MHA Update Newsletter
March 20, 2015
Save the Dates!

 June 1 and 2, 2015

MHA Annual Meeting
Four Seasons

Hotel Baltimore


MHEI Programs & Webinars


March 26

WEBINAR: Transformation to Value-Based Care: How Ready Are You?


Quick Links


Facts vs. Feelings

More than 25 years ago, federal lawmakers wisely saw fit to enact the so-called "Stark laws," limiting physician referrals to facilities in which they have a financial interest and preventing health care providers from acting in their own financial self-interest, rather than in the best medical interest of their patients.


There are similar regulations in Maryland that nullify any financial motivation for further diagnostic testing, limit unnecessary utilization and, as a result, help keep health care costs in check. In fact, Maryland has some of the toughest laws in the country.


This system, