has found racial and ethnic disparities in patient access to, and usage of, electronic health records (Source: “Report confirms racial disparities in patient access to their health data,” Healthcare IT News, Jan. 5).

Published in the Journal of the American Medical Informatics Association, the ONC study found that in 2019 and 2020, "black and Hispanic individuals were significantly less likely to report being offered and subsequently accessing their portal."

Black and Hispanic people were not offered (5.2 percentage points less likely) and did not access patient portals (7.9 percentage points less likely) nearly as often as white people. 

But when offered access, disparities largely diminished. According to the study, "individuals offered a portal and encouraged to use it by their providers "were 21 percentage points more likely to access it."

"Taken together, our findings point to the important role of healthcare providers in increasing access to EHI by offering portals and encouraging their use," study coauthor Chelsea Richwine, an economist with ONC's Office of Technology, wrote.

The federal Department of Health and Human Services (HHS) announced this week that it has designated $60 million to strengthen healthcare workforces in rural communities through a number of initiatives (Source: “HHS investing $60M to boost rural healthcare workforce,” Healthcare Dive, Aug. 9).

According to an HHS press release, About $46 million in funding through the American Rescue Plan will go to 31 recipients with the goal of expanding healthcare capacity in rural and tribal areas by creating job development, training and placement programs for dental hygienists, medical assistants, doulas and other community-based healthcare professionals.

Another $10 million will go to 13 organizations to create new medical residency programs in rural communities to boost the number of physicians training in those areas. And about $4 million will go to 18 recipients with the goal of improving health outcomes and quality for rural patients and veterans living in those communities.

About 14% of Americans live in rural communities, though those areas represent nearly 75% of primary care health professional shortage areas in the county, according to a February report from the Center for American Progress, a left-leaning think tank.

As the COVID-19 pandemic exacerbated existing health equities, health systems nationwide have implemented a series of initiatives to reduce disparities (Source: “13 leaders on health equity initiatives launched in the last year,” Becker Hospital Review). 

Leaders from 13 health systems from across the country answered a series of questions on their health equity initiatives and shared lessons learned so far with editors of Becker Hospital Review.

More than 100 million people in America ― including 41% of adults ― are carrying medical debt, according to an investigation by KHN and NPR (source: “100 million people in America are saddled with health care debt,” Kaiser Health News via Ohio Capital Journal, June 21).

The investigation reveals a problem that, despite new attention from the White House and Congress, is far more pervasive than previously reported. That is because much of the debt that patients accrue is hidden as credit card balances, loans from family, or payment plans to hospitals and other medical providers.

To calculate the true extent and burden of this debt, the KHN-NPR investigation draws on a nationwide poll conducted by KFF for this project.

In the past five years, more than half of U.S. adults report they’ve gone into debt because of medical or dental bills, the KFF poll found. A quarter of adults with health care debt owe more than $5,000. And about 1 in 5 with any amount of debt said they don’t expect to ever pay it off.

Nationwide, according to the poll, Black adults are 50% more likely and Hispanic adults are 35% more likely than whites to owe money for care.