News

A Letter to Ohio Radiologists: Past and Present

johnolsen@columbus.rr.com

Dear Colleagues,

I am writing to make an appeal for and justification of organized radiology and organized medicine with the hope of encouraging your participation, even if that means as little as only paying dues and giving financial support. As institutions change and more radiologists become salaried employees, there is a tendency to think “the institution will look after me”, or “I can’t do very much relative to my situation anyway”. I assure you that both of these ideas are far from the truth.

Your status in the medical community and position in the new payment system depends mostly on how well each of you is perceived as creating value and how well organized radiology both is and is perceived as creating value within the universe of medicine. Long term these are probably more important than your groups negotiating ability. Most of us do the right things to be valued consultants and helpmates to our patients and clinical colleagues. Embracing the American College of Radiology (ACR) imaging 3.0 concepts can keep us on the right course for the future. Employing data organized with ACR guidelines can aid in illustrating our value in the Health System. The ACR has favorably shaped the economic environment of radiology practice to the benefit of all radiologists for over 60 years. A weakened ACR will reduce the ability of our radiology profession to preserve a favorable position in the payment system. Those of us who are employed should remind our employers that they also have a stake in supporting the ACR as the long- term impact of a weak ACR is a reduction in our employers ability to generate revenue from our work.   Aside from profoundly impacting our socioeconomic world, the ACR also offers excellent training programs in leadership, management, business, human resources and other related topics, all designed for the busy radiologist.   I urge you to join the ACR and to contribute generously to the ACR Political Action Committee (RADPAC).

The egregious multiple procedure payment reduction, as an example, was not recently made less egregious because it was unfair but through intense lobbying of Congress. The budget resolution requiring computer order entry with decision support rather than radiology benefit managers, was constructive for our specialty, as was the successful pushback against the Veterans Administration proposal for Advanced Practice Nurses to read CT and MR exams at the VA, but these outcomes do not happen by accident.

Here in Ohio, the Department of Health was about to adapt a policy promulgated by the Pharmacy Board that all radiology contrast would have to be injected by physicians and not by technologists. Statewide this would have been disruptive to radiology practice and it came down to the wire that the Ohio Radiological Society (ORS) was able to induce the Pharmacy Board to withdraw this proposal which was already agreed to by the Health Department over our objection. When you join ACR you also join ORS.

All government organs basically want to help, but any policy change or action has winners and losers, and it takes vigilance and money not to come out on the short end. Every one of us should contribute both to RADPAC and to the Ohio Radiology Society Political Action Committee (ORSPAC). Online ORSPAC contributions are now possible.

The Pharmacy Board success described above was achieved by our attorney Victor Goodman who has been essential for much of our success. Victor and his colleague Rachel have relationships with most of the Ohio Government such that much of what might affect Radiology is communicated to them well before getting to the formal proposal stage. Their service has been invaluable through the years, but it is not free, and were it not for our historical relationship such effective help might be beyond our means. Victor and Rachel are paid out of the ORS legal budget. Rachel manages ORSPAC but ORSPAC expenses are also in the legal budget. All contributions to ORSPAC go to supporting the election of Ohio legislators, judges and candidates favorable to radiology.

As the ACR is our political and socioeconomic organization, the Radiological Society of North America (RSNA) is our scientific organization. Both RSNA and ACR are among the most effective organizations in organized medicine, and we are truly blessed to have them and the great leaders who created and continue to recreate them. I wish all radiologists belonged to both. I want to make an appeal for the Research and Education Fund of the RSNA. Before creating this fund, Radiology was at a serious disadvantage. The public could identify with Heart Disease, Cancer, Arthritis, etc., so the respective organizations had an easier path for fundraising, but no one suffers from or dies of Radiology. Radiology was several generations behind most of medicine in terms of raising money to fund research. The Research and Education Fund has been an amazing success but needs continuous ongoing support. Grants from the fund have been multiplied forty- fold by grantees obtaining additional funding from other sources such as the NIH.  Always remember that today’s research leads to tomorrows bread and butter.

Please support yourself and Radiology by joining ACR which includes ORS and supporting RADPAC (National) and ORSPAC (Ohio) and joining the RSNA and supporting The Research and Education Fund. If you follow your money with active participation, so much the better.

