MHA Update Newsletter
January 23, 2015
Save the Dates!

 June 1 and 2, 2015

MHA Annual Meeting
Four Seasons

Hotel Baltimore


MHEI Programs & Webinars

January 27

MPSC Positive Accountability and Just Culture


Quick Links


Under the Radar

Take a minute to glance up at the sky. At any given moment, there are some 5,000 planes criss-crossing the skies above the United States, about 87,000 per day. Of those, nearly 29,000 are commercial flights.


Of course, human flight itself is a marvel of engineering and perseverance, but the sheer magnitude of daily flying operations is staggering. Consider also the countless people who, somewhere along the line, have a hand in making sure that when you step onto a commercial jet your flight is comfortable, affordable and, above all, safe.


A single flight starts with the manufacturers - welders, machinists and engineers, then the quality testers, then the pre-flight crew - the fuel staff, the safety inspectors and ground agents. Of course, there are the pilots, air traffic controllers, flight attendants. All play a role, though the public is usually only aware of the pilots and the flight crew.


Likewise, the amazing things you do in your hospital every day depend on so many hands beyond those of your doctors and nurses. Whether the final product is a safe trip home from the airport or from your hospital, the point is that there's a lot that goes on behind the scenes.


That's also true at your Maryland Hospital Association. As you work every day to take health care in a new direction, we work every day to make sure your path ... the path of politics, regulations, and legislation ... is a smooth one.


Guiding us is MHA's Strategic Plan, which lays out a rolling three-year roadmap, discussed and approved through our member-driven governance process, which we follow. That roadmap ensures that through the daily avalanche of emails, phone calls and meetings among regulators, legislators, media, physicians, nurses, hospital executives and others, MHA's team stays on track for you. While the big stuff like a new governor and a new Legislature dominate the headlines, it's the behind-the-scenes activities that keep us on track to help your organization succeed.


Below, you'll see a summary of some of the things we're doing on your behalf. A lot of it involves hospital leaders as well as front-line hospital workers. Some of it involves others outside our field. But each and every activity - like those performed by airline workers - is meaningfully undertaken to help you on your path to success as Maryland shows the nation what true innovation in health care is all about.

Carmela signature
In This Issue
MHA's Strategies in Motion

Click here to download a printable version of MHA's Strategy in Motion.


As 2015 kicks off, here's just some of what's going on behind the scenes on your behalf as MHA works to help hospitals succeed under the revised Medicare waiver and advocate for you before legislative, executive and regulatory bodies. Each activity aligns with MHA's strategic plan, which includes three overarching goals:

  • Lead health care innovation in Maryland while ensuring hospitals' financial stability
  • Move Maryland hospitals to the leading edge of quality, safety and population health
  • Lead efforts to improve the experience of care for Marylander
Building Relationships

Immediately after November's election, MHA began to establish and, in some cases, rekindle relationships with Gov. Larry Hogan and his key appointees, several of whom are returning from the Ehrlich era. After a successful December reception at which the governor met with hospital leaders, MHA President & CEO Carmela Coyle and MHA staff met personally with the first transition team executive to be named by Gov. Hogan, Robert Neall. Coyle and some of our hospital leaders met personally with Gov. Hogan as he held brief meetings to get acquainted with all interests across Maryland. In addition, Coyle has met with Insurance Commissioner Al Redmer, Chief of Staff Craig Williams, Health Secretary Van Mitchell (who will meet with MHA's Executive Committee next week), and Budget Secretary David Brinkley. Key messages: hospitals and their more than 100,000 employees are key economic engines; we can help the administration cut costs by succeeding under the waiver; and we are here to help with all things health care.


Waiver Watch

Success under Maryland's Medicare waiver means tracking hospitals' performance under the five key measurements of the waiver: three financial targets and two quality metrics. MHA has brought in new staff expertise to help us work closely with HSCRC and its contractors to validate the waiver results that are being compiled by HSCRC and the federal Center for Medicare and Medicaid Innovation, and to analyze the underlying service trends. MHA staff analyzes detailed Medicare claims data, HSCRC abstract data, and other policy projections from the Centers for Medicare & Medicaid Services, the Medicare Payment Advisory Commission, and others, to understand hospital versus non-hospital spending trends, as well as overall health care spending trends compared to expected levels. These analyses help us track and impact regulatory decisions affecting important categories such as readmissions, uncompensated care, population and demographic adjustments, avoidable utilization policies, and more.


Defining Complications 

Much progress has been made to reduce complications in Maryland's hospitals, the result of better clinical care as well as improved documentation and coding. Key to continued success, which is part of our charge under the new Medicare waiver, is to standardize definitions for various complications. MHA's Joint Quality-Finance Work Group has approved the first phase of work toward this end, which addresses the considerable variability in criteria used for certain diagnoses that hinders collaboration on care improvement. MHA is convening four other work groups of physician, clinical, documentation and coding professionals to propose standard clinical definitions for certain conditions. And we have asked hospital chief medical officers, chief nursing officers and heads of quality to submit to us clinical criteria and definitions they have established, so that we can work toward an all-important, measureable and universal standard.



To meet the goals of the Medicare waiver, collaboration and cooperation across the health care field are paramount. This means of course, that physicians must have the same types of incentives to work with us and improve health as hospitals do under global budgets. Gainsharing, a structured arrangement to provide incentives for physicians to work with hospitals to reduce costs, has proved successful in New Jersey and New York and is an important step toward other population-based payment arrangements. MHA has convened interested hospital leaders to guide development of a proposal for such a program in Maryland. Working with HSCRC and the new Hogan administration, MHA will seek authority for a gainsharing program under our existing waiver contract. MHA held an all-member informational webinar in the late spring to explain how the program would build on hospitals' current efforts and enhance the opportunity to achieve efficiencies and multiply savings. We held similar sessions with MedChi and HSCRC. MHA in August engaged Applied Medical Software, which has designed, developed and implemented large scale, comprehensive gainsharing programs in New Jersey and New York. MHA will soon begin recruitment across the hospital field.


Population Health

MHA's affiliate, the Maryland Healthcare Education Institute, is all in for population health. MHEI offers several classes in skills essential to succeeding in this health care transformation, several available onsite at hospitals. Its popular annual conference in October has for three years singularly focused on population health issues, bringing to attendees leading edge thinking as well as real-life examples that work. MHEI's value-based summit in March helps health care providers develop strategies for delivering better, faster and less expensive care. While emergency department expenditures account for between 2 percent and 4 percent of overall health care expenditures, for example, the ED serves as a gateway for more than half of all hospital admissions; that could be a key to success under the revised waiver.


MHA continues to lead Maryland's Care Transitions Steering Committee, which is charged with, at the local level, helping hospitals work with cross continuum teams to improve care transitions and reduce readmissions; and at the state level, to provide visibility and mobilize solutions to common systemic challenges surrounding readmissions. MHA's President & CEO Carmela Coyle also co-chairs HSCRC's Care Coordination and Infrastructure Work Group, which is charged with, among other things, identifying statewide and regional "accelerators" of care coordination and how Medicare data can be acquired and used to improve care coordination.


On the readmissions front, 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 federal Agency for Healthcare Research and Quality. 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 will benefit. MHA will hold three webinars and a face-to-face meeting as part of the Learning Network, a key part of our overall readmissions activities.


Talking About the Waiver

MHA is using a report from Annapolis research firm OpinionWorks, which recommends how to position the waiver with the public, to inform our communications materials and advocacy efforts. An outgrowth of several community conversations MHA participated in about how to talk with the public about Maryland's unique way of paying for and delivering hospital care, the report will be presented to MHA's Executive Committee. Commissioned by Health Care for All, the report bases its conclusions on a series of focus groups held throughout Maryland over the past six months. The focus groups helped identify the elements of the modernized waiver and its attendant changes that would likely be received as positive, as well as those that would be perceived negatively. In January, MHA hosted Health Care for All and dozens of community, health care and religious leaders to discuss the report and develop strategies for how it can build effective communication around the modernized waiver. Health Care for All is using the report as the foundation for 10 statewide public meetings it is holding to explain the waiver and how it is changing health care in Maryland.


Hospital Executives Discuss Waiver with Senate Committees
A group of hospital advocates and executives on Thursday told the state's Senate Budget and Taxation and Finance committees that while progress is being made to improve the quality of health care and keep costs down, there is still much work to be done. Following an overview from Health Services Cost Review Commission Chairman John Colmers and Executive Director Donna Kinzer, MHA President and CEO Carmela Coyle updated the committee on current status of the modernized Medicare waiver and discussed the importance of infrastructure investment and eliminating the Medicaid tax as means to help meet the waiver's metrics. Greater Baltimore Medical Center CEO John Chessare discussed his hospital's transition to a Patient-Centered Medical Home - a change that has required significant infrastructure investments and represents a shift from volume to value. Johns Hopkins Medicine Director of Clinical Resource Management Amy Deutschendorf explained the importance of care coordination in reducing readmissions, one of the waiver metrics that hospitals are not currently meeting, and the importance of having available funds to invest in these efforts.

