MHA Update Newsletter
January 9, 2015
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 June 1 and 2, 2015

MHA Annual Meeting
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Funding Better Health Care

There's a powerful moral lesson many of us were taught as children in Aesop's well-known fable, The Grasshopper and the Ant. As the story goes, the grasshopper fritters away his summer singing, while the ant toils, collecting food. When winter arrives, the grasshopper, starving, approaches the ant to ask for food, only to be rebuked for its casual attitude during the harvest months.


During the past year, as Maryland's hospitals have toiled to reconfigure their resources to meet the targets of a modernized waiver, you have very much followed the ant's good example. But hospitals' industriousness and resolve by themselves cannot achieve the goals. We need the Health Services Cost Review Commission to provide the financial flexibility that will allow us to, like the ant, make investments now that will pay off for years to come.


MHA is pressing hard for the HSCRC to provide a midyear rate increase of 0.75 percent. This is based, in part, on the key principle established by the HSCRC's advisory council on the waiver, which states that the HSCRC should: "...strike a balance between near-term cost control, which is paramount, and making the required investments in physical and human infrastructure necessary for success. If we do not meet the near-term targets, there will be no long-term program. But, if we fail to make the needed infrastructure investments, we will not have the toolkit of reforms necessary to achieve lasting success" and "(g)iven the challenging targets in this initiative, goals should be set in the aggregate as close to the targets as practicable based on the degree of comfort that individual targets will be met."


While the HSCRC has expressed some concerns about meeting the financial targets of the modernized waiver, the early data indicate this will not be a problem. What would be a problem would be creating challenges down the road by failing to invest now. As MHA's letter to the HSCRC points out: 

  • Hospitals have outperformed on spending limits, and projected spending per capita for the year is 2.01 percent, 44 percent below the 3.58 percent ceiling
  • A rate adjustment creates zero risk of exceeding the waiver's financial limits
  • Investing in care coordination and population health infrastructure is essential to success
  • Hospital margins are highly vulnerable, in part due to a six-year history of below-inflation updates

Also, hospitals now have an infrastructure reporting template that will be used to detail precisely how funds for care coordination and population health efforts are spent. That means hospitals will be more transparent than ever about these investments, with the HSCRC and the broader public as well.


The 0.75 percent request will be considered at the Jan. 14 HSCRC meeting, no small feat in and of itself as it was initially assigned to a work group for consideration. And in addition to the work MHA has been doing to directly help the HSCRC understand why this increase is critical, we're working with consumer and community-based agencies to gain their public support for investments in care coordination and population health.


The moral of Aesop's fable, depending on which translation you read, is: "Prepare today for the needs that you will have tomorrow." It was true during Aesop's time. It is true today for Maryland's hospitals. 
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In This Issue
Community Leaders Gather on Waiver

MHA and the nonprofit Health Care for All on Monday hosted dozens of community, health care, and religious leaders to discuss the best strategies for talking with patients and the public at large about the changes coming to hospitals and health care as a result of the modernized Medicare waiver. The conversation ranged from topics like how consumers perceive the waiver and its accompanying changes to faith-based health partnerships that work to improve community health. The featured speaker was Steve Raabe of OpinionWorks, who shared findings from a series of statewide focus groups on the waiver. Health Care for All is now conducting 10 statewide community forums to explain the waiver and how it is changing health care in Maryland to key constituencies, such as unions and faith organizations. Stay tuned for information on how Raabe's work can help you explain the waiver in your community.


Contacts: David Simon/Jim Reiter

Sexual Assault Protocols Sought

HB 963, a law passed during the 2014 legislative session, requires all hospitals that provide emergency medical services to have a protocol to provide timely access to a sexual assault medical forensic examination by a forensic nurse examiner or physician. The bill also authorizes a planning committee to review the protocols and to examine other issues to improve the experience of care for individuals seeking a sexual assault forensic exam. The planning committee is now meeting and would like to review hospital protocols. Hospital legislative liaisons this week received a request from MHA to send an electronic or faxed copy of your hospital's procedure for triaging and caring for an individual that comes to your emergency department and is in need of a sexual assault forensic exam. The planning committee hopes to have them by January 30.


Contact: Katie Wunderlich
Learning Network to Address Medicaid Readmissions

Maryland is one of three states participating in a Learning Network to implement the Hospital Guide to Reducing Medicaid Readmissions, a free resource from the Agency for Healthcare Research and Quality (AHRQ). The only federal tool tailored for the adult Medicaid population, the guide helps acute care facilities adapt or expand their current Medicaid readmission reduction efforts. Hospitals at all stages of readmission reduction work can benefit; highlights of the guide include: 

  • Consolidated best practices from readmissions toolkits like RED, STAAR, and BOOST,tailored to meet the transitional care requirements for Medicaid patients. 
  • Thirteen customizable online tools to develop your Medicaid reduction strategy, such as
    • The Conditions of Participation checklist to comply with Centers for Medicare & Medicaid Services guidelines to standardize and improve transitional care for all patients
    • A cross-continuum tool to identify and develop partnerships with transitional care facilities and community-based resources to reduce Medicaid readmissions 

Click here to download the guide . MHA will hold three webinars (February 25, March 11, and March 25 from 1-2 p.m.) and a face-to-face meeting on April 1 as part of the Learning Network.