Your support for all or any of the above would be of great benefit to yourself and your profession but this is only part of the story.   There are broader issues requiring attention. The Ohio State Medical Association (OSMA) has been essential to the well-being of all Ohio citizens and physicians.   This includes for example dealing with unfair practices of medical insurance companies, guiding state legislation, and medical malpractice and tort reform.   The favorable malpractice climate in Ohio is the direct result of intense work by OSMA members and staff even including electing Ohio Supreme Court justices who interpret the law rather than legislate law from the bench. Losing several favorable justices on the Ohio Supreme Court could undo more than 15 years of successful effort and renew the malpractice crisis.

Let me describe an episode mostly known only to those who deal with medical billing where only OSMA was able to fix a serious problem. Since the start of Medicare, Ohio Medicine had constructive relationships with Nationwide and then with Palmetto as our Medicare insurance carriers.   When CGS became our carrier , they brought incredibly backward business practices that compromised physician payments and they were callously unresponsive to physicians and their representatives. In addition, the Medical Director seemed to have a particular animus towards Radiology. OSMA enlisted our senators Sherrod Brown and Rob Portman to arrange a meeting with Kathleen Sibelius the then Secretary of Health and therefore head of CMS (Centers for Medicare and Medicaid services) to discuss the Ohio situation.   CGS was ordered to correct all deficiencies or lose the Medicare contract.   CGS Immediately modernized their business practices, and they also replaced the Medical Director who was antagonistic to Radiology. The new Directors are excellent leaders, supportive of physicians and working hard to make the system work well for all three constituents, patients, physicians and the federal government.   Radiology could not resolve this issue, only OSMA representing all Ohio physicians could succeed.

An anecdote… The Ohio Radiological Society and the radiologists of Kentucky (the other CGS state) worked together on our particular CGS problem to share costs, demonstrate solidarity, and avoid duplication of effort.   During the joint OSMA/ CMS discussions, CGS claimed that all the problems were unique to Ohio. OSMA soundly refuted CGS based on the ORS work with Kentucky…. and this ended the last shred of CGS credibility.

OSMA performs valuable service to the medical community but as more physicians become salaried (over 50% as of three years ago) the membership of OSMA is declining.   OSMA is just as important for salaried physicians but the value is not yet as well recognized. Also declining are contributions to the OSMA political action committee (OSMAPAC). Last year the Nursing Association PAC raised 40% more money than the physicians which is not a good situation as nursing continues to lobby the legislature to allow more encroachment on the practice of medicine.   The Ohio Trial Lawyers Association PAC which works to undo our favorable Ohio malpractice situation has 60% more money than OSMAPAC.

Four years ago, in a major policy change implemented in hope of increasing physician participation, it was no longer required that OSMA members join the local county medical society or that local members join the OSMA. So far this has not increased physician participation, perhaps it has slowed the decline, and the local societies still supply the delegates that form the grass roots of OSMA governance. Generally, the local societies also perform valuable services to the community such as Free Clinics, attempt to adjudicate local issues and are a great way to meet and bond with other physicians and serve your community.

Please remember your contributions to ORSPAC, RADPAC and the Research and Education fund of the RSNA and join the respective organizations if not already a member.   Also please give thought to joining and supporting a non-radiology organization.

A review of Ohio Radiological Society achievements would include:

Successfully lobbied Ohio Medicaid and most insurers to pay for Breast Tomosynthysis and have sponsored legislation to mandate coverage.

When Ohio Medicaid was revised by Governor Kasich we negotiated favorable terms for radiology that avoided most of the cuts experienced by other providers.

In the recent Breast Density Legislation, we Influenced the bill language and composed the wording of the patient notification letters even though we opposed the legislation as an intrusion on medical practice. We made the bill as innocuous as possible and excluded it from being the basis of any malpractice action.

Successfully supporting and maintaining the Ohio Department of Health’s education and training standards for all applications of therapeutic radiation. (Same as the Nuclear Regulatory Commission standard.)   Dermatology was asking for a dispensation from the rules so they could use their own in office equipment to employ therapeutic amounts of ionizing radiation to treat patients with skin cancer without obtaining the requisite training, and had garnered some political support to allow this.

Radiology Assistant Legislation defining practice guidelines and disallowing independent practice. This in response to a legislative proposal to recognize Radiology Assistants as independent practitioners.

