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2nd Ohio Pharmacy Advocacy Forum

Ohio College of Clinical Pharmacy, Ohio Colleges of Pharmacy
and Council for Ohio Health Care Advocacy
In colla…
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ZIKA VIRUS

ZIKA VIRUS
Zika virus disease (Zika) is a disease caused by Zika virus that is spread to people primarily through …
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Proposed Bill Would Require Payment …

Proposed Bill Would Require Payment Disclosures to Advanced Practice Nurses and Physician Assistants

A proposed bi…
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Interprofessional Legislative Update

HPU-LogoBy Lori Herf, MA

The Ohio General Assembly has dedicated much of the winter and spring months to budget (HB 59) deliberations. With the new state fiscal year beginning on July 1st, 2013, legislative leaders will focus most of their attention not only on the fiscal operations of the state of Ohio, but also on the many policy changes made as amendments to state budget provisions.

APRNs and Physician Assistants

Language was considered that would have allowed advanced practice nurses and physician assistants to admit patients to hospitals. That provision is now being considered independently of the budget as HB 139.

Pharmacists

A number of pharmacy provisions remain part of the budget as well. One of the provisions would require that Medicaid managed care organiza-tions provide 90 days notice to pharmacies being terminated as a network provider and extends the notice to all types of health care providers. In the case of pharmacies, similarly the budget would require that 90 days advance notice be given regarding the removal of a prescribed drug from the formulary or preferred drug list used by the organization or administrator or any change in the terms governing access to the drug. The amendment that we are opposing in the budget which is HB 59 dealt with remote dispensing.

The amendment would have allowed a pharmacy that is licensed as a terminal distributor of dangerous drugs to use a remote drug dispensing system at a nursing home or residential care facility. The pharmacist would not be required to be physically present where the system is used to dispense the drugs. COHCA has strong concerns regarding this provision and asked legislators to remove the language from the budget bill. The Ohio Senate did remove the language from the substitute version of the bill; however the bill will be amended next week and then be considered by a conference committee that could reinsert the language into the final version of the bill.

Other Bills:

House Bill 44

HEALTH EMERGENCIES (McClain)
To require the Director of Health to develop protocols regarding the authority to administer, deliver, distribute, or dispense drugs during certain public health emergencies. This is currently pending in

House Health and Aging Committee where it has received two hearings.

Requires the Director of Health to develop one or more protocols that authorize certain licensed health professionals to administer, deliver, or distribute drugs during a public health emergency; requires the Director to develop protocols as well that authorize pharmacists and pharmacy interns to dispense limited quantities of dangerous drugs without a prescription or record of a prescription during a public health emergency; and provides that an individual who administers, delivers, distributes or dispenses a drug or dangerous drug in accordance with one or more of those protocols is not liable for, nor subject to civil damages, criminal prosecution, or professional disciplinary action, unless the individual’s acts of omissions constitute willful, wanton misconduct.

House Bill 60

MATERNITY UNITS (Huffman)
To require that rules governing maternity units, newborn care nurseries, and maternity homes include certain provisions pertaining to the authority to make decisions regarding the transfer of patients to other facilities and to specify procedures for granting variances or waivers of any requirement in the rules governing operation of such facilities.

Currently pending in House Health and Aging where it has received two hearings.

The bill codifies an administrative rule that authorizes the Director of Health to grant a variance from or waiver of any of the requirements of rules regarding the operation of a maternity unit, newborn care nursery, or maternity home; requires the Director to adopt rules regarding application forms to be used and procedures to be followed in applying for a variance or waiver; requires the Director to review all applications for variances and waivers and, not later than 90 days after receipt of an application, to determine whether to grant the variance or waiver and notify the applicant of the decision.

House Bill 83

PSYCHOLOGY LAWS (Hackett)
To make 14 major changes to the law that gov-erns the practice of psychology. Heard in the House Health and Aging Committee; reported out of committee; passed the House 96-1; currently pending in the Senate Medicaid, Health and Hu-man Services Committee.

