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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 Disclosures to Advanced Practice Nurses and Physician Assistants

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Bill would give Ohio nurses more latitude in treating patients

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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.


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

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

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

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

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

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

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

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

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

COHCA On Facebook

House Committee Expected To Vote On Bill Aimed At Expanding Reach Of Advanced Practice RNs – After Key Changes

A House panel is expected to vote on a bill this week dealing with advanced practice registered nurses, but the measure will likely undergo significant changes after much debate.

A substitute bill of the measure (HB 216) expected to come before the House Health and Aging Committee Wednesday would retain the requirement in current law that APRNs have a collaborative agreement with physicians, but would ease some of the restrictions on that relationship to make life easier for nurses.

The proposal originally called for eliminating the requirement that APRNs have collaborative agreements with physicians in order to practice, which supporters of the bill said was a hindrance to more APRNs expanding care into underserved, particularly rural, areas. (See Gongwer Ohio Report, January 20, 2016)

Opponents of eliminating that requirement, including the Ohio State Medical Association, said it could be bad for patients, as APRNs don’t receive as wide a scope of training as physicians.

The new version of the bill maintains the requirement, but would allow physicians to collaborate with a maximum of five APRNs, up from the current limit of three. (Comp Doc)

“Under that new ratio, there’s two additional APRNs that can go out to the rural areas and provide that access,” Tim Maglione, senior director of government relations for the OSMA, said in an interview. “There’s hundreds and hundreds of physicians that will be able to increase that ratio. We’re talking about hundreds and hundreds of APRNs potentially being available, going out into the rural area to practice.”

The OSMA was originally opposed to the bill, and is neutral to the substitute bill. The change ensures APRNs remain part of a collaborative team, which is where most medical practices are trending, Mr. Maglione said.

“The point we’ve been trying to make from the very beginning is that health care is moving to this team-based approach where multiple providers are working together for the care of the patient,” he said. “Our concern when 216 was first introduced was, in a way, it carved out the advanced practice nurses from that team, siloing them out from that team. It really went against the trend that is the optimal way to care for patients.”

Terri Miller, president of the Ohio Association of Advanced Practice Nurses, said the substitute bill is a positive step forward.

“It’s not our dream bill, but it still has quite a few changes in it that are definitely going to be good for the citizens of Ohio and will also help the APRNs in our state,” she said in an interview.

Regarding the collaborative agreements with physicians, the sub bill also creates a 120-day grace period during which a nurse can continue to practice if her collaborating physician ends the relationship.

Other changes in the sub bill include eliminating a requirement that APRNs go through a 1,500-hour externship before they can write prescriptions, and changing the formulary for the drugs APRNs can prescribe from inclusionary to exclusionary. The formulary change means nurses won’t have to wait months to be able to prescribe a new drug.

Ms. Miller said the bill also clarifies language in the law to make it easier for APRNs from out of state to become registered in Ohio.

“I think it’s a step in the right direction,” she said.

Rep. Dorothy Pelanda (R-Marysville), the sponsor of the bill, could not be reached for comment prior to deadline.

A separate bill (HB 548) slated for a hearing this week in House Health includes provisions from the original House Bill 216 dealing with certified registered nurse anesthetists. (See Gongwer Ohio Report, May 16, 2016)
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4 days ago  ·  

NCSBN Publishes National Guidelines for Nursing Delegation

NCSBN has published national guidelines for nursing delegation, with the goal of providing clear direction and standardization of the nursing delegation process. In 2015, NCSBN convened two panels of experts representing education, research and practice to discuss the literature and key issues, and evaluate delegate research findings. The guidelines provide clarification on the responsibilities associated with delegation and give direction for employers, nurse leaders, staff nurses and delegates. Additionally, the guidelines are meant to address delegation with respect to the various levels of nursing licensure.
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2 weeks ago  ·  

New Analysis Finds that Medical Errors are the Third Leading Cause of Death in U.S.

A recent analysis by Johns Hopkins University School of Medicine researchers found that medical errors rank just behind heart disease and cancer as the third leading cause of death in the U.S. Researchers examined four studies that analyzed medical death rate data from 2000 to 2008. Using hospital admission rates from 2013, they extrapolated to conclude that, based on 35,416,020 hospitalizations, 251,454 deaths stemmed from a medical error.