Telemedicine Legislation requiring an Ohio Medical License for out of state practitioners providing services to patients located in Ohio.   (Several legislators consistently referred to this bill which affects all Ohio Medicine as the “Radiology Bill”)

Legislation requiring that hospitals billing globally for screening mammograms must actually pay the agreed payment to the radiologist. Bill also separately required additional payment for digital mammography and CAD.

Regular interaction with State Agencies, OSMA and Medicare and “ad hoc” with legislators and other organizations.

Legislation allowing patient self- referral for Screening Mammograms at a time when Ohio law required physician referral for all ionizing radiation. This included Ohio adopting the ACR’s MQSA standards well before they were a Federal requirement.

Legislation creating training standards and requiring the licensing of Radiology and Nuclear Medicine technologists and assisting the Ohio Department of Health in writing and maintaining the resultant rules.

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Rachel WinderA Letter to Ohio Radiologists: Past and Present

New Ohio Elected Officials Get to Work

Ohio has six new statewide officeholders this year including Governor Mike DeWine; Lt. Governor Jon Husted; Attorney General Dave Yost; Secretary of State Frank LaRose; Auditor of State Keith Faber; and Treasurer of State Robert Sprague.

The Ohio House of Representatives has elected a new Speaker and there are more than 30 new freshman members of the House.

Larry Householder (R-Glenford) who previously served as Speaker from 2001-2004, won the support of the majority of the House of Representatives over former Speaker Ryan Smith (R-Bidwell).  The House Democrats were instrumental in helping Speaker Householder win and his supporters in both the Republican and Democrat caucuses have received coveted roles on House committees.

The House Health Committee will be chaired by Representative Derrick Merrin (R-Monclova Township).  One physician, Beth Liston (D-Dublin), sits on that committee.  In the Senate, the Health, Human Services and Medicaid Committee will be chaired by Senator Dave Burke (R-Marysville).  They also have one physician, Senator Steve Huffman (R-Tipp City), that is a member of the Senate committee.

Ohio Senate President Larry Obhof (R-Medina) continues to lead in the Ohio Senate. He has laid out his Senate priorities this week. Expect to see activity relating to Reducing Agency Regulation; Lake Erie Protection; Criminal Sentencing Reform; School Construction; Human Trafficking; Opioids; Military Families; and Opportunity Zone legislation to generate economic development.

Governor DeWine will release his budget priorities by March 15th and the focus of the Ohio Legislature will be passing the two-year Ohio budget by July 1, 2019. The bill will contain funding for Ohio government entities and programs, but will also include policy that could impact our membership relating to Medicaid, insurance mandates, pharmacy benefit managers, price transparency, the opioid epidemic and other important issues. We will monitor and report on issues of importance throughout the budget process.

Governor DeWine has appointed every member of his cabinet except the Department of Health. We anxiously await his choice and will report on it as it is announced.  The Department of Health houses the Radiation Advisory Council (RAC) which oversees important work impacting radiology in the state.  Dr. John Olsen represents the Ohio State Radiological Society as a member of the RAC.

More to come.  Check back often for updates.

 

*[Reminder: Please consider a donation to the ORSPAC in the $25 – $250 range.  The ORSPAC needs your support today to help ensure a bright tomorrow for Ohio’s professional radiology community.  Just click the secure link below.]

https://www.osrs.org/donate/

*The ORSPAC cannot accept corporate contributions.  All contributions are voluntary.

Thank you for investing in the future of our profession. We are stronger together.

 

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Rachel WinderNew Ohio Elected Officials Get to Work

Radiologists Vote!

Dear Fellow Ohio State Radiological Society Member:

2018 Midterm Elections

We are within a week of the 2018 Midterm Election. In January, we will have a completely new administration with a new Governor and expected staffing shifts in every cabinet agency.  Every statewide office will have a new leader and the state legislature will have many new members and a likely shift in majority caucus and minority caucus numbers.  There are two important Ohio Supreme Court seats up for grabs. All 16 Congressional Districts have elections and U.S. Senator Sherrod Brown is being challenged by former Congressman Jim Renacci.  You’ve probably seen the ads and if you’re like me, you’re looking forward to them stopping the day AFTER the election, November 7th.

But first, you need to get to the polls!  You can vote early at your local Board of Elections or vote on election day — next Tuesday, November 6th.