House Bill 94

HEALTH PLANS (Gonzales)
To require a health insuring corporation, public employee benefit plan, or sickness and accident insurer to reimburse a board of health for any services provided to an individual by the board that is covered by a plan issued to the individual by the health insuring corporation, public employee benefit plan, or sickness and accident insurer upon request submitted by the Board of Health.

Currently pending in House Insurance Committee; has received two hearings.

House Bill 123

TELEHEALTH SERVICES (Gonzales, Wachtmann)
Regarding Medicaid and health insurance coverage of telehealth services.

Currently pending in House Health and Aging Committee where it has received two hearings.

The bill authorizes health care insurers to provide coverage of telehealth services provided by health care professionals and facilities, requires the Office of Medical Assistance to adopt rules establishing standards for Medicaid reimbursement of telehealth services provided by health care professionals and facilities; specifies that coverage of a telehealth service applies only if the service involves an immediate and direct interaction with a patient, is medically appropriate and necessary, and is provided by a licensed health care provider or facility; and requires that a health care provider seeking reimbursement for telehealth service maintain documentation of providing the service as part of the patient records the provider maintains.

House Bill 131

TANNING REGULATIONS (Johnson, Stinziano)
To regulate chemical tanning and prohibit tanning facilities from allowing the use of sun lamps by certain individuals under 18 years of age.

Currently pending in House Health and Aging Committee where it has received three hearings.

Prohibits an operator or employee of a tanning facility from allowing an individual under age 18 to use the facility’s fluorescent sun lamp tanning services unless the individual presents a prescription issued by a physician; and requires the State Board of Cosmetology to regulate chemical tanning facilities.

House Bill 139

HOSPITAL ADMISSIONS (Gonzales)
To permit certain advanced practice registered nurses and physician assistants to admit patients to hospitals.

Currently pending in House Health and Aging Committee where it has received two hearings.

Current law allows only physicians, dentists and podiatrists who are members of the medical staff to admit patients to hospitals. The bill would add clinical nurse specialists, certified nurse midwives and certified nurse practitioners who have a standard care arrangement with a physician or podiatrist who is a member of the medical staff. The bill would also allow physician’s assistants, under the supervision, control or direction of a physician or podiatrist who is a member of the medical staff, to admit patients to hospitals. The bill also would require the APRN or PA to notify the collaborating or supervising physician or podiatrist not later than 12 hours after admitting a patient to a hospital.

House Bill 147

MASTECTOMY GUIDANCE (Patmon, Wachtmann)
To require a surgeon performing a mastectomy, lymph node dissection, or lumpectomy in a hospital to guide the patient and provide referrals in accordance with the standards of the National Accreditation Program for Breast Centers and to name this act the Lizzie B. Byrd Act.”

Currently pending in the House Health and Aging Committee where it has had two hearings.

The bill, in addition to the above would require the sur-geon performing a mastectomy or lumpectomy to refer a patient if breast reconstruction is appropriate, and requires the surgeon to offer the patient a preoperative referral to a reconstructive or plastic surgeon in accordance with NAPBC standards.

House Bill 159

DENTAL SERVICES (Hacket, Schuring)
To prohibit a health insurer from establishing a fee schedule for dental providers for services that are not covered by any contract or participating provider agreement between the health insurer and the dental provider.

Currently the bill is pending in the House Insurance Committee where it has had one hearing.

Prohibits a contracting entity from requiring a dental provider to provide services to plan enrollees at a fee set by or subject to approval by the contracting entity unless certain circumstances are met; makes setting or requiring the insurer’s approval of fees for dental services an unfair and deceptive act in the business of insurance unless certain circumstances are met; and makes the offering of a health benefit plan that sets fees for dental services an unfair and deceptive act in the business of insurance unless certain circumstances apply.

House Bill 165

HYPERBARIC TECHNOLOGISTS (Roegner)
Exempts certified hyperbaric technologists from the laws governing the practice of respiratory care.

Currently pending in the House Health and Aging Committee. Has not been heard.

House Bill 170

DRUG OVERDOSES (Johnson, Stinziano)
To provide that a licensed health professional authorized to prescribe naloxone, if acting with reasonable care, may prescribe, administer, dispense or furnish naloxone to a person who is, or a person who is in a position to assist a person who is, apparently experiencing or who is likely to experience an opioid-related overdose without being subject to administrative action or criminal prosecution, to provide that a person who is in a position to assist a person who is apparently experiencing or who is likely to experience an opiod-related overdose is not subject to actions of professional licensing boards, administrative action, or criminal prosecution for a drug offense or practicing medicine without a license if the person acting in good faith, obtains naloxone prescription from a licensed health professional and administers it to a person for an opioid-related overdose, and to provide that peace officers and licensed emergency responders who are acting in good faith are not subject to administrative action or criminal prosecution for a drug offense or practicing medicine without a license for administering naloxone to a person who is apparently experiencing an opioid-related overdose.

Currently pending in the House Health and Aging Committee. It has not yet been heard by the committee.

Senate Bill 4

NEWBORN SCREENINGS (Manning, Oelslager)
To require a pulse oximetry screening for each newborn born in a hospital or freestanding birthing center.

Received two hearings in Senate Medicaid, Health and Human Services Committee, reported out of Committee; passed the Senate 33-0; referred to House Health and Aging Committee where it has received 5 hearings.

Requires hospitals and freestanding birthing centers to conduct a pulse oximetry screening on each newborn (unless a parent objects on religious grounds) for purposes of detecting critical congenital health defects; requires the Director of Health to adopt rules establishing standards and procedures for the pulse oximetry screenings.

Senate Bill 43

CIVIL COMMITMENT (Burke)
Makes a number of changes to the laws governing the civil commitment of and treatment provided to mentally ill persons.

Currently pending in Senate Criminal Justice Committee. It has received one hearing.

Senate Bill 99

CANCER MEDICATIONS (Oelslager, Tavares)
Regarding insurance coverage for rarely administered cancer medications.

Pending in Senate Insurance and Financial Institutions Committee where it has not received a hearing.

Neurosurgery Physician Assistant at Akron Children’s

Combines the Best of Care and Cure

Holly Zeller, PA-C sits down with Julie Tsirambidis, CNP to go over privilege delineation forms at Akron Children’s Hospital.  This is one of their many overlapping moments where NP and PA practice comes together.  Becoming more frequent is this visibility- that NPs and PAs sit side by side with their physician counterparts to enhance patient care.  After years of working in silos, these disciplines agree the time to work together is long overdue.  Hence, the Center for Advanced Practice at Akron Children’s Hospital was formed in April 2011.  The goals are vast, but include the practice and regulatory oversight of APNs and PAs, on boarding programs, and integration with medical staff leadership to name but a few.

Zeller, who is a board certified physician assistant, works in partnership with Dr. Roger Hudgins, director of the Division of Neurosurgery at Children’s Hospital.  When she is not examining patients during office hours, Holly assists Hudgins in the operating room and shares on-call duties with him for after-hours emergencies.  Additionally, on a daily basis, Zeller rounds on all inpatients, formulates plans of care, interprets imaging, triages new patient referrals, and completes various types of different procedures in the NICU, PICU, patient floors and ER.  At the end of each day, all “Mommy Call” questions which have accumulated throughout the day are addressed by calling the parent of the patient back to address their questions. “Every day is a little bit different,” she says.  Zeller, 44, of Richfield,Ohio, is one of now 18 physician assistants (PAs) who work all across Akron Children’s Hospital.  There are over 150 advanced practice providers at Akron Children’s with a director leading the way.  The center actually oversees and brings together Advanced Practice Nurses (CRNA, CNP, and CNS) and Physician Assistants under one umbrella.  The director, Julie Tsirambidis, CNP, truly believes this is the way of the future.  “We have more in common that we have separate.  Coming together to promote our professional needs, despite our regulatory difference truly sets us apart, and brings improved understanding to our patients, families, and hospital staff.”  “Many years ago, MDs and DOs, would not even work together in the same hospital, and see how far they have come- this journey is a similar beginning, in my opinion.” Tsirambidis said.

