2017 Advocacy Wrap-Up & 2018 Top Issues Preview! 

OSMA Priorities

The first half of Ohio’s legislative session ended mid-December with a flurry of activity on many OSMA priorities. Below is a recap of the issues we are working on and a preview of what is to come when the legislature kicks back into session in January 2018:

Health Care Price Transparency:
State Rep. Stephen Huffman (R-Tipp City) has introduced HB 416, new legislation that he says will give patients a clearer idea of what their doctor or hospital bill will be before a medical procedure is performed. His proposal is a direct response to a state price transparency law that was set to go into effect in January 2017; however, multiple health care associations, including the Ohio State Medical Association (OSMA), sued the state claiming the new statute has unworkable provisions that could frustrate and harm patients.

Dr. Huffman’s efforts are appreciated and health care groups believe his language is a significant improvement over the current law that was passed without any physician input. Under Huffman’s proposal, when asked by a patient, providers would be required to disclose certain specific information regarding how much their medical services will cost. 
Unlike the current law, which requires doctors and hospitals to proactively provide detailed information for every service, regardless of whether the patient asks for it or not, this is limited to services that are scheduled at least seven days in advance. In addition, if a physician must obtain prior authorization to provide a medical service, the bill would then require the insurer to provide the patient information regarding what the insurer will pay and what is the patient’s responsibility. The physician would only be required to submit the prior authorization request. The insurer would be required to provide any information regarding price to the patient. Previous language would have placed that burden upon the physician and hospital.

Health care groups prefer Huffman’s legislation over provisions in the state law and believe that it is a good starting point for future discussions. In the coming months, work will be done with the sponsor and interested parties to ensure meaningful price transparency for patient benefit without increasing the administrative burden on physician practices. This bill is not expected to be pushed through the legislature quickly and the lawsuit over the state law is still pending. We will continue to follow developments and alert members.

Update – HB 145, “One-Bite” Substance Abuse Treatment Program for Health Care Practitioners: 
Work continues to be done to advance HB 145, which would create a confidential drug treatment program for doctors and other health care providers, as it currently is deliberated in Senate committee hearings. The bill passed out of the Ohio House earlier in the year. We hope to have this bill passed out of the Senate in January 2018. 

Update – HB 273, Maintenance of Certification:
HB 273 would prohibit the medical board from using maintenance of certification (MOC) as a requirement of licensure and prohibit hospitals and insurers from using MOC as a condition of employment, privileges or reimbursement. Physician groups remain divided on this legislation with OSMA and others supporting the legislation, while hospitals and other physician groups oppose. Work will be done in the coming months to calm some of the concerns opponents have with the legislation. To read testimony from the first hearings on the bill, click here, and open the drop-down menus for hearings on the following dates: 9/20, 10/11, and 10/25. Stay tuned as we provide updates as this issue progresses. 

Telemedicine Reimbursement Parity:
Telemedicine reimbursement parity would require health insurers to cover telemedicine services to the same extent that they would cover an in-person service. A provision creating telemedicine parity was in the House version of the 2018-2019 Ohio Budget bill originally, but unfortunately it was removed later in its journey to the Governor’s desk.

Although it was not included in the final version signed into law by Governor John Kasich, we are seizing upon the opportunity to advance standalone legislation this general assembly. By ensuring proper reimbursement to physicians, creating telemedicine reimbursement parity is a valuable opportunity to increase access to critical patient care, particularly for Ohioans in underserved areas.

Independent Practice & Prescriptive Authority – CRNAs:
HB 191 would grant certified registered nurse anesthetists (CRNAs) independent practice authority and prescriptive authority. It has been reintroduced in the Ohio Legislature from the prior General Assembly during which its passage was prevented by a coalition of medical groups. Not only was this pushback driven by serious concerns about patient safety, but under the physician anesthesiologist-led anesthesia care team model, physicians emphasized that there is no patient care need for this change. We will continue to oppose this legislation and stress that physician anesthetists should remain the leaders of the care team.

We continue to work with the Ohio State Board of Pharmacy (OSBOP) to revise the current regulations on physicians who are compounding in-office. The current rules and regulations are overly burdensome and cause patient care delays. 

The pharmacy board announced in December 2017 the creation of the Hazardous Drug Compounding Rules Review Committee. The board created this committee for the purposes of reviewing and recommending rules on the compounding of hazardous drugs in a pharmacy and other compounding related rules as required. We will continue to keep you updated.

Anthem Issues:
As most know, Anthem Blue Cross and Blue Shield announced beginning January 1st they would begin reducing reimbursement for modifier 25 by 50%. Due to extensive advocacy to date, Anthem has delayed the implementation of the policy until March 1, 2018 and in addition, Anthem has also announced reducing the reduction to the e/m when modifier 25 is appended from 50% to 25%. We will continue to put pressure on Anthem to see if additional changes can be made. More to come on this issue.  

There are several other policies that are of concern to patient care, including those related to hospital outpatient imaging and retrospective review of payment for emergency services. The session in late December was the first step in working through alternatives to the original policies. The OSMA will continue to work with the appropriate specialty societies to ensure that we advocate directly with Anthem and regulators on behalf of the impacted physicians and patients.

Update – HB 131 – Physical Therapy Scope of Practice:
The OSMA continues to sound off against a piece of legislation that is once again vying to grant physical therapists (PTs) the legal authority to diagnose a patient’s medical conditions as well as order medical tests and imaging. During the last General Assembly, the OSMA worked tirelessly against this legislation to assert that a physical therapist does not have the proper education and training to diagnose medical conditions. HB 131 would allow PTs to order tests and imaging which could be duplicative, unnecessary and costly. Recently, the OSMA responded to amendments made to the bill and continued to assert that breach of scope that remains in this bill is inappropriate.