Supreme Court Races

Moreover, the Supreme Courts candidates endorsed by the Ohio State Medical Association are Justice Mary DeGenaro and Judge Craig Baldwin.  Often overlooked, these elected positions are vitally important to physicians and to maintaining consistent medical liability laws in Ohio.  Mary DeGenaro and Craig Baldwin do not believe in “legislating from the bench” and will protect us from having unexpected shifts in the liability environment.

Of course, the Ohio Radiological Society Political Action Committee (ORSPAC) was able to support these candidates, but only with modest contributions.  We need to be doing more for Radiology.   Please consider joining the PAC and help our profession get stronger in Ohio.

At the Statehouse

Here’s are a few things happening in Columbus right now:

  • Medicaid created a portal for providers to share complaints about Managed Care Organizations.  Initial feedback is that it’s working.  If you have experience with it, please let us know what you think.  We are told the process takes 3 minutes, so do not hesitate to try it if you’re running into problems.
  • After the election, there will be a busy lame duck session (November-December).  We are watching many, many scope of practice bills regarding medical providers that would like to expand their independence and prescription authority.  CRNAs, Psychologists, Pharmacists, Physical Therapists, APRNs and others are seeking changes in scope of practice laws and consistently point out a shortage of physicians in rural Ohio as a main argument.
  • Regulatory Reform is on the horizon.  The Ohio Senate President has indicated that sweeping reforms are a priority for him in this lame duck session.
  • The Ohio Department of Health has released new draft rules that would create unnecessary regulations for Ohio Radiologists.  Many providers and even some policymakers acknowledge that there is no data to support a number of these burdensome regulatory changes.  There is a state law requiring that Ohio maintain standards no less stringent than the “suggested state regulations for control of radiation” by the Conference of Radiation Control Program Directors.  Your OSRS is pushing back and fighting for the Department to find a solution that makes sense for you or seek a change in Ohio law.

Join the PAC

Again, take a minute and join the PAC.  If you donate a minimum of $200 a year, you’ll be a member of the President’s Club and have access to special events, but any amount is needed and appreciated.  Check it out and see how easy we’ve made it to give. (*corporate contributions are prohibited)

Thank you in advance for your much needed support.

NOVEMBER 6, 2018 IS ELECTION DAY!!

Don’t Forget to Vote.

Sincerely,

Eric C. Bourekas MD, MBA, FACR

President, Ohio State Radiological Society

 

OSRS Executive Committee Members

Eric Bourekas, MD, MBA, FACR – President

Mark Sands, MD, FACR – Secretary

Yogesh Patel, MD, FACR – Treasurer

Tom Nogueira, MD, Past-President

 

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Rachel WinderRadiologists Vote!

OSRS at the Ohio Statehouse

The Spring Session is winding down at the Ohio Statehouse.  We have a new Speaker of the House and just 2 Session days left before they break for the Summer.  Oftentimes, the legislature will be back once or twice in the Fall before the election and then in full swing during Lame Duck after the election.

A few items to highlight:

Cultural Competency:  SB 16 with would require health care professionals to complete instruction in cultural competency received a hearing this week.  Many witnesses testifying in support of the bill said that the business case for culturally and linguistically appropriate services help health care organizations’ bottom line and improve health outcomes.  They also stated that improved communication helps avoid malpractice suits and improves patient compliance with health care professionals’ recommendations.  The bill has had two hearings in Senate Health, Human Services and Medicaid Committee.

Physical Therapy Diagnosis:  HB 131 originally would have allowed Physical Therapists to make a medical diagnosis and order imaging.  The current version that passed the House and received its second hearing in the Senate Health, Human Services and Medicaid Committee last week would simply allow a Physical Therapists to make a “therapy” diagnosis which is defined to specifically exclude a “medical” diagnosis.

Physician Assistants:  SB 259 proposes to streamline the process for becoming a PA in Ohio.  Changes include increasing the ratio of PAs supervised by a physician from 3 to 5;  allows supervision agreements to remain onsite rather than filing them with the OSMB; and reduces the requirements for PAs if the PA practiced at least 1000 hours in the military or with a public health service among other changes.  After a few changes to the bill, he OSMA has taken a position of neutral.

  • Separately, we are aware there are efforts by radiologist assistants at the Federal level to recognize RAs as non-physician providers under Medicare.  If successful, that would likely expand efforts by Radiology Assistants to reduce supervision requirements here in Ohio.