As part of their master’s degree program, PAs can elect a surgical track that prepares them to work in the operating room.   After college, Zeller worked in the pharmaceutical field before taking a break to stay home with her children.  When she decided to return to work, she wanted a job in the medical field but didn’t want to travel anymore.  She embarked upon graduate school education and completed the PA program.  The PA education is very similar to that of the medical school model.

Zeller initially practiced with the congenital heart surgical team at Rainbow Babies and Children’s Hospital inClevelandbefore joining Akron.  When Dr. Hudgins joined Children’s two years ago, he requested a PA for his team.  He has especially relied on Zeller to share the patient load since the death this summer of the hospital’s only other neurosurgeon, Dr. Henry Bartkowski.  When Dr. Bartkowski became ill, Dr. Hudgins and Zeller formulated a plan to continue the quality care provided to the neurosurgery patients, by trying to split the evening and weekend call, thus allowing the other some “off time.” The two divide and conquer on office days, with each visiting patients and talking with families.  They frequently huddle to compare notes and examine patients’ images and other test results.  Zeller will assist in the OR on surgery days, and often performs the closing procedures.  This teamwork allows Hudgins to dictate this post-operative notes and get ready for the next patient while Zeller finishes the procedures.  “It really becomes a seamless way for getting a lot more work done than you could by yourself, plus the families love her,” Hudgins said

For information, or to join our neurosurgery team, check us out at

https://www.akronchildrens.org/cms/careers/index.html

COHCA On Facebook

Doctors Cannot Yet Recommend Pot, Medical Board Says

A physician is not permitted to issue a state-approved written recommendation to use medical
marijuana until obtaining a certificate from the State Medical Board of Ohio, the agency has
announced.

According to HB523 (Huffman), which legalized medical marijuana, the rules determining the
standards needed to secure such a certificate do not have to be in place until Sept. 8, 2017.

In a statement on its website, the board pointed to the "affirmative defense" sections of the law,
saying they could potentially protect patients who seek to use marijuana prior to the
implementation of rules related to the Medical Marijuan Control Program.

"According to the law, a patient, parent, or guardian can only raise an affirmative defense if they
have, among other requirements, received a written recommendation from his or her doctor that
certifies a certain number of criteria are met The board recommends that physicians consult with
their private legal counsel and/or employer for interpretation of the legislation," the agency
said. "The board recognizes that as a result of the requirements of the affirmative defense,
physicians will face potentially challenging inquiries from patients during the time period between
the effective date of the statute and the date when the certificate to recommend process is fully operational with the
medical board. The medical board will conduct a thorough process in the promulgation of rules
related to the certificate to recommend."

Medical marijuana proponent Sen. Kenny Yuko (D-Richmond Heights) issued a statement in response to
the State Medical Board of Ohio, saying the goal of the affirmative defense provision is to allow
patients with a qualifying condition to obtain the drug without waiting on rulemaking.

"It would protect them from a possession of marijuana or marijuana paraphernalia conviction. This
was considered an appropriate compromise to avoid forcing those in significant need to wait while
Ohio took the important time to effectively establish the regulatory system," Yuko said. "The
affirmative defense section spells out everything a physician would need to do to provide patients
with this limited, short-term protection without having to wait for the agencies. It simply wouldn’
make sense to read it any other way."

Ohio Cannabis Association Executive Director Brian Wright told Hannah News he was not surprised by
the board’s statement, adding that it is unfortunate that patients who have been waiting decades
for treatment will likely have to wait even longer to obtain their medication legally.

"We’ve got a board here who is clearly referring doctors to their attorneys but not giving them the
specific guidance. I think that would be helpful, but it’s just that early in the process," Wright
said. "At this point for physicians, I don’t know that anybody wants to step up and be the
precedent here. We have heard reports of people out there claiming to be able to write these
letters. There’s just not enough information, I think, for a legitimate licensed physician to be
comfortable writing these recommendations at this time."

Wright also mentioned the fact that attorneys were very recently given the green light from the
Ohio Supreme Court to advise clients on medical marijuana. (See The Hannah Report, 9/20/16.)

Ohio State University law professor Douglas Berman, editor of the blog "Marijuana Law, Policy &
Reform," said the affirmative defense section is an "odd duck" for a number of reasons.