Researchers highlight how shortcomings in vital statistics tracking may keep the scale of medical error deaths out of the public eye. The study researchers note that the Centers for Disease Control and Prevention (CDC) uses U.S. death certificates to identify causes of death. These causes are coded, quantified, ranked and published as mortality statistics. The CDC statistics are often used to set health care priorities, however, the CDC’s published mortality statistics only tally the underlying cause of death, such as heart disease or cancer, the condition that led a person to seek medical treatment. The coding system used by the CDC to record death certificate data doesn’t capture communication breakdown, diagnostic error and poor judgement that cost lives.

Researchers recommend adding a new question to death certificates specifically asking if a preventable complication of care contributed. Additionally, researchers urge the CDC to add medical errors to its annual list reporting the top causes of death. Researches also suggest a root cause analysis approach in which hospitals utilize a rapid and efficient independent investigation into deaths to determine whether error played a role.
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2 weeks ago  ·  

Ohio governor issues emergency order to outlaw new drug

The Associated Press
Ohio Gov. John Kasich (KAY’-sihk) has issued an emergency order allowing the state pharmacy board to move quickly to outlaw a deadly synthetic painkiller.

The governor’s action Wednesday targets a painkiller known as U-47700. The drug is considered more than seven times as powerful as morphine.

The governor’s order allows the state pharmacy board to suspend rules normally needed when classifying new drugs.

The order would place U-47700 in the same category as drugs like cocaine and heroin.

Authorities in northeastern Ohio say they’re starting to see signs of the drug in recent investigations of overdoses.

Overdose deaths are the leading cause of accidental deaths in Ohio, surpassing car crashes. Most of the deaths involve the abuse of legal painkillers and a growing heroin epidemic.

Copyright The Associated Press
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3 weeks ago  ·  

New Medicaid Rules Could Ease Rural Health Care’s Problems

A sweeping Medicaid change has the potential for states to address the dangerous shortage of doctors outside urban and suburban areas.

A sign outside one of a growing number of rural hospitals that are closing across the country. (AP/Gerry Broome)

The Obama administration released a new set of rules last week for managed care plans under Medicaid and the Children’s Health Insurance Program (CHIP). The document, clocking in at 1,425 pages, mostly strengthens and modernizes existing rules. But there are some sweeping changes.

Perhaps most notably, states now must set “maximum time and distance” standards to ensure that there are enough doctors in the right places. What the maximum time and distance will be is left up to the individual states to decide.

This has the potential to be a game-changer for rural areas, which have more Medicaid patients but far fewer doctors than urban areas. While 21 percent of rural residents are on Medicaid — compared with 16 percent in urban areas — only 10 percent of doctors are located in rural areas.

Health officials, though, wonder — and worry about — how these standards will be executed.

“How does a state like Nevada write such a standard when most people live in one area?” said Maggie Elehwany, government affairs and policy vice president for the National Rural Health Association. The sparsely populated state has a high concentration of people in the southern part, which could make it difficult to create a standard to serve all residents. "We know what CMS [the Centers for Medicare and Medicaid] is trying to do, so we’re happy about it because there is such a workforce shortage. But it is really hard right now to see what states are going to do."

What wouldn’t be helpful, according to Elehwany, is for states to simply set high time and distance maximums — like three hours and 100 miles. That won’t ensure or improve access to care and will just be another regulation for states to follow, she said.

Matt Salo, executive director of the National Association of Medicaid Directors, said the new regulations have been well-received from officials he’s talked to, but "it’s going to take a lot of energy and resources to come into compliance, and health officials need to start thinking: How do you roll this out in a way that makes sense? What’s the right way — not easiest — to measure access to care?”

As officials digest all 1,400 pages of the new rules, Elehwany hopes the federal government will back the new regulations with funding for programs.

“There are a great community-based services that could be launched or ramped up that could reduce health disparities," she said. "Rural areas have a tremendous need not only for care but for community health workers who understand the culture. Those are the people best positioned to encourage these populations to stay healthy."

Many states have already made attempts to address the doctor shortage in rural areas. Alaska, for example, works with the state university to disperse mental health providers in the most far-flung areas; more than half the states encourage the use of telemedicine; Missouri lets medical school graduates practice in rural areas without completing a residency; and roughly a dozen states have formed a pact that makes it easier for doctors to practice in multiple states.

Despite all of these attempts, the drought of medical help remains for much of rural America.

Governing Magazine
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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 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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