Recent COHCA Articles

Issue 2

Issue 2 – Why This is Not a Good Proposition for Ohio
Issue 2  is slated for a vote on the November 2017 ballot. …
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Important Dues Process Update

At our most recent board meeting in Columbus, there was a discussion regarding… |read more|…
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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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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

President’s Message

A message from our President.

At our most recent board meeting in Columbus, there was a discussion regarding…

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COHCA On Facebook

NEW REGULATIONS FOR DRUG WHOLESALERS
Now Ohio is expanding its monitoring and tracking tools to the more than 500 wholesale
pharmaceutical distributors doing business in the state, the companies that buy drugs from
manufacturers and resell them to the some 20,000 Ohio pharmacies, doctors, clinics and hospitals
that, in turn, sell and dispense and administer directly to patients. Wholesalers often have
substantial information about the overall flow of drugs, and large spikes in their shipments hint
at problematic activity that could be illegal. Giving law enforcement and regulatory officials a
better, more consistent and more accurate understanding of these kinds of shipments – and giving
them better tools to ensure compliance – will only help make Ohio safer from the opiate epidemic
and those who would seek to profit from it. With these new regulations in place, Ohio will have one
of – if not the most – comprehensive and rigorous approaches to combating the opiate epidemic of
any state in the nation.

To help fill in the gap created by increasingly weak federal laws and regulations, Gov. Kasich and
Ohio’s Board of Pharmacy have worked together to develop new regulations on drug wholesalers in
order to give officials better tools to combat prescription abuse. Highlights include:
• Suspicious Orders Reporting – More Uniform, Detailed and Timely: Orders that wholesalers believe
to be suspicious must be reported to the federal Drug Enforcement Administration. Most states,
including Ohio, model their own reporting regulations on those used by the DEA, but it is clear
that improvements can be made. Instead of waiting on the federal

government to act, Ohio will create new requirements with detailed definitions and uniform,
electronic reporting formats, to make sure officials are alerted to emerging problems before they
get out of control.
• Due Diligence – Requiring Wholesalers to Better Research Their Customers: Wholesalers will be
required to obtain more detailed, precise information on those to whom they sell opiates and other
controlled substances, including conducting site-visits and reviewing drug utilization reports so
that they have deeper data sets to use when evaluating if an order is suspicious or not.
• Shipping Controls – Holding Suspicious Orders Until All Questions Are Answered: No wholesaler
will be permitted to ship any order that is deemed to be suspicious under the new requirements.
Wholesalers will be responsible for reviewing all suspicious orders to determine if orders are
reasonable prior to sale. Orders that are not deemed reasonable based upon the required review
criteria are prohibited from being sold.
• Developing Additional Enforcement Penalties for Violations: New enforcement penalties will be
created to address violations for failing to comply with these new rules.
In order to effectively use its current and new data in enforcement activities, the Board of
Pharmacy is developing data analytics tools to monitor wholesale drug sales with the help of
experts in the field. These new capabilities will be an important compliment to existing and new
regulatory authority in order to help safeguard Ohioans from the opiate epidemic.

BOTTOM LINE: Wholesalers are a critical central link in the drug supply chain and can play an
important role in alerting officials to problems on the frontlines. New regulations will help
define that role more clearly and create uniform, consistent guidelines for what is expected from
wholesalers and how they can comply. With additional data from wholesalers, Ohio regulatory and law
enforcement officials will be able to make Ohio’s work to combat prescription drug abuse even more
effective and save more lives from the addiction epidemic. See MoreSee Less

3 weeks ago  ·  

Nurse Anesthetists Push For Bill Eliminating Supervisory Requirement

Eliminating the mandate for certified registered nurse anesthetists to be supervised by a physician would improve access to care, particularly in rural areas, proponents told a House panel Wednesday.

Members of the House Health Committee, however, questioned if the measure to do so (HB 191+ *Track) would hinder the quality of care or pose risks to patients.

Angela Milosh, a CRNA in the Cleveland area, outlined education requirements for the nurses. They must have a bachelor’s degree in nursing or a regulated field, be licensed as a registered nurse, have a year working in a critical care environment, complete a graduate program in anesthesia that leads to a master’s or doctoral degree and pass a national certification exam.

The process takes at least seven years of education and experience, she said. The education program is designed to ensure each student is competent in all parts of anesthesia care delivery.

"This is not another pathway to become a physician; it is simply another pathway to become an anesthesia provider," she said. "CRNAs and physicians are held to the same standard of anesthesia care. Anesthesia is given the same way, regardless of whether it is provided by a CRNA or a physician. In fact, study after study has demonstrated no difference in outcomes based on who provides the anesthesia care."

Rep. Nickie Antonio (D-Lakewood) said several other health professional groups have raised questions about the bill, including the ability to order pain medications.

"The concern is about putting one more prescriber, especially of opioids, into the mix," she asked.

Ms. Milosh said the bill would not allow CRNAs to write prescriptions for drugs to take home. The change would allow patients to receive the care they need when they need it, instead of waiting for the medication to be ordered, she said.

Tony Snyder, president and CEO of Pomerene Hospital in Holmes County, said the bill would improve access to care and lower the cost of care.

Small, rural hospitals are often unable to recruit anesthesiologists, and rely heavily on CRNAs to provide anesthesia needs, he said.

Mr. Snyder told Rep. Jay Edwards (R-Nelsonville) that the bill allows hospitals to choose the model they prefer for their facilities.

Rep. Theresa Gavarone (R-Bowling Green) asked why facilities would hire anesthesiologists if the bill passes.

Hospitals might prefer to have anesthesiologists on staff for various reasons, including if they have surgeons on hand who prefer to work with anesthesiologists, Mr. Snyder said.

Chairman Rep. Steve Huffman (R-Tipp City) said facilities that do intensive operations, such as brain surgeries or nine-hour heart surgeries, would likely still prefer to have anesthesiologists.

Dr. Carmen Doty-Armstrong, a physician at Findlay Women’s Care and other facilities in Findlay and Tiffin, said anesthesia care delivered in CRNA-only facilities is done with the same standards as other provider models.

The current supervisory requirements often see physicians with no training in anesthesia care and cause concern among doctors who worry they could be held liable for care in which they have no specialty, she said.

"House Bill 191 will clarify state law to allow CRNAs, the actual anesthesia provider, the ability to place anesthesia orders and remove this confusion," she said. "Of note, CRNAs are the only advanced practice nurses without the ability to order in Ohio, even though they have more clinical education hour requirements necessary to achieve certification than do nurse midwives, clinical nurse specialists, and nurse practitioners."

Rep. Antonio asked who can be a supervisory physician now and how the bill would improve the situation.

In some hospitals, anesthesiologists supervise CRNAs, while in smaller hospitals the supervisory physician is the doctor providing surgery, Dr. Doty-Armstrong said. Some doctors fear the supervisory requirement would make them liable for action by the CRNA.

Rep. Niraj Antani (R-Miamisburg) asked how often supervisory physicians have been sued for malpractice because of a CRNA’s actions. Dr. Doty-Armstrong said she was not aware of any cases.

Anna Polyak, senior director of state government affairs at the American Association of Nurse Anesthetists, said court decisions have indicated surgeons aren’t automatically liable for the conduct of CRNAs.

"While removing supervision language from the state law may not have actual impact on surgeon liability, it will, however, remove the perception of surgeon liability and alleviate concerns that some surgeons have about supervising another provider whose scope of practice is different than their own," she said. See MoreSee Less

1 month 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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