"So I’m not surprised that the State Medical Board is essentially saying, ‘We don’t really know how
to figure that out, talk t a lawyer,’" Berman said. "At the same time … it gets to the heart of
what has proven to be, I think, an enduring challenge not just in these transition stages but for
every state that’s tried to do a serious well-regulated medical marijuana regime, which is that
doctors become a kind of gatekeeper, but [because of] marijuana’s status both as a
federally-prohibited substance and as a under-researched form of medicine, it’s distinctly
challenging for doctors and medical boards to know how to deal with their role as gatekeeper."

He said the board’s decision will likely make it harder for doctors to recommend marijuana before
rules are written.

"Who wants to go see their lawyer before they bother to go do their job? But at the same time, I
don’t think it’s a mistake or a cop-out of sorts by the State Medical Board. I think it’s kind of
the position they’re difficultly [sic] put in, given the wa in which all medical marijuana programs
get administered, and particularly the way that HB523 created this short-term defense, but a
defense that itself depends on still getting blessing from a doctor," Berman said.

"They could have written the defense more broadly, and said, ‘If a person has gotten medical
treatment for one of the diseases that are listed in HB523, then they can argue that this was a
medical use in court,’ rather than have them … nee to get a doctor OK for medical marijuana," he
said.

He said the law does not say the patient necessarily needs to receive a recommendation from an Ohio
doctor.

"It also leads me to wonder if somebody who has gotten a state-compliant recommendation in another
state might be in a better position than an Ohioan right now," he said, noting this could cause
further complication because some states are more lax (California) than others on how difficult it
is to obtain medical marijuana. He also noted that most people using medical marijuana right now
are smoking it, which is prohibited in HB523.

"There are just so many elements to meeting this affirmative defense," he said. "Now, are lots of
people using ‘medical marijuana’ in Ohio without getting arrested? Sure. Is there now an even
stronger argument when a cop comes and busts up your place in Ohio that you’ve been using it
compliant with the affirmative defense and they shouldn’t even arrest you? Maybe.

"Though it will be awfully hard to meet the terms of this affirmative defense — made that much
harder, I suppose, by the medical board guidance — that doesn’t mean this affirmative defense
doesn’t serve a role," he continued, noting it’s possible a patient could be better equipped to
convince a prosecutor to drop the case if they could show they are sufferin from a condition listed
in HB523. "I think that’s the interesting thing to watch now, with the affirmative defense."

He said even before enactment of HB523, there were almost certainly people getting away with using
marijuana for medic purposes.

"A cancer patient who is smoking some marijuana on their doctor’s suggestion to help deal with
chemotherapy or are otherwise in a bad state, I don’t think cops or prosecutors are worrying about
that person anyway, even if they find out they’re involved in marijuana usage," Berman said.
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2 days ago  ·  

New Research Finds There are More Graduates of Baccalaureate Nursing Programs than Associate Degree Programs

According to new research published in the Nursing Economics journal, there are considerably more graduates of baccalaureate degree nursing (BSN) programs than associate degree nursing (ADN) programs. Researchers examined graduation trends by degree using updated data from the Integrated Post-secondary Education Data System and NCSBN data. An analysis of the data revealed that by 2014, BSN graduates exceeded ADN graduates by one third. Researchers note that a large portion of this growth can be attributed to the increase in the number of registered nurse (RN) to BSN completion programs following the 2011 Institute of Medicine report and health care reform legislation.

In addition, the number of RNs earning graduate degrees is rapidly increasing, as approximately 38,000 RNs received graduate degrees in 2014. Researchers note that these changes in nursing education increase the readiness of nurses to capitalize on new opportunities, overcome challenges and take on new roles and responsibilities as the nation’s health care delivery and payments systems continue to evolve.
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3 weeks ago  ·  

White House sends money to states to fight opioids, urges Congress to provide more



Congress passes opioids bill

Stephen Koff, cleveland.com

WASHINGTON — Ohio will get a share of millions in federal grants to fight heroin and prescription opioid abuse, the White House said, but much more money is needed — and, the White House contended, the Republican-led Congress won’t provide it.

