MHA Update Newsletter
March 13, 2015
Save the Dates!

 June 1 and 2, 2015

MHA Annual Meeting
Four Seasons

Hotel Baltimore


MHEI Programs & Webinars


March 18

Physician Leadership Initiative



March 19

MPSC Failure Modes and Effects Analysis



WEBINAR: Challenges for Nursing: Complying with CMS and The Joint Commission Standards


Quick Links


On the Front Lines

The state's battle to overcome Maryland's heroin epidemic is underway, as the Heroin and Opioid Emergency Task Force kicks off a series of regional summits next week to better understand the nature of the problem. The summits will bring together hospitals, addiction experts, law enforcement, behavioral health professionals, those who have struggled with addiction, their families, and others to help zero in on solutions to this pervasive problem.


And the problem is getting worse. Heroin overdose deaths have jumped in recent years, from 247 in 2011 to 464 in 2013 - an 88 percent increase. In the first six months of 2014 alone, there were 296 deaths.


As you well know, many of the people suffering from heroin addiction wind up in hospitals' emergency departments, where care is most expensive, and certainly not the appropriate place to address the underlying addiction problem. That's one reason hospitals must be highly engaged with the task force and its efforts.


The task force will need your help to:

  • Share information about the summits and the task force with your communities
  • Understand the impact of the heroin epidemic on your community - it's important that the task force hear from hospital leaders and clinicians
  • Provide concrete recommendations for solutions 

As we work on this problem together, it's important that hospitals have a leading presence at the summits and throughout this process. You can register for the summits here; questions and comments can be emailed here.


As Gov. Hogan noted in his executive orders creating the task force and the Intra-agency Heroin and Opioid Coordinating Council, heroin abuse is no less than a public health crisis for the citizens of Maryland. And when the health of the public we serve is threatened ... that's one of the many opportunities for hospitals to show what they're all about.

Carmela signature
In This Issue
At Work in Annapolis

It is that time of session when bills are moving quickly to meet crossover deadlines. On Tuesday and Wednesday, MHA testified in support of SB188-Task Force to Study the Establishment of Health Courts, which would

require a task force to study the adequacy and cost of state laws and policies relating to the litigation of medical malpractice cases. It also would make recommendations regarding the establishment of health courts to hear medical malpractice cases and the feasibility of assigning a medical malpractice case to a single judge throughout the litigation process.


Also on Tuesday, MHA testified in support of HB650 Blue Ribbon Commission to Study Maryland's Behavioral Health System sponsored by Delegate Joseline Pena Melnyk. This bill would create an independent, statewide Blue Ribbon Commission composed of experts in the field who will analyze the current problems with Maryland's behavioral health system. The commission will provide concrete, actionable recommendations to address the deficiencies contributing to this growing crisis.


On Wednesday, MHA testified on several other bills in both the Senate and House. MHA submitted written testimony in support of SB430-HB975 Maryland Medical Assistance Program-Mental Health and Substance Use Disorder Benefits-Parity, which provides that certain provisions of law apply to mental health and substance use disorder benefits provided by the Maryland Medical Assistance Program or administered by an administrative services organization; requires the Department of Health and Mental Hygiene to use certain standards in determining compliance with a certain provision of law; requires the department to use certain criteria in determining medical necessity for substance use disorder services; and generally relates to the Maryland Medical Assistance Program and mental health and substance use disorder benefits.


MHA supported via written testimony SB469-HB367 Public Health-Maryland Behavioral Health Crisis Response System, which requires the Behavioral Health Administration to create a statewide Behavioral Health Crisis Response System that provides 24/7 response through skilled clinical intervention, and to respond quickly and effectively to community crisis situations. The system would feature walk-in crisis communication centers open 24 hours a day in each Maryland jurisdiction or region, in coordination with local agencies, police and emergency medical services, and behavioral health providers, as well as provide crisis residential beds to serve as an alternative to hospitalization.


