Fiscal Note & Local Impact Statement
126 th General Assembly of Ohio
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CONTENTS: |
To revise the law governing information hospitals are to
provide to the Department of Health and the public |
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STATE FUND |
FY 2006* |
FY 2007 |
FUTURE YEARS |
|
General Revenue Fund |
|||
|
Revenues |
- 0 - |
- 0 - |
|
|
Expenditures |
- 0 - |
Increase |
Increase |
Note: The state
fiscal year is July 1 through June 30.
For example, FY 2006 is July 1, 2005 – June 30, 2006.
*LSC has assumed that the bill will not be enacted until FY
2007. Therefore, costs will not occur
until FY 2007.
·
The
bill requires the Department of Health (ODH) to make available on its web site
(1) price, admission, and discharge data for all patients and (2) performance
measure data for each hospital in the state.
ODH currently collects price, admission, and discharge data for
nongovernmental patients, as well as some other data from hospitals and
displays it on its web site. It is
unknown at this time whether the web site currently used to display hospital
information could be retrofitted to fulfill the requirements within the bill or
whether a new web site would be needed.
ODH will realize an increase in expenditures relating to the bill. It is possible that ODH will need additional
staff, hardware, software, etc. for the implementation of this bill unless ODH
contracts with outside vendors.
However, it is unknown at this time the exact amount of the
increase. However, the bill does give
the Director of Health rule-making authority governing hospitals’ submission of
both performance measure information and price, admission, and discharge
data. As such, it is possible that the
Director could require hospital submissions to be submitted in a format that
would require less data analysis/manipulation on the Department’s part. For purposes of this fiscal note, costs are
assumed to be paid out of the GRF, since there is no funding specified in the
bill for its implementation.
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LOCAL
GOVERNMENT |
FY 2006 |
FY 2007 |
FUTURE YEARS |
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|
County and Municipal
Hospitals |
||||
|
Revenues |
- 0 - |
- 0 - |
- 0 - |
|
|
Expenditures |
- 0 - |
Increase |
Increase |
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Note: For most local governments, the fiscal year is the calendar year. The school district fiscal year is July 1 through June 30.
·
County
and municipal hospitals will realize an increase in expenditures relating to
the required submission of price, admission, and discharge data for all
patients in the top 60 diagnosis related groups (DRGs) most frequently treated
on an inpatient and outpatient basis.
Currently, every hospital is required to annually disclose to ODH
certain data for nongovernmental patients in each of the 100 DRGs most
frequently treated on an inpatient basis as represented by discharges during
the previous calendar year.
Governmental patients make up approximately 55% of hospital visits
statewide. As such, the hospitals will
be required to submit a great deal of additional information. It is likely that reporting will not begin
until 2007, therefore, it is assumed that costs will not begin until then.
For fiscal analyses, a "yes" local impact determination is
defined as an annual cost of more than $1,000 for any affected county, city, or
township with a population of less than 5,000 or an annual cost of more than
$5,000 for any affected county, city, or township with a population of 5,000 or more.
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The bill makes changes to
the law governing information hospitals are to provide to the Department of
Health (ODH) and the public. The
changes are discussed below.
Fiscal Impact to the Department of Health
Hospital Performance Measures
Advisory Council
The bill creates the
Hospital Performance Measures Advisory Council. The bill specifies that the council members shall serve without
remuneration (except to the extent that serving on the council is considered a
part of their regular duties) and shall not be reimbursed for expenses. ODH shall provide meeting space and staff
and other administrative support for the council. There will not likely be any increase in ODH expenditures as a
result of this provision. However, it
is possible that there could be indirect costs since ODH staff selected to help
with the council will have more duties to fulfill and could potentially have to
work overtime. Any such costs should be
minimal.
Data Collection and Analysis
Group
The bill requires the
Director of Health to convene a group of experts in data collection and
analysis or a related field. These
members shall serve without remuneration (except to the extent that serving in
the group is considered a part of their regular employment duties) and they are
not reimbursed for expenses incurred in performing group duties. The bill establishes the responsibilities of
the group.
Infection Control Group
The bill permits the
Director of Health, when determined necessary, to convene a group of health
care consumers, nurses, etc. in infection control. These members shall serve without remuneration (except to the
extent that serving in the group is considered a part of their regular
employment duties) and they are not reimbursed for expenses incurred in
performing group duties. The bill
establishes the responsibilities of the group.
Internet Web Site
The Director of Health shall
make the data provided by hospitals (both performance measure data and price,
admission, and discharge data) available on an Internet web site. The information submitted shall be presented
on a web site in a manner that enables the public to compare hospitals’ records
in meeting the performance measures for hospital inpatient and outpatient
services. In making the information
available on a web site, the Director shall do all of the following:
·
Enable
the public to compare the hospitals’ records in meeting the performance
measures for specific diagnoses and procedures;
·
Enable
the public to make the comparisons by different geographic regions, such as by
county or zip code;
·
Include
a report of each hospital’s overall record in meeting the performance measures;
·
To
the extent possible, include state and federal benchmarks for the performance
measures;
·
Include
information and explanations of why there are differences in performance
measures from hospital to hospital;
·
Exclude
a hospital’s record in meeting a specific performance measure if the hospital’s
caseload for the diagnosis or procedure that the performance measure concerns
is insufficient, to make the hospital’s record for the diagnosis or procedure a
reliable indicator of its ability to treat the diagnosis or provide the
procedure in a quality manner; and
·
Clearly
identify the sources of data used on the web site and explain the analytical
methods used in determining hospitals’ records in meeting performance measures.
