Ohio hospitals

State experts address health challenges facing Ohio

Last week WBNS-TV in Columbus focused its weekly Face the State program on addressing Ohio’s health challenges.

Panelists on the program included HPIO President Amy Rohling McGee, along with Kurt Lewis, President and CEO of UnitedHealthcare of Ohio, Dr. Sheldon Retchin, Professor of Public Health and Medicine at the Ohio State University and Wendy Patton, Senior Project Director at Policy Matters Ohio.

The panel discussion included healthcare spending and health value in Ohio and how policymakers should address the state’s opioid epidemic.

$50 million Toledo project to address social determinants of health

Toledo-based healthcare system ProMedica announced this week that it is making a 10-year, $50 million investment, funded in large part from late philanthropist Russell J. Ebeid, to create a research center and neighborhood revitalization program to address community health in Toledo (Source: “ProMedica announces $50 million to address community health,” Toledo Blade, Oct. 16, 2017).

According to the health system, $28.5 million was given as a gift from Ebeid’s widow. ProMedica has committed to raise another $21.5 million from community fund-raising and matching ProMedica investments, according to a news release announcing the donation.

The funds will go toward research and programs related to social determinants of health. ProMedica will create the Ebeid Neighborhood Program, which will offer social and educational services in UpTown Toledo. It will expand the offerings at the ProMedica Ebeid Institute for Population Health located in that neighborhood.

As health reform dust settles, rural hospitals still fear for future

Rural hospitals across Ohio fear for their future, even with repeal and replace seemingly out of the equation (Source: “Rural hospitals teeter on edge of closing, cutting services in post-healthcare reform world,” Cleveland Plain Dealer, Aug. 14, 2017)

Forty-one percent of all rural hospitals in the nation, including 13 Ohio facilities, operate at a loss. Nationally, 80 rural hospitals have closed since 2010, according to The Chartis Center for Rural Health. Another 273 are at risk.

The American Hospital Association estimates hospitals receive 90 cents per dollar spent on Medicaid and 88 cents per dollar on Medicare. Hospitals with greater shares of Medicaid and Medicare patients have to find ways to make up the difference, despite rising costs of supplies, prescriptions and providing care. In Ohio, rural hospitals fare a bit better than those in other parts of the country because of the Medicaid expansion under the Affordable Care Act that provided insurance to an extra 700,000 people.

Ohio healthcare transparency law in legal limbo

Two years after it passed unanimously in Ohio’s state Legislature, a law meant to inform patients what health care procedures will cost has yet to be implemented (Source: “Health-care price transparency faces opposition in Ohio from hospitals and doctors,” Kaiser Health News via Cincinnati Enquirer, July 23, 2017).

One of the most stringent in a group of similar state laws being proposed across the country, Ohio’s Healthcare Price Transparency Law stipulated that providers had to give patients a “good faith” estimate of what non-emergency services would cost individuals after insurance before they commenced treatment.

But the law didn’t go into force on Jan. 1 as scheduled. The Ohio Hospital Association, one of the most vocal critics of the law, has filed a court injunction that is currently delaying enactment.

Joining the hospital association in its legal action are a wide range of provider groups including Ohio State Medical Association, the Ohio Psychological Association, the Ohio Physical Therapy Association, and the Ohio chapters of the American Academy of Pediatrics, the American College of Surgeons, and the American Osteopathic Association. These groups say that the law, which applies only to elective procedures, is too broad and that forcing providers to create estimates before procedures would slow down patient care.

But Jerry Friedman, a retired health policy adviser for the Ohio State University Wexner Medical Center, said the opposition doesn’t stem from genuine concern about patients but from a desire to keep the secret rates that providers have negotiated with insurers under wraps. Transparency would mean explaining to consumers why the hospital charged them $1,000 for a test, he said, adding that providers “don’t want to expose this house of cards they’ve built between hospital physician industry and the insurance industry.”

Rep. Jim Butler, an Oakwood Republican who authored the law, said, “If you really want patients to be empowered, they really need the information.”

The law’s next test will come in August, when the first court hearing on the association’s lawsuit is scheduled. The Kasich administration said it couldn’t comment on the law because of the pending litigation.

HPIO co-hosting regional forum in Chicago on health systems, population health

The Health Policy Institute is partnering with organizations from other Midwestern states to host the Midwest Forum on Hospitals, Health Systems and Population Health. The forum will take place Nov. 29 to Dec. 1 at the Westin Michigan Avenue in Chicago.

Those interested in the forum can sign up to receive email updates about the event. Event organizers have also released a call for abstracts, which are due by 11:59 p.m. central time on Friday, June 16. 

The Midwest Forum on Hospitals, Health Systems and Population Health: Partnerships to Build a Culture of Health will bring together organizations and key stakeholders dedicated to improving the health of all Americans. The goal of the meeting is to engage attendees in a broad dialogue across sectors to solve complex issues to improve the health of communities and integrate clinical and community health and prevention strategies. Participants will share innovative models that are working and inspire the audience to take action to help transform the existing system of care in the United States to a system that strategically plans for and supports the health of its population.

Building on health equity as the core forum theme, topics include:

  • The policy environment for population health and health system transformation
  • Using data for care coordination and population health
  • Aligning financial incentives and payment for population health
  • The role of purchasers and payers in population health
  • Integrating physical and behavioral health
  • Developing clinical/community linkages
  • Connecting health with community development
  • How to engage consumers and patients in population health
  • Collaborating on and leveraging community health needs assessments and planning
  • Partnerships for health equity and social determinants of health

Ohio hospitals, senators express concern over GOP healthcare bill

Ohio hospitals and state lawmakers expressed concern this week that the Republican plan to repeal and replace the ACA could harm the state's successful Medicaid expansion and the financial stability of many hospitals (Source: “Republican healthcare plan's impact on Medicaid expansion worries hospitals, lawmakers,” Cleveland Plain Dealer, March 8, 2017).