Wednesday's schedule included several bill hearings in the House Judiciary Committee. MHA was part of several panels that testified in support of HB817 Health Care Malpractice-Limitation on Noneconomic Damages, which decreases to $500,000 the cap on noneconomic damages in health care malpractice claims arising on or after October 1, 2015. This proposal would lower liability costs and the cost of health care in Maryland. Further, the practice of defensive medicine, aided by a high-value damages ceiling, unnecessarily inflates the cost of providing health care, which threatens hospitals' ability to live within the fiscal constraints of a modernized Medicare waiver.


MHA offered oral and written testimony in opposition to HB398 Civil Actions-Noneconomic Damages-Catastrophic Injury, which would increase the maximum amount of noneconomic damages that may be recovered in health care malpractice and other civil actions for a catastrophic injury under specified circumstances. This proposal would raise fees for plaintiffs' attorneys and increase malpractice insurance rates (and thus health care costs for everyone). Further, the practice of defensive medicine, encouraged by astronomical jury awards, unnecessarily inflates the cost of providing health care, which threatens hospitals' ability to live within the fiscal constraints of a modernized Medicare waiver. If the waiver is lost due to failure to meet these fiscal limits, Maryland stands to lose an estimated $2 billion each year in federal dollars.


MHA provided oral and written testimony opposing HB470 Health Care Malpractice-Certificates and Reports of Qualified Experts, which requires that, in health care malpractice cases, an objection to the sufficiency of a certificate of qualified expert or report must be filed within 14 days after the filing of the certificate or report. The bill further specifies that, if the arbitration panel chairman or the court rules that a party's certificate or report is legally insufficient, the party must file a legally sufficient certificate and report from an attesting expert within 30 days of the order's entry.


MHA testified and provided written support for HB547 Medical Liability Efficiency Act of 2015. This bill repeals the provisions relating to the Health Care Alternative Dispute Resolution Office; prohibits a person from bringing an action against a health care provider for a medical injury unless the person provides to the health care provider a specified notice, medical records, and releases at least 90 days in advance of the action; terminates the Health Claims Arbitration Fund; alters the content of specified certificates of a qualified expert. This bill takes a series of practical steps to make Maryland's liability climate more efficient and more equitable by changing liability-related regulations so that they will: discourage the practice of defensive medicine, foster better communication between doctors and patients, help patients be compensated in a fair and timely manner, reduce incidence of frivolous lawsuits and reduce liability premiums.


MHA again joined several panels and testified in support of SB585-HB553 Maryland No-Fault Injured Baby Fund, which is a critical measure to ensure that the tens of thousands of women who give birth in Maryland each year have access to quality obstetric services. In addition, for the handful of cases each year that would qualify for reimbursement from this fund, a no-fault mechanism provides timely, efficient compensation - without asking injured parties to play in the "litigation lottery," where results are uncertain and won't be determined for years.


On Thursday, MHA testified and provided written supportive testimony for SB513-HB613 Hospitals-Rate-Setting Participation in 340B Program Under the Federal Public Health Service Act, which alters the definition of "hospital services" to include a specified hospital outpatient service of a specified hospital (those that are part of a merged asset hospital system) for the purpose of allowing the hospital outpatient service to continue to participate in the federal 340B Program under rates set by the Health Services Cost Review Commission.


MHA also testified in opposition of SB572-HB1006 Hospitals-Designation of Caregivers, which would require hospitals to provide patients or the legal guardians of patients with a specified number of opportunities to designate a caregiver within a specified number of hours after the entrance of the patient to the hospital, and before the patient is discharged from the hospital; and require a hospital to document in a patient's medical record specified information. The bill requires hospital staff to develop a discharge plan that describes a patent's after-care assistance needs and how those needs will be managed at a patient's residence, and to provide designated caregivers with instructions, as well as a demonstration of after-care tasks in the discharge plan. The bill is redundant to the standards that hospitals are already meeting.