Telemedicine:  HB 546 would prohibit health benefit plans from treating telemedicine services differently from in-person health care services.  The provision was part of the Budget Bill last year in the House, but was removed in the Senate.  It received its third hearing in House Health Committee.

Right to Shop:  HB 399 would allow a patient to choose wherever he or she would like to go for a medical procedure and not be required to choose the least expensive option.  The patient can choose to apply any shared savings incentive to their out-of-pocket costs.  HB 399 is a proposed compromise to the Health Care Transparency legislation that was blocked by a lawsuit.  HB 399 received its first hearing last week.

Please contact Victor Goodman (nvgoodman@beneschlaw.com) or Rachel Winder (rwinder@beneschlaw.com) if you would like additional information.

Support your profession and donate today:  https://www.osrs.org/donate/

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Rachel WinderOSRS at the Ohio Statehouse

Ohio House Members Vote to Elect Ryan Smith (R-Bidwell) as Speaker of the House

As you may have heard by now, Ohio elected Rep. Ryan Smith, the Chair of the Ohio House Finance Committee, as Speaker of the Ohio House in dramatic fashion yesterday.  The post was vacant after Speaker Cliff Rosenberger resigned amid an FBI investigation.

The rules require that the majority of the members present vote to elect the Speaker.  Rep. Smith would have needed 46 votes because of the absence of some members on the House Floor.  He was able to secure 44 votes.  There was a small faction of Republicans that support Larry Householder (R-Glenford) for Speaker in 2019 who voted for other candidates; and almost the entire minority caucus voted for their minority leader, Fred Strahorn (D-Dayton).  Four of the members absent, if present, were Smith supporters and would have provided the votes necessary for him to reach support of the majority of the members present.

Because Rep. Smith could not gain the support of the majority of the members present, a law exists in the Ohio Revised Code that allows a speaker to be elected by a plurality of votes, but only after ten votes are taken.

So…. 2 ½  hours later, after an individual voice vote for all 91 members present voted TEN times each, on the eleventh vote, Speaker Smith was formally elected and sworn in as Ohio’s newest Speaker of the Ohio House.

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Ohio Revised Code

101.21 Majority required to tenth voting.

A majority of the votes given at an election for an officer of either house shall be necessary to elect. If a choice is not made on or before the tenth voting, the person thereafter receiving the highest number of votes shall be declared elected.

 

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Rachel WinderOhio House Members Vote to Elect Ryan Smith (R-Bidwell) as Speaker of the House

Check-in: What’s Happening at the Ohio Statehouse?

It’s campaign season in Ohio!  You’ve likely noticed when you turn on your local television station or open up your Facebook page or Twitter feed or even your newspaper for those of us that still read them.  The current Governor, John Kasich, is term-limited and the race is on to see who will succeed him.  The primary election is scheduled for May 8, 2018.  The Republican field consists of the current Attorney General Mike DeWine and the current Lt. Governor Mary Taylor.  The Democrat hopefuls include Richard Cordray, most recently the director for the Federal Consumer Financial Protection Bureau, former Cleveland Mayor and Congressman Dennis Kucinich, State Senator Joe Schiavoni, and former Ohio Supreme Court Justice William O’Neill.

The Speaker of the House, Cliff Rosenberger, resigned abruptly this month announcing he was being investigated by the FBI for possible campaign finance violations.  There are at least two representatives that would like to succeed him and are waging aggressive campaigns in Columbus and in House district seats throughout Ohio.  Every other statewide seat is open this year along with two seats on the Ohio Supreme Court.  2018 is sure to be an interesting election year.

Meanwhile at the Statehouse, although they are taking a break before the primary election, discussions continue on issues affecting the practice of medicine.  Here is a brief summary of a few of the bills.  Click on the links to learn more:

HB72 STEP THERAPY PROTOCOLS (JOHNSON T, ANTONIO N) To adopt requirements related to step therapy protocols implemented by health plan issuers and the Department of Medicaid.
Current Status:    4/11/2018 – House Health , (Fifth Hearing)
State Bill Page:     https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA132-HB-72

HB131 PHYSICAL THERAPY LAWS (GAVARONE T, REINEKE W) To modify the laws governing the practice of physical therapy.  The original version of the bill allowed Physical Therapists to order imaging, but that language has since been removed.
Current Status:     4/11/2018 – PASSED BY HOUSE; Vote 95-0
State Bill Page:      https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA132-HB-131

