OSMA's 2016 Advocacy Wins
How the OSMA Changed Health Care in 2016:
New Rules for Prior Authorization
The Prior Authorization Reform Act, one of the most comprehensive patient-advocacy bills in the country, was signed into law by Governor John Kasich. New rules including the development of a web-based system for processing requests, faster timeframes for responses, and prohibition of retroactive denial of a prior-approved treatment or procedure promote efficiency, transparency, and fairness in the prior authorization process in Ohio. Some provisions of the law are effective in January 2017 and others in January 2018.
Prescription Opioid Abuse/Misuse Declines
The opioid epidemic persists in Ohio and nationwide, but some positive trends are emerging in the fight. The rate of overdose deaths from prescription opioids, and the total number of opioids prescribed are both declining. With more prescribers using OARRS to track a patient’s prescription history, the number of patients that are “doctor shopping” has decreased dramatically.
Death rates from heroin and illicit fentanyl continue to climb. In this next phase of the battle, the OSMA will urge the state legislature to increase access to recovery and treatment options for those suffering from addiction.
The OSMA has created two education campaigns. Smart Rx® is an on-demand education program on opioid prescribing guidelines, best practices for treating pain patients, and warning signs of addiction. The BeSmart campaign provides additional resources for Ohio prescribers to educate patients about the dangers of prescription drug abuse.
Physician-led Care Model Preserved
A bill that would have given APRNs complete independent practice authority in Ohio was shut down. The OSMA and AMA worked together to ensure the physician-led, team-based approach to patient care was preserved in the final APRN law that passed, safely modernizing the relationship between physicians and APRNs.
Legislation that would have granted unnecessary and potentially dangerous changes to the scope of practice for CRNAs, a bill seeking to give psychologists authority to prescribe psychotropic drugs, and a proposal that would have allowed physical therapists to “diagnose” a patient’s condition were also unsuccessful in 2016.
By working with a patient’s physician, pharmacists can now administer certain drugs by injection pursuant to a protocol and manage a patient’s drug therapy through a consult agreement.
Unclear & Burdensome Price Transparency Law Halted
Ohio’s new health care price transparency law is vague, making it extremely difficult to ensure physician and hospital compliance. The OSMA, the Ohio Hospital Association (OHA) and other professional associations filed a lawsuit against the state of Ohio and received a favorable ruling, temporarily halting the effective date of this approved law. This coalition will continue the dialogue with lawmakers and other interested parties to create a price transparency law which benefits all.
Regulatory Burdens Addressed
The State Medical Board of Ohio suggested removal of the “one-bite” rule that allows a physician to confidentially seek treatment for substance abuse or impairments one time without reporting to the Board. The OSMA and other medical associations successfully defended the “one-bite” rule.
The Ohio State Board of Pharmacy released new rules for in-office compounding of drugs by physicians. After hearing concerns of many affected physician members who saw these rules as burdensome and unnecessary, the OSMA responded to the board’s actions. As a result, the dangerous drugs compounding rule has been retracted and redrafted.
The Medical Board of Ohio sent letters to 12,000 physicians implying that these doctors violated the Ohio law on opioid prescribing guidelines. The OSMA questioned the Board about how roughly 1/3 of all licensed Ohio physicians could be in violation of these laws. The Board later acknowledged that the letter’s intent, to enforce greater compliance with OARRS, may have been misinterpreted.
Tort Reform Set for 2017
The Medical Malpractice Litigation Improvements Act aims to improve the medical liability climate in Ohio. In all, there are 10 specific reforms designed to improve the litigation environment. There were two hearings on the bill in 2016 which helped lay the ground work on this initiative.
More Recap on Legislative Issues of 2016:
HB 523 – This bill legalized medical marijuana in Ohio and while the OSMA was unable to be fully supportive of this legislation because of both the conclusions it drew about the medicinal benefits of marijuana absent conclusive clinical research and the lack of FDA approval it proposed, the OSMA was still involved in the process of the bill’s drafting and revisions. The physician perspective the OSMA provided was largely a part of establishing a responsible regulatory process for a medical marijuana program in our state.
HB 116 – This new law will allow pharmacists to “sync” multiple prescriptions so they can be filled on the same day of the month. The OSMA was supportive of this legislation, believing it would serve to eliminate a burden from patients prescribed multiple prescriptions and increase medication adherence.
HB 505 – This new law will give Ohio pharmacists the ability to dispense safe and potentially less expensive biologic medications to patients, by substituting an FDA approved interchangeable biologic for a prescribed biologic product. The OSMA closely followed this law, ensuring that the proper safeguards would be in place to promote patient safety with any biologic substitution.
SB 332 – This law takes a comprehensive approach to addressing Ohio’s infant mortality rates. The OSMA was supportive of this law, except for one provision which would have mandated cultural competency continuing medical education for physicians, setting a dangerous precedent. The OSMA was able to fight for the removal of this provision with success.
HCR 16 – This resolution asked CMS to revise survey measures included in the Hospital Consumer Assessment of Healthcare Providers and Systems that relate to patient pain management. The OSMA was supportive of this measure as the survey measures may need to be reexamined to ensure that providers do not feel pressured to prescribe opioids to patients for pain regardless of clinical judgment, fearing low patient satisfaction scores.
HB 110 – Called the “Good Samaritan Law”, this law establishes criminal liability protections for individuals that call 911 for medical help for a person experiencing an overdose. The OSMA believes that this law will help save more lives, as individuals may feel more inclined to call for help, not fearing personal repercussions if they do so.
HB 290 – This new law will allow a physician to treat a terminally ill patient with a drug that is not approved by the United States Food and Drug Administration and permit a drug manufacturer to provide such a drug to the patient or physician. The OSMA believed this law represented an opportunity to give providers and terminally-ill patients an important exercise in medical control, and another chance extending or saving a patient’s life, especially when other treatment options have been exhausted or proved ineffective.
HB 443/SB 243 – This legislation would create new requirements for the implementation of step therapy protocols by health plan issuers, utilization review organizations and the Medicaid program, in order to make the process work better for patients. The OSMA will continue to work on this issue in 2017, as this legislation represents a step forward in ensuring that step therapy works for patients more efficiently, and that patients in circumstances in which is it advisable are able to receive an exemption from the step therapy protocols required by health plan issuers.