GOP leaders counter they have already increased anti-drug spending dramatically.

The disagreement has set up an odd juxtaposition, with Republican lawmakers such as Ohio U.S. Sen. Rob Portman — from a state with staggering drug-death and overdose numbers — agreeing with Democrats at times and talking about anti-drug strategies every week, while his party stresses financial concerns.

By early August, Cuyahoga County had reported over 280 deaths this year from heroin or fentanyl overdoses. Forty-seven were in July alone.

Emergency responders in Cincinnati recently reported 30 heroin overdoses in a single day.

Ohio will be awarded shares of grants from three federal programs, according to the U.S. Department of Health and Human Services:
•Strengthening prevention efforts: 21 states including Ohio will share up to $9 million to fight prescription drug misuse. HHS said the program is designed to raise awareness about the dangers of sharing medications and work with pharmaceutical and medical communities on the risks of overprescribing. The program, funded through Strategic Prevention Framework Partnerships for Prescription Drugs Grants also seeks to raise community awareness.
•Preventing drug overdoses: Ohio and 13 other states will share up to $11.5 million to support ongoing to address high overdose death rates and improve toxicology and drug screening. States can use the money for prescription drug monitoring programs, further prevention efforts and evaluation of strategies to improve safe prescribing practices.
•Tracking overdoses: Ohio and 11 other states will share $4.27 million to better track fatal and non-fatal opioid overdoses. The information is intended to help local authorities and the Centers for Disease Control and Prevention better respond to overdoses.

The grants were awarded on the basis of need, of target populations and other factors. Altogether, HHS announced $53 million nationwide, but Ohio’s share is just a fraction of that and HHS said that even the national grant totals are insufficient for the need.

Washington agrees people are dying, disagrees on money

Washington agrees people are dying, disagrees on money

With dueling bills and dollars, the political parties in Washington say they want to deal with the opioid crisis now – if only they could agree on things.


President Barack Obama has asked Congress to approve $1.1 billion for the effort over two years, which would make Ohio eligible for up to $45 million. That is unlikely to happen this year, and a new president takes office in 2017.

Congress passed the Comprehensive Addiction and Recovery Act in July and Obama signed it, an agreement that authorized $181 million a year in new spending. But authorization is not the same as an actual appropriation from Congress (see the video above to understand), and HHS Secretary Sylvia Burwell said this week that even the $181 million authorization, if provided, is not eno
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4 weeks ago  ·  

Naloxone Sving Lives

Naloxone saving lives: “ Ohio’s record 3,050 drug overdose toll in 2015 would have been much higher were it not for naloxone,” Dispatch reporter Alan Johnson writes.

“Naloxone, a drug which can reverse potentially fatal overdoses, was used 19,782 times by emergency personnel in Ohio last year, the Ohio Department of Health said. That’s not to say there would have been 19,782 more fatalities without naloxone, also known by the trade name Narcan. Sometimes it takes several doses to save one overdose victim. The drug is often used in cases that would not have otherwise been fatal. And sometimes it just doesn’t work.”

From the Columbus Dispatch
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4 weeks ago  ·  

 

Health Care Professions…

 

COHCA – Partnering

in Patient Care

COHCA, a interprofessional group, are partners in patient care: better care, lower costs, a partnership that will help improve the quality, safety, and affordability of health care for all Ohioans. Nationally, healthcare initiatives are fostering partnerships in patient care.


 

COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…

COHCA’S FIRST SUSTAINING ORGANIZATIONAL SPONSOR - Cleveland Clinic's Zielony Nursing Institute

COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…

COHCA’S FIRST GOLD SPONSOR AND A FOUNDING MEMBER - Dr. Jeri Milstead PhD, RN, NEA-BC, FAAN 

COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…

COHCA’S FIRST PLATINUM ORGANIZATIONAL SPONSOR - The Southern Ohio Chapter of the American College of Nurse-Midwives 

COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…

COHCA PLATINUM ORGANIZATIONAL SPONSOR - Ohio Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP)

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