HB145 IMPAIRED MEDICAL PRACTITIONERS (HUFFMAN S, SPRAGUE R) To provide for the establishment of a confidential program for the treatment of certain impaired practitioners and to declare an emergency.
Current Status:      2/8/2018 – SIGNED BY GOVERNOR; eff. immediately
State Bill Page:       https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA132-HB-145

HB273  PHYSICIAN CERTIFICATION (GAVARONE T) To prohibit a physician from being required to secure a maintenance of certification as a condition of obtaining licensure, reimbursement, or employment or obtaining admitting privileges or surgical privileges at a hospital or health care facility.
Current Status:      10/25/2017 – House Health , (Third Hearing)
State Bill Page:       https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA132-HB-273

HB317  PRO BONO HEALTHCARE DEDUCTION (YOUNG R) To authorize, for six years, a personal income tax deduction for a physician based on the number of hours the physician provides uncompensated medical services through a hospital, free clinic, or nongovernmental medical organization.
Current Status:    3/20/2018 – SUBSTITUTE BILL ACCEPTED, House Ways and Means, (Third Hearing)
State Bill Page:    https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA132-HB-317

HB416  HEALTH PRICE TRANSPARENCY (HUFFMAN S) Regarding the provision of cost estimates for scheduled health care services and health care services requiring insurer preauthorization.
Current Status:      3/7/2018 – House Insurance, (Third Hearing)
State Bill Page:       https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA132-HB-416

HB536  HEALTH INSURANCE-EMERGENCY COVERAGE (REECE A) To prohibit health plan issuers, including those participating in the Medicaid care management system, from implementing any form of selective emergency services coverage.
Current Status:   3/21/2018 – House Insurance, (First Hearing)
State Bill Page:    https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA132-HB-536

HB546  TELEMEDICINE-HEALTH BENEFIT PLANS (PATTON T) To prohibit health benefit plans from treating telemedicine services differently from in-person health care services solely because they are provided as telemedicine services.
Current Status:   4/11/2018 – House Health , (First Hearing)
State Bill Page:    https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA132-HB-546

SB16   HEALTH CARE CULTURE COMPETENCY (TAVARES C) To require certain health care professionals to complete instruction in cultural competency.
Current Status:   3/7/2017 – Senate Health, Human Services and Medicaid, (First Hearing)
State Bill Page:    https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA132-SB-16

There are also ongoing discussions about finding pathways to use protocol for contrast and physician reimbursement for surprise out of network non-coverage among other important issues.

There is a lot more to do, but we need resources — especially during election year!   Please consider a donation to the ORSPAC in the $25 – $250 range.  The ORSPAC needs your support today, to help ensure a bright tomorrow for Ohio’s professional radiology community.

It takes only a minute.  Please click the secure link below.

 

https://www.osrs.org/donate/

*The ORSPAC cannot accept corporate contributions and all contributions are voluntary.

Thank you for investing in the future of our profession.

If you have any questions on this information or any other issues, feel free to reach out to one of your advocates, Victor Goodman at nvgoodman@beneschlaw.com or Rachel Winder at rwinder@beneschlaw.com.

 

 

 

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Rachel WinderCheck-in: What’s Happening at the Ohio Statehouse?

New Ohio Bill Seeks Medical Price Transparency

Gongwer News

November 14, 2017

Ohioans who need certain medical procedures would be able to get detailed cost estimates before undergoing the processes under legislation detailed by a House Republican on Tuesday.

Rep. Steve Huffman (R-Tipp City) said the bill would impact procedures that require prior authorization, helping consumers shop for providers and facilities that might have lower rates.

The bill would succeed a related two-year-old law that has never been implemented due to an ongoing court challenge, he said.  That provision was included in a BWC budget bill (HB52, 131st General Assembly), and was challenged in court by a coalition of medical organizations.

Mr. Huffman, who chairs the House Health Committee, said patients, hospitals and physicians want transparency in the system, and the bill would help achieve that goal.

The cost estimates would require providers to offer a good-faith estimate of costs, including the expected cost to the patient and information about whether the provider is out of the patient’s insurance network.  Some patients, he added, trust their doctors and hospitals and won’t seek the information.

Regardless, the information would help patients make more informed decisions about their care, the lawmaker said.