MHA Supports No-Fault Birth Injury Fund
MHA President and CEO Carmela Coyle joined state Del. Dan Morhaim, M.D., at a press conference Wednesday in Annapolis in support of Morhaim's bill to create a no-fault birth injury fund for Maryland. The fund would generate $25 million per year, paid for by hospitals, to provide timely, efficient compensation for injured babies. Coyle noted the merits of a birth injury fund, including avoidance of the "litigation lottery" and greater access to obstetrical services for all Marylanders. Morhaim emphasized the strong bipartisan support for the bill, evidenced in a statewide poll conducted by OpinionWorks that showed 69 percent of Democrats and 52 percent of Republicans support the creation of a birth injury fund. Steve Raabe, founder and president of OpinionWorks, also spoke at the press conference, noting that voters, by a 3-1 margin, overwhelmingly support the concept of a birth injury fund. Dr. Tyler Cemet, president of MedChi, pointed out that the motivation for doctors and hospitals to create this fund is that they will be better able to care for their patients. Lawyers, on the other hand, he said, are motivated by financial interests. Click here to view video of the press conference.
Commissioners Hear Concerns about Readmissions Policy, Total Quality Payments at Risk

The Health Services Cost Review Commission this week took action on final staff recommendations on its Readmissions Reduction Incentive Program, as well as the total amount of inpatient revenue at risk for all of its quality-based programs. Despite significant concerns raised by MHA, commissioners voted to implement these policy changes for rates beginning July 1, 2016, which use calendar year 2015 as the performance period. Commissioners also received a draft recommendation on using $15 million in funding identified in the 2014 Budget Reconciliation Financing Act on a series of regional and statewide care coordination efforts. You can read more in this month's edition of Newsbreak.


Contact: Mike Robbins
MHA Seeking Comment on Work Group Definitions
Clinical and quality leaders on Wednesday received a request for comment on proposed definitions for Acute Renal Failure / Acute Kidney Injury (ARF/AKI). This request is part of an effort to address the variability in clinical criteria used to define certain diagnoses. Standardization of this definition will support hospitals' ability to effectively collaborate on care improvement as well as facilitate accurate measurement of improvement under the new hospital waiver and the Maryland Hospital Acquired Condition payment policy. To support this work, MHA convened four multidisciplinary work groups from a cross-section of Maryland's community and teaching hospitals and health systems. In addition to the work group that is addressing ARF/AKI, three other work groups are concurrently developing definitions on urinary tract infections, obstetrical hemorrhage, obstetric laceration, respiratory failure, pneumonia and aspiration pneumonia. Final definitions will be disseminated to all hospitals with the request that Medical Executive Committees consider them for adoption. Materials from each of the work groups can be found here.
Register for Statewide Readmissions Meeting

Please register now to join us for our statewide meeting on reducing Medicaid readmissions on Wednesday, April 1 at Turf Valley. During the meeting, which marks the conclusion of MHA's Learning Network to reduce Medicaid readmissions, hospitals will recap the work over the past several weeks and learn about additional strategies that will help accelerate progress on improving care transitions and reducing avoidable readmissions. Register here.


The Learning Network's last webinar will be March 25 from 1 p.m. to 2 p.m. To register, please click here.


Contact: Sheena Siddiqui
Can Individual Coaching Help Your Managers?
MHEI new logoWe know from experience that all the information learned in a classroom doesn't always make it back to an organization in a manner that takes full advantage of its power. At the Maryland Healthcare Education Institute, we recognize that many times what is needed is concentrated attention to a real-world problem, on-site at an organization, with one-on-one attention for a manager from an experienced facilitator/leader. For this reason, MHEI is now offering, as part of our array of services, one-on-one specific coaching for any manager in your system. Many times, the coaching is paired with a classroom experience in which the lessons from the session provide the basis for the coaching. On other occasions the coaching is designed specifically for the particular situation the manager is facing. In either scenario, MHEI professionals work with individual managers to assist in helping them successfully accomplish their task.

