12/19/2019

A Year in Physician Advocacy – 2019 Update & 2020 Preview!

It would be an understatement to say that 2019 was a hectic year for the OSMA Advocacy team. With a biennial budget process that went into overtime and many other major issues taking center stage, the OSMA was on-hand at the Statehouse day after day: meeting with legislators, testifying in committee hearings, and attending meetings with other interested parties to work on proposals which would impact the practice of medicine in Ohio.

Read on for a summary of the activity on the OSMA’s main advocacy priorities and ongoing issues this year, and for a sneak peek into what topics are expected to be in the spotlight in the New Year!

1. Out-of-Network or “Surprise” Medical Billing

On both federal and state levels, surprise billing has been a major source of buzz in 2019. The deliberations over a need for a solution to this complex issue have been ongoing for years, but within the past year, media attention surrounding the topic has increased and legislators in both D.C. and in downtown Columbus have proposed several legislative “fixes.” Overall, the goal is to remove patients from the middle of payment disputes between providers and insurers and protect them from surprise out-of-network billing.

The OSMA is deeply committed to this effort, and has continued to emphasize that any comprehensive surprise billing solution must strike a fair balance between insurers and physicians and not upset the fragile system by which those two entities negotiate contracts. There are currently two pieces of legislation on surprise billing in the Ohio Legislature: one House bill (HB 388) and one Senate bill (SB 198). While the Senate bill is physician-friendly and backed by the OSMA, the House proposal contains several highly concerning provisions which the OSMA believes would sacrifice a critical amount of the little leverage physicians have in the contracting process and tip the balance more in favor of the insurer. As we move into 2020, the OSMA continues to work on the issues in HB 388 with legislators and work to support comprehensive and balanced patient protections like those found in SB 198.

2. Mental Health Parity

The Mental Health Parity and Addiction Equity Act, bipartisan legislation introduced in December by Rep. Allison Russo (D-Upper Arlington) and Rep. Phil Plummer (R-Dayton) in the House and by Sen. Theresa Gavarone (R-Bowling Green) and Sen. Sean O’Brien (D-Bazetta) in the Senate. This legislation will better ensure Ohioans have access to mental health and substance abuse treatment by prohibiting insurers from covering illnesses of the brain more restrictively than illnesses of the body.

The Mental Health Parity and Addiction Equity Act (MHPAEA) was signed into law federally in 2008, but unfortunately Ohio’s state statute regarding parity, enacted two years prior, does not align with the federal law and has yet to be updated to reflect it. Senate Bill 254 and its companion, House Bill 443, would update Ohio’s state law to align with the MHPAEA, requiring insurers (many of which are already complying with the federal law in other states) to provide coverage for mental illness equal to coverage provided for physical ailments. 

The OSMA has been a part of the Parity at 10 coalition supporting this legislation and expects to participate in proceedings surrounding its journey in the legislature in the coming year.

3. Scope of Practice – APRNs

House Bill 177, introduced at the end of March 2019 by Rep. Tom Brinkman (R-Mt. Lookout), continues to be an independent practice bill which would allow Ohio advanced practice registered nurses (APRNs) to practice without a collaborating physician or podiatrist.

The most recent version of the legislation adds a stipulation that in order to gain independent practice authority, an APRN must complete 2,000 hours of “clinical practice.” The term “clinical practice” is not clearly defined in the bill, but it does state that these hours are to be completed in a standard care arrangement with a licensed health care practitioner. This means that for roughly the equivalent of one year, an APRN would be required to be in a standard care arrangement, but notably, it does not have to be with a physician. Under this substitute version of HB 177, this arrangement could be with another APRN, and again, is only for a period of about one year. After this is completed, the APRN would be able to practice independently under substitute HB 177.

Along with other physician groups, the OSMA will continue to advocate against this bill, touting the positive impact of the current physician-led collaborative model, and urging patient safety concerns. As of now, the bill remains in the Ohio House Health Committee, where discussion on its contents and its future are expected to be ongoing into 2020.

4. Scope of Practice – CRNAs

The OSMA is pleased to report that after years of work on the issue of expanded certified registered nurse anesthetist (CRNA) scope of practice, we have reached a suitable compromise with the sponsors and proponents of the bill currently before the Ohio House Health Committee.

Read our post OSMA Prevails in CRNA Scope Deliberations for more details.

5. Scope of Practice – Psychologists

House Bill 323, introduced at the end of August by Rep. Don Manning (R-New Middletown) would allow certain psychologists in Ohio to prescribe medications for the treatment of mental illness and/or substance use disorder. The OSMA and the Ohio Psychiatric Physicians Association (OPPA) have worked together on this issue for several years.

Stressing concerns about patient safety, the OSMA and OPPA have emphasized that Ohioans with mental illness and/or substance use disorders should receive the same high-quality, safe prescribing by medically-trained clinicians as is received by those who have other medical conditions. Moving into the 2020 year, the coalition expects to continue working with the sponsor on this bill.

6. Medical Price Transparency

Senate Bill 97, a proposal sponsored by Sen. Steve Huffman (R-Tipp City) which would require that patients be provided with cost estimate for scheduled hospital procedures 7 days in advance, has passed out of the Senate and is now with the House Health Committee for consideration.

The OSMA has been working collaboratively with the legislature and other interested parties on the complex issue of medical price transparency for several years now. As providers alone do not have all of the information necessary to provide a patient a meaningful estimate for the cost of a health care service, the OSMA advocacy team has continued to emphasize to legislators that providers and payers need to work collaboratively. The process of providing this information to patients must also be administratively manageable and workable for Ohio’s physicians and providers to avoid any negative impact on health care delivery.

The OSMA has been largely supportive of this effort by Sen. Huffman (who is also a physician) as SB 97 would encourage this type of collaboration between providers and insurers in order to help Ohioans to make more informed decisions regarding their care and allow them to better anticipate costs.

7. Ban on Tanning for Minors

House Bill 329, legislation to place a ban on use of sun lamp tanning services by minors, was recently introduced and had its first proponent hearing on Tuesday, December 10. Current statute allows for 16 or 17 year-olds in Ohio to use tanning beds with parental consent. There were several witnesses on hand to present testimony. Dr. Shannon Trotter testified before the House Health Committee on behalf of the OSMA and the Ohio Dermatological Association, detailing the risks associated with UV exposure from tanning beds, particularly in youth. The OSMA anticipates that ongoing efforts to support this bill will proceed in 2020.

After a busy 2019, the OSMA wishes all members a happy and safe holiday season. Stay tuned for updates from the OSMA on these and other issues as we begin the 2020 year!