Rep. Huffman said he envisions the process being implemented for procedures that don’t require prior authorization in the future.  He added that the bill doesn’t address emergency situations, and other cases when time might be of the essence.

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The bill is supported by the OHA and the OSMA both stating that it provides an appropriate level of expectation and responsibility on both the provider and the insurer.

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Rachel WinderNew Ohio Bill Seeks Medical Price Transparency

Ohio Bill on Tomosynthesis Coverage Receives Statehouse Hearing

Ohio Senate Bill 121, which would include tomosynthesis in the definition of screening mammography for insurance purposes, received its second hearing in the Senate Financial Institutions and Insurance Committee recently.  Below is an article that was included in a statehouse news publication, Gongwer, summarizing the hearing and the support the OSRS received from the medical community.  No additional hearings have been scheduled.  Let Chairman Hottinger know how tomosynthesis impacts your patients and ask for passage of Senate Bill 121.

Hottinger@ohiosenate.gov

Tuesday, October 3, 2017

Witnesses Support Bill Requiring Insurers To cover Mammogram Procedure

Doctors and provider groups urged a Senate panel Tuesday to back a bill that would require insurers to cover a new form of mammogram as a way to assist in the detection of breast cancer.

Victor Goodman, representing the Ohio State Radiological Society, told the Senate Insurance and Financial Institutions Committee that the state has required insurers to cover screening mammography since 1997.  The bill, SB 121, would require insurers to cover tomosynthesis as a part of breast cancer screenings.

He predicted opponents would likely say the bill imposes a new coverage mandate on insurers, but the General Assembly in the past acknowledged that new technology would be developed for mammography.

“This is not a new mandate,” he said.  “It’s something that’s been part of the Ohio Revised Code essentially since 1997.”

Dr. Bang Huynh, a radiologist with Columbus Radiology from Grant Hospital, said the tomosynthesis process, also known as 3D mammography, has improved detection rates.

“The reason cancer detection is so important is the earlier we are able to detect it, the better we are able to treat the patient,” he said.

Senator Bob Hackett (R-London) asked if the 2D mammography is always done first.

“You don’t have the option of deciding after you do the 2D whether to do the tomo or not,” he said.  Any subsequent test would be a diagnostic test, not a screening test covered as preventative care.

Senator Dave Burke (R-Marysville) said the General Assembly would be legislating how a procedure should happen at a physician’s office.

Dr. Huynh said he didn’t think of the bill as mandating what is being done in a doctor’s office.

“I don’t really see how this would force anybody to do anything that’s against their interests,” he said.

Senator Burke asked why an insurer would deny someone a procedure that could be potentially beneficial.

Dr. Huynh said until recently a lot of insurers were not covering tomosynthesis.

“I would ask them, why would not cover something that could be beneficial to patients?” he said.

Camille Grubbs, with Hologic, a manufacturer of breast tomosynthesis technology, said the technology is no longer considered experimental or investigational.

Judy Brandell, a nurse navigator at Mercy Health Fairfield Hospital, said in written testimony that insurance coverage of tomosynthesis and 3D mammography can be confusing for patients.

“Women are often confused and intimidated by their insurance coverage and the changes from year to year,” she wrote.  “So if the technologists and nurses don’t know for sure if they are covered, they end up declining due to potential additional and unknown costs.  From my perspective, it’s especially frustrating that the younger age range, who more frequently have dense and sometimes extremely dense breast tissue, will decline due to the inconsistency of coverage.”

The Ohio State Medical Association, Ohio Society of Radiologic Technologists, Ohio State University Medical Center and OhioHealth offered written testimony in support of the bill.

 

 

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Rachel WinderOhio Bill on Tomosynthesis Coverage Receives Statehouse Hearing

Ohio SB 121 to Include Tomosynthesis as Screening Mammography

Great news!! Legislation that was initiated by the Ohio State Radiological Society was introduced in Ohio today by Senator John Eklund (R-Munson Twp) to include “Tomosynthesis” as part of the required screening mammography benefits under health insurance policies.  Senate Bill 121 can be viewed at this link under “current version”.  https://www.legislature.ohio.gov/legislation/legislation-documents?id=GA132-SB-121

We will keep you posted as the bill is assigned to committee and advocacy opportunities are presented.

 

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Rachel WinderOhio SB 121 to Include Tomosynthesis as Screening Mammography