Plans to reduce federal funding for the state-run insurance plan for low-income residents and to limit enrollment could once again increase the number of uninsured patients in the state, they fear.

"We have 36 of 220 hospitals in the state operating with negative margins in the current environment," and another 14 hospitals operate on a zero to two percent margin, said Ohio Hospital Association president and CEO Michael Abrams. "If you take a million people who are currently insured and phase them out over a couple years, you're going to cause severe problems to those providing them care."

The GOP plan would drastically change the way Medicaid is funded, changing the program to a per-capita capped allotment. For states like Ohio that expanded Medicaid eligibility, the new plan would continue to cover anyone enrolled at the end of 2019 but not if those people dropped out, or tried to re-enroll.

Ohio's senators, Democrat Sherrod Brown and Republican Rob Portman, have also expressed their concerns about the proposed healthcare plan. Portman joined three other GOP senators from Medicaid expansion states in a letter to Senate Majority Leader Mitch McConnell expressing concern that the draft health care plan doesn't protect those who have received insurance through the federally-subsidized program.

Hospitals, other providers fighting Ohio price transparency law

The Ohio Hospital Association and several other provider organizations have filed a lawsuit against the state of Ohio to block a law requiring price disclosures to patients before they are given non-emergency treatment (Source: “Ohio hospitals want to overturn price disclosure law,” Dayton Daily News, Dec. 27, 2016).

Before non-emergency services are rendered, a healthcare provider would have to give patients written estimates on how much their insurer will be billed for each procedure, test or service, how much their insurers will pay, and calculations for the patients’ out-of-pocket costs. The hospitals, doctors and others suing the state call it “poorly written, confusing, ambiguous ... and impossible legislation.”

The bill’s sponsor, Rep. Jim Butler, R-Oakwood, countered that the health care lobby is resisting price transparency. “It is definitely not something that is impossible for them to carry out. They just don’t want to carry it out. That’s the problem,” Butler said.

In late December, Williams County Common Pleas Court Judge J.T. Stelzer issued a 30-day restraining order, blocking the law from taking effect Jan. 1, and scheduled a hearing for Jan. 20. The list of groups joining the lawsuit is extensive: Ohio Hospital Association, Ohio State Medical Association, Ohio Psychological Association, Ohio Physical Therapy Association, Ohio Chapter of the American Academy of Pediatrics and others.

The Kasich administration declined to comment on the suit, saying it doesn’t talk about pending litigation.

Ohio hospital readmission rates declining

Hospitals across the nation, including in Ohio, are doing a better job of slowing hospital readmissions, new federal data show (Source: “Hospital readmissions decline in Ohio, nationwide,” Columbus Dispatch, Sept. 21, 2016).

Ohio is one of 49 states reporting declines of patient readmissions, and among 11 where percentages fell by more than 10 percent between 2010 and 2015, according to data released by Centers for Medicare and Medicaid Services. Overall, Ohio tied with New York for the sixth-largest percentage reduction nationwide, with a 10.6 percent drop. Nationally, the average decrease was 8 percent, with only Vermont posting an increase, according to CMS officials. In total, 565,000 readmissions were avoided compared to if rates had stayed constant at 2010 levels.

2016 state health assessment draft released

The Governor’s Office of Health Transformation and the Ohio Department of Health today released a draft of the 2016 state health assessment.

The state health assessment is a comprehensive and actionable picture of health and wellbeing in Ohio. The purpose of the state health assessment is to:

  • Inform identification of priorities for the upcoming state health improvement plan
  • Provide a template for state agencies and local partners (uniform set of categories and metrics to use in related assessments)

The report includes information from several sources in order to provide a comprehensive picture of health and wellbeing in Ohio. Using existing data, this document presents data profiles on health outcomes and a broad range of factors that impact health outcomes, healthcare spending and disparities. These data profiles are followed by summaries of new information collected for this assessment, including qualitative information gathered through key informant interviews and regional forums. The Health Policy Institute of Ohio was commissioned to facilitate the state health assessment process and produce the publication.

The public is invited to provide input on the state health assessment until noon on July 5, 2016.

The final state health assessment is expected to be released later this summer, followed by the release of the 2016 state health improvement plan later this year.

Non-profit health systems broadening community-benefit efforts

Leaders of some not-for-profit hospital systems, including several in Ohio, are beginning to make the case for greater investment in broad public health and community improvement programs (Source: “Hospitals broaden scope of community-benefit work,” Modern Healthcare, Nov. 25, 2015). 

Their programs include Ascension's development of a mixed-use housing, retail and community space in Baltimore and Toledo, and Ohio-based ProMedica's partnership with the Alliance to End Hunger to host a hunger symposium in Washington. 

Such efforts are starting to dovetail with those of philanthropic foundations and community and social service organizations. “We keep backing up into the healthcare world,” said David Erickson, director of the Center for Community Development Investments at the Federal Reserve Bank of San Francisco. “We see (hospitals) as potential partners.”

While health system leaders cite their not-for-profit and/or religious missions to help their communities as the reason for their public health push, they also recognize that their systems face growing pressure to justify their tax-exempt status as their charity-care burden shrinks under the Affordable Care Act, particularly in states that have expanded Medicaid under the law.