Contact: Mark Rulle
Prime Welcomes a Unique Opportunity to Create Revenue
PRIME New logoPrime, the shared services/group purchasing subsidiary of MHA, would like to introduce its members to The Mainsail Group. This group helps clients find new and significant means of revenue and cost containment. They help hospitals form strategic partnerships with consumer brands in a manner supportive of a health system's mission. Everyone agrees that economic constraints, as they currently stand, mean future operational and financial difficulties for health care. Mainsail works with astute operators to help maximize ancillary points of revenue while hospitals shore up their plans to succeed in their core business. Models used to create these multi-million dollar partnerships borrow heavily from sports marketing principles created to take financial advantage of hospitals being a "community destination," similar to an arena or stadium. Their track record includes the generation of over $95 million of new savings and revenue for leading hospitals across the country. Health systems can realize $210 to $315 per bed in net financial gain on an annual basis. Their consulting service requires zero upfront cost, and they only receive payment if they first generate financial gain for their clients.

Contact: Jim Johnston
Spring Into Sustainability: An Introduction to Sustainable Practices for Long Term Care Facilities

Maryland Hospitals for a Healthy Environment (MD H2E), in partnership with the Beacon Institute of LifeSpan Network,is hosting an opportunity for senior living facilities to learn about environmental sustainability practices. Sustainable health care practices promote new roles for retired citizens that will benefit their physical, mental and emotional health. Increasing community collaboration on sustainable and local food production will benefit producers, consumers, and the environment, and will foster increased self-reliance among communities.This conference is the first of its kind to bring examples from other long-term care facilities in the area. This is an interactive learning opportunity with the chance to connect and learn from hospitals, chefs and other senior care facilities that have sustainability programs in place. The program will be held Tuesday, April 28 from8 a.m. to 2 The Institute for Integrative Health, 1407 Fleet St., Baltimore, MD 21231.


Contact: Tarah Ranke
The Week Ahead

Tuesday, March 17

MHA Council on Financial Policy meeting


Thursday, March 19

Prime Board meeting


Mark Your Calendars for MHA's Annual Meeting

MHA's annual meeting is scheduled for June 1-2 in Baltimore and will feature a pair of exciting guest speakers, as well as peer learning breakout sessions. Paul Keckley, Ph.D. is the managing director of the Navigant Center for Healthcare Research and Policy Analysis. He'll turn his analysis toward Maryland's five-year experiment and how the hospital field nationwide is restructuring to achieve the Triple Aim. For our Davidson Lecture, Dr. Leana Wen, Baltimore City Health Department Commissioner, will share thoughts on population health management, and why she moved out of the emergency room and into the world of public health.In addition, the association's annual business meeting will be conducted.Registration will be available in the next couple of weeks. Stay tuned for details on how to sign up.


Contact: Kathy Gotwalt



Save the Date for a Leadership Summit on Cross Continuum Partnership Models

LifeSpan and MHA will convene top national leaders from the hospital and post-acute continuum to highlight specific examples of how cross-organizational and cross-setting partnerships can improve patient outcomes, avoid utilization and help reduce health care costs. The meeting is May 12 at The Hotel at Arundel Preserve.


Contact: Lisa Fichman

Top News from This Week



Time to Mend Maryland's Behavioral Health Safety Net
Center Maryland, By Carmela Coyle, March 2


Maryland Weighs 'Death with Dignity' Legislation
The Washington Post, By Ovetta Wiggins, March 6


Assembly Leaders, Hogan Agree on Augustine Bills
The Baltimore Sun, By Michael Dresser, March 9


Hundreds of Hospitals Struggle to Improve Patient Satisfaction
Kaiser Health News, By Jordan Rau, March 10


Civil, Disability Rights Groups Clash Over 'Death with Dignity' Bill
The Daily Record, by Steve Lash, March 10


Mental Health Providers Look for Federal Incentives to go Digital, Too
Kaiser Health News, By Lisa Gillespie, March 11


Plaintiffs', Defense Lawyers Clash Over Medmal Cap
The Daily Record, By Steve Lash, March 11


Maryland Has No New Money to Spend, Revenue Board Says
The Baltimore Sun, By Michael Dresser, March 11