Contact: Valerie Shearer-Overton
Feds Issue Final Regulations for Charitable Hospitals
The IRS and Department of the Treasury have released final regulations that implement the requirements for charitable hospitals resulting from the Affordable Care Act. The regulations address financial assistance policies, limitations on charges, billing and collection, as well as community health needs assessment and sanctions for noncompliance. The final rules apply to tax years beginning after Dec 29, 2015. AHA has outlined guidelines to strengthen the relationship between hospitals and their communities and to reassure patients, regardless of their ability to pay, of hospitals' commitment to caring. The attached advisory contains further details on the final regulations.
CDC Announces Antiviral Shortage Request Progress

The 2014- 2015 flu season has been especially severe and some facilities have reported difficulty accessing antiviral supplies. The Centers for Disease Control and Prevention (CDC) is working with antiviral manufacturers and assures all states that there are no national supply shortages, but rather distribution delays. If a health care facility is experiencing problems getting antiviral orders filled, attempts should first be made to obtain stock from associated institutions, members of a health care coalition, or other mutual aid avenues. If after these attempts the facility is still unable to obtain stock and is in danger of exhausting its supply, it should contact the local health department: 

  1. Complete the DHMH Emergency Medical Countermeasure Request Form, completing all fields starting with line 1. Remember to indicate the quantity of the antiviral you are requesting. If the needed formulation is not listed on the form, you can enter the needed item beginning at line 173.
  2. Contact your local health department to alert it of the problem and send the request form.
  3. The local health department will contact the Office of Preparedness and Response (OP&R) to convey the request.
  4. OP&R will work with federal partners to coordinate with supply chain partners to rapidly redirect supply to the identified healthcare facility.
  5. DHMH will communicate back to the facility and local health department what is being done to ensure antiviral supplies are quickly accessible to the requestor. 
Any Maryland health care facility may make a request, but must first have placed an order through regularly established channels or the CDC will not be able to expedite that order. Making a request is not a guarantee that a facility will receive supplies more rapidly. It is an avenue to allow CDC to work with vendors to prioritize existing orders.
MHEI Physician Leadership Cohort II Forming
MHEI new logo
In 2014, MHEI began a Physician Leadership Program for emerging physician leaders, designed to assist in understanding issues around staff motivation, emotional intelligence, organizational culture and other leadership concerns. The initial cohort began September 2014 and will conclude this spring. MHEI is looking for physicians interested in participating in the second cohort, which begins in September. Each cohort consists of no more than 15 participants and will be available on a first come, first served basis. For program details and dates contact Alison Burrows at MHEI.

Contact: Alison Burrows
The Week Ahead

Tuesday, January 27

- MHA Executive Committee meeting


Friday, January 30

Carmela Coyle presents at the MedStar Montgomery Medical Center Board Retreat

In Case You Missed It

New Guidance on Humidity Levels in the OR

A change in the standards regulating a hospital's physical environment in the operating room may conflict with the instructions for use on some equipment and supplies routinely used in surgery. To ensure patient safety during surgery, the American Hospital Association, in collaboration with its personal membership groups, the American Society for Healthcare Engineering and the Association for Healthcare Resource & Materials Management, urges hospitals to examine their humidity levels in the operating room and consider the effects on equipment and products used during surgery. This advisory and associated attachments will assist in your assessment.
Top News from This Week


Hogan Pledges Culture of 'Tolerance and Mutual Respect' in Annapolis
The Baltimore Sun, By Michael Dresser and Erin Cox, January 21, 2015


What is President Obama's 'Precision Medicine' Plan, and How Might it Help You?
The Washington Post, By Lenny Bernstein, January 21, 2015


'Just' a Small Businessman, Hogan Bringing a New Style to State House
The Baltimore Sun, By Erin Cox, January 20, 2015


Nearly 140 Businesses Sign Up For Coverage Through State Health Exchange
The Baltimore Sun, By Meredith Cohn, January 20, 2015


Accountable Care Organizations: Like H.M.O.s, But Different
The New York Times, By Austin Frakt, January 19, 2015


Preventing Falls in Seniors an Ongoing Effort
The Baltimore Sun, By Meredith Cohn, January 19, 2015


Flu is Hitting Maryland Earlier and Harder
The Baltimore Sun, By Meredith Cohn, January 18, 2015


O'Malley Suggests $640 Million in Budget Cuts in Final Days in Office
The Washington Post, By Ovetta Wiggins, January 16, 2015