Contact: Nicole Stallings

MHA Comments on Proposed Changes

MHA this week sent comment letters to the Health Services Cost Review Commission on proposed changes to the following three programs: 

  • Draft Recommendation for Modifying the Maryland Hospital Acquired Conditions Program for FY 2017
  • Draft Recommendation for Updating the Hospital Readmission Reduction Incentive Program for FY 2017
  • Draft Recommendation for Aggregate Revenue Amount at Risk under Maryland Hospital Quality Programs for FY 2017 

The comment letters can be downloaded at the MHA website

MIEMMS, DHMH Respond to Flu Spike
In light of a significant increase in flu cases over the past month, the Maryland Institute for Emergency Medical Services Systems and the Department of Health and Mental Hygiene have asked hospitals to evaluate institutional measures that may be useful in expediting the transfer of patient care from EMS providers to emergency department medical staff, as well to evaluate the emergency department transfer of patients and inpatient resources. MIEMMS and DHMH sent a letter to hospitals on Thursday with the request, as well as additional information on how to best manage patient flow. Questions should be directed to Dr. Richard Alcorta of MIEMMS at 410-706-0880 or Dr. Lucy Wilson of DHMH at 410-767-6700.
For Your Information
The minutes from the December 2 MHA Executive Committee meeting can now be downloaded from the MHA website.
Emergency Medicine Population Health Summit set for March
MHEI new logo

The Maryland Healthcare Education Institute's Value Based Emergency Medicine Summit will address several key issues, including: 

  • Quantifying the Impact of Value-Based Emergency Medicine Strategies
  • Innovative Strategies for Managing High Utilizers of the ED
  • Strategies for Aligning Hospital and Emergency Physician Incentives
  • Variability in Physician Practice - What is it Costing Your Hospital and What You Should Do About It 

The summit will be held March 13 at the Baltimore Marriot Waterfront. Registration is available through the MHEI website, with the first 100 registrants receiving a discount.

Contact: Kelly Heacock
Prime to Share Choice Offerings in Update
PRIME New logoOpportunities from Prime, MHA's shared service/group purchasing subsidiary, are now a regular feature in MHA Update. While Prime offers many benefits, including connections to vetted, cost-efficient vendors and an annual shareback program for members, working with Prime directly benefits hospitals in another way: Each year, revenue from Prime is directed to MHA to support advocacy efforts that improve the overall health care environment in Maryland. These revenues are critical to MHA's work in supporting things like the Medicare waiver and the elimination of the onerous Medicaid tax. As you consider your purchasing options, we encourage you to take a look at what Prime can do for you - not only in helping you make the best purchasing choice for your hospital, but in helping all hospitals throughout Maryland thrive. Stay tuned over the next few weeks for Prime's first opportunity.

Contact: Jim Johnston
The Week Ahead

Wednesday, January 14

Health Services Cost Review Commission meeting


Thursday, January 15

Carmela Coyle presents to the Maryland Organization of Nurse Executives 

MHA Financial Technical Work Group meeting

In Case You Missed It

AHA releases community health resource

AHA's Community Connections initiative recently released "Ideas & Innovations for Hospital Leaders," an annual publication highlighting innovative hospital programs to promote community health, access to health care, and other social and basic needs. Printed copies were mailed to all hospital CEOs to inspire and spark dialogue. For more on the AHA initiative and additional case examples, visit


Top News from This Week



Md. Panel Approves O'Malley Proposal for More Than $200 Million in Budget Cuts
The Washington Post, By Ovetta Wiggins, January 7, 2015


President Pledges First Veto in 2015 Obamacare Wars
Modern Healthcare, By Paul Demko, January 7, 2015


Why For-Profit Hospitals Are Poised for a Strong 2015 (And Not-For-Profits Aren't)
Modern Healthcare, By Beth Kutscher, January 6, 2015


Health Exchange Enrolls More Than 156,000 People
The Baltimore Sun, By Meredith Cohn, January 5, 2015


Hospital Quality Reporting May Hold Down Prices
Modern Healthcare, By Melanie Evans, January 5, 2015


Some Forced to Buy on Health Insurance Exchanges for the First Time
The Baltimore Sun, By Meredith Cohn, January 4, 2015


Sharfstein Preparing for Leadership Role at Johns Hopkins University
WTOP, By Paula Wolfson, January 4, 2015


Hogan's Pick for Health Chief Says He'll Avoid Conflicts
The Baltimore Sun, By Michael Dresser and Meredith Cohn, January 2, 2015