ODH is permitted to contract
out certain duties. The Director of
Health must also adopt rules to, among other things, govern hospitals’
submission of performance measure information and price, admission, and
discharge data. The bill also permits
the Director of Health to audit any performance measure information submitted
by hospitals to the Director, including information adjusted for risk.
ODH currently collects some
data from hospitals. This information
is displayed at http://pubapps.odh.ohio.gov/pwh/publicwarehouse.aspx. It is
unknown at this time whether the web site currently used to display hospital
information could be retrofitted to fulfill the requirements within the bill or
whether a new web site would be needed.
ODH will realize an increase in expenditures relating to the bill. It is possible that ODH will need additional
staff, hardware, software, etc. for the implementation of this bill unless ODH
contracts with outside vendors.
However, it is unknown at this time the exact amount of the
increase. However, the bill does give
the Director of Health rule-making authority governing hospitals’ submission of
both performance measure information and price, admission, and discharge
data. As such, it is possible that the
Director could require hospital submissions to be submitted in a format that
would require less intensive data analysis/manipulation on the Department’s
part.
There is no funding source
for these additional responsibilities.
For purposes of this fiscal note, the costs are assumed to be paid for
out of the GRF.
Fiscal Impact to Government Owned Hospitals
Performance Measure Data
The bill
requires each hospital to semiannually submit data to the Director of Health
that shows the hospital’s record in meeting each of the performance measures
for hospital inpatient and outpatient services established by the Agency for
Health Care Research and Quality, the National Quality Forum, the United States
Centers for Medicare and Medicaid, the National Committee for Quality
Assurance, and the Joint Commission on Accreditation of Healthcare
Organizations. The bill also specifies
the requirements that each hospital must meet in submitting this data. For example, hospitals are to include data
about the hospital’s caseloads, adjusted length of stays, complication rates,
and mortality rates, as well as adjust the information to reflect risk factors
in accordance with the method selected by the data collection and analysis
group, among other things. Hospitals
are permitted to provide for a third party to determine whether any performance
measure information submitted to ODH should be adjusted for risk. The Director of Health is permitted to audit
any performance measure information, including information that has been
adjusted for risk.
According to the
Ohio Hospital Association (OHA), hospitals currently submit performance measure
data that shows the hospital’s record in meeting measures established by the
Agency for Health Care Research and Quality, the National Quality Forum, the
United States Centers for Medicare and Medicaid, the National Committee for
Quality Assurance, and the Joint Commission on Accreditation of Healthcare
Organizations. Some of this performance
measure data is displayed on OHA’s web site (http://www.ohanet.org/portal/). There are links to many organizations that
rank or rate hospitals, as well as links that help consumers find the best
hospital for their condition. Since
hospitals currently submit this data to these entities there should be minimal
costs to government-owned hospitals as a result.
Price, Admission, and
Discharge Data
Currently, every hospital is
required to annually disclose to ODH certain data for nongovernmental patients
in each of the 100 diagnosis related groups (DRGs) most frequently treated on
an inpatient basis as represented by discharges during the previous calendar
year. The disclosures must be made on
or before March 1st of each year and the Department must maintain these
disclosures as a public record.
Hospitals must disclose the following:
(1) total number of patients discharged, (2) mean, median, and range of
total hospital charges, (3) mean, median, and range of length of stay, (4)
number of admissions, and (5) number of patients falling within certain
diagnosis related group numbers used in federal Medicare regulations. Hospitals must make copies of this available
on request for a reasonable fee and must advise that the information is also
available from ODH. Comments from the
hospitals concerning deviations must be included. The bill makes some changes to this. The bill repeals current law that permits ODH to obtain
information about Medicare patients from the U.S. Department of Health &
Human Services and Medicaid patients from the Ohio Department of Job and Family
Services. The bill requires that
hospitals disclose to ODH, on or before the first day of May each year, the
previously mentioned data for all patients (not just nongovernmental patients),
in each of the 60 (not 100) DRGs most frequently treated on an inpatient basis
and in each of the 60 DRGs most frequently treated on an outpatient basis as
represented by inpatient and outpatient discharges, respectively, in the
previous calendar year.
Hospitals currently report
price, admission, and discharge information to ODH for nongovernmental patients
in each of the top 100 DRGs for inpatient procedures. The bill requires hospitals to submit this data on all patients
in each of the top 60 DRGs treated on an inpatient and outpatient basis in the
previous calendar year. Hospitals
currently report costs for Medicaid and Medicare patients to other
agencies. However, the bill would
require hospitals to report charges for these patients, which is different
information than cost information.
Also, governmental patients make up approximately 55% of Ohio’s
statewide hospital visits, so this is a substantial amount of additional
information that will be required to be reported. As such, government-owned hospital costs will increase. OHA does not have an exact estimate at this
time. According to OHA, hospitals do
not currently report DRGs for outpatients.
Price Information List
Currently, hospitals are
required to compile, make available for inspection by the public, and update a
price information list. The bill adds a
requirement that the list be compiled and made available in a format that
complies with the electronic transactions standards and code sets adopted by
the U.S. Secretary of Health & Human Services under the Health Insurance
Portability and Accountability Act. The
list must also include the hospital’s billing policies in regards to interest
charged on unpaid amounts. The bill
also specifies that the list shall be made available free of charge on the
hospital’s web site and must post an announcement of the list’s availability in
specified areas.
LSC fiscal staff: Wendy Risner, Budget Analyst