Doctors, Ohio legislators talk health care reform during Cleveland forum

CLEVELAND, Ohio — Doctors and state legislators from Greater Cleveland talked about health care reform during a forum at the Cleveland Clinic’s Lutheran Hospital Monday evening.

Forum participants touched on federal health care reform efforts, but they talked mostly about Ohio reforms.

Dr. Roy Thomas, president of the Ohio State Medical Association (OSMA), started the evening by repeating the association’s opposition to both U.S. House and Senate health care reform bills.

“While the [American Medical Association] has officially taken the stance of support for the House and Senate versions going through the national process, the OSMA has officially taken a position of opposition,” Thomas told the audience of mostly doctors who belong to the Ohio medical association or the Academy of Medicine of Cleveland & Northern Ohio, both sponsors of the forum.

“That does not mean that we’re opposed to everything in those two pieces of legislation,” said Thomas, an Elyria ophthalmologist. “And it does not mean we’re opposed to health system reform.”

However, both federal bills lack a permanent fix or repeal of the Medicare physician payment formula known as the sustainable growth rate. Both bills also ban new physician-owned hospitals. Meanwhile, each of the bills has other shortcomings, such as exclusion of medical liability measures and payment cuts for imaging services.

Dr. John Bastulli, vice president of legislative affairs for the academy, said he sees health care reform efforts in Washington creating “unaccountable bureaucracies making decisions with respect to patient care, thereby inserting more hurdles between the patient and his or her physician.” Bastulli, a Cleveland anesthesiologist, also is concerned that proposed federal legislation fails to address tort reform, which are limits on tort damages, such as medical malpractice, awarded by courts.

In Ohio, legislators should protect tort reform measures and move toward a new generation of reforms that include special courts for medical liability lawsuits against doctors, Bastulli said. The academy plans to work with OSMA against Ohio House Bill 361 (Toledo Legal News), which would roll back some gains made toward tort reform, he said.

Ohio Rep. William Batchelder, a Medina Republican and Ohio House minority leader, said he helped draft and pass meaningful medical malpractice reform in 1976, aimed at stabilizing high malpractice insurance rates paid by doctors. However, the Ohio Supreme Court “has struck down whole sections of” the law, said Batchelder, who has spent more than 30 years in the Ohio House. “I think we have to look at medical malpractice again.”

Jeff Smith, OSMA’s director of government relations, said “scope of practice” is another legislative push by Ohio physician advocates. “You are constantly under barrage by allied health care practitioners,” Smith said, speaking to the doctors in the audience. For instance, Ohio House Bill 253 would give advanced practical nurses the ability to prescribe Schedule II narcotics and House Bill 314 would allow registered nurses to pronounce death.

“Should registered nurses be able to prescribe Schedule II narcotics? We don’t think so, at least not in an unsupervised way,” Smith said. “Psychologists want to prescribe drugs. Registered nurses want to pronounce deaths. So there are all these things that are defined as the practice of medicine… that more and more, the allied medical health practitioners want to do.”

Some of the initiatives make the system more efficient. “And when they’re done in a safe way for the benefit of patients, we’ll support those efforts,” Smith said. “But many of these initiatives are being done merely to advance a profession through the will of the legislature.”

Also on the Ohio legislative agenda is House Bill 122/Senate Bill 98, which would require health insurers to operate fair and transparent physician ranking systems, Smith said. House Bill 185 would keep insurers from unilaterally changing their service contracts with doctors.

Meanwhile, House Bill 267 would remove some of the regulatory burden that dampens the use of electronic prescribing by doctors and pharmacists in Ohio, Smith said. And Senate Bill 210/House Bill 373, dubbed the Healthy Choices for Healthy Children Act, would require schools to provide healthy foods and exercise to children. The Senate bill was sponsored by Sen. Kevin Coughlin, a Cuyahoga Falls Democrat, who attended Monday’s forum.

Pending legislation also includes mandated insurance coverage for colorectal cancer screening (House Bill 56) and diabetes screening (House Bill 81), Smith said. House Bill 173 would require that minor children get a written prescription from their doctors before using tanning beds, which can contribute to skin cancer.

Ohio Sen. Nina Turner, a Cleveland Democrat, and Ohio Rep. Timothy DeGeeter, a Democrat from Parma, also attended the forum.