HB 193 – Flu Vaccines:
The Ohio State Medical Association (OSMA) opposes HB 193, which would prohibit an employer from taking an adverse employment action against a person due to the individual not being vaccinated against influenza. The medical community is highly concerned about this legislation. 

In healt care facilities, flu vaccine rules are common as a safety measure mandated for being allowed to work in the facility and with patients. As it now stands as re-referred in the House Health Committee, the OSMA will continue to push back against this legislation, asserting that elected officials must leave the decision regarding hiring criteria such as this to the employer. 

2017 Election – Issue 2:
For months, the Ohio State Medical Association (OSMA) echoed the warnings of more than 30 organizations representing health care professionals, veterans,’ groups, and business interests as part of a coalition against the ballot initiative Issue 2. 

While the OSMA agrees that lowering prescription drug prices is crucial, the vague language describing Issue 2 almost assured this proposal is was not likely to achieve that stated goal, despite what its supporters claimed. Many raised serious concerns that if passed, it could have negative consequences for Ohioans and some of the state’s most vulnerable patients. 

Issue 2 would have required that the state pay no more for drugs than the price paid by the U.S. Department of Veterans Affairs (the VA). Experts objectively studied and analyzed the proposal and the majority believed that passing Issue 2 would have been misguided, and would in fact only make the problem of high prescription drug costs worse by raising prescription prices for most Ohioans. It contained several vaguely-worded, troubling provisions, and many also reported it could result in a disastrous reduction in access to needed medications for some patients. 

The OSMA joined the Ohioans Against the Deceptive Rx ballot Issue coalition and urged its members and Ohioans to vote “no” on Issue 2 during the 2017 election. 

Ultimately, Ohio voters decided that Issue 2 was not the right solution for lowering drug prices in Ohio, and responded to the ballot initiative with a resounding “NO” vote. The issue of prescription drug prices is not likely to go away, however, as the problem continues to burden millions of Ohio patients. The OSMA will be ready to coordinate in other opportunities and cooperative efforts that may arise in the search for a more viable, efficient, and inclusive solution. 

Prescriptive Authority – Psychologists:
HB 326 would authorize certain psychologists to prescribe psychotropic drugs for the treatment of drug addiction and mental illnesses. An alliance of groups in the medical community raised concerns when the prior version of this bill was introduced in the last General Assembly, stating that psychologists do not possess the proper medical training and education to prescribe drugs to patients. The bill mandates pharmacological training for psychologists interested in prescribing. 

The OSMA, the Ohio Academy of Family Physicians, and the Ohio Psychiatric Physicians Association have stressed that the knowledge and experience of a licensed physician are vastly different than those of a psychologist. The educational requirements of this bill are inadequate. The OSMA will remain firm in our stance against this legislative effort and will continue to advocate for physician-led, team-based patient care. 

Tort Reform:
HB 7, known as the Medical Malpractice Litigation Improvements Act, will continue to be a major priority during the coming year. The bill has had several hearings in the Ohio House. The OSMA hopes to strengthen and fill loopholes in the existing tort reform statute, which has resulted in 10 years of declining and stable medical liability insurance rates in our state. HB 7 includes 10 provisions which bolster current protections with enhancements such as reducing “shotgun lawsuits,” and abrogating the “Loss of Chance” theory. 

Step Therapy:
Legislation to accomplish step therapy reform was supported by the OSMA in the last General Assembly as HB 443 and SB 243. It has been reintroduced in the Ohio Senate and House as HB 72 (sponsors Rep. Terry Johnson, R-McDermott, and Rep. Nickie Antonio, D-Lakewood) and SB 56 (sponsors Sen. Peggy Lehner, R-Kettering, and Sen. Charleta Tavares, D-Columbus). The legislation will adopt specific requirements related to step therapy protocols implemented by health plan issuers and the Department of Medicaid. 

It will require health plan issuers or utilization review organizations that implement a step therapy protocol to establish clinical review criteria in relation to that step therapy protocol that:
Recommends that the prescription drugs be taken in the specific sequence required by the step therapy protocol; and, 
Are developed and endorsed in an explicit and transparent process by an independent, multidisciplinary panel of experts not affiliated with the organization or plan issuer, based on high quality studies, research and medical practice.

It will also:

• Require health plan issuers to provide the patient and prescriber access to a clear and convenient process to request a step therapy exemption when coverage of a drug for the treatment of any medical condition is restricted for use using a step therapy protocol.

• Create requirements for the step therapy exemption process, including making the process easily accessible on the department’s web site, and requiring that supporting rationale and documentation be submitted with each exemption request.

The legislation requires that the health plan issuer or utilization review organization expeditiously grant a step therapy exemption determination request if:

• If the required prescription drug is contraindicated or will likely cause an adverse reaction by or physical or mental harm to the patient based on the medical history of the patient and known characteristics of the drug.

• The required prescription drug is expected to be ineffective based on the known relevant physical or mental characteristics of the patient and the known characteristics of the prescription drug regimen.

• The patient has tried the required prescription drug while under their current or previous health insurance or health benefit plan, or another prescription drug in the same pharmacologic class or with the same mechanism of action and such prescription drug was discontinued due to lack of efficacy or effectiveness, diminished effect, or an adverse event.

• The required prescription drug is not in the best interest of the patient, based on medical appropriateness.

• The patient is stable on a prescription drug selected by their health care provider for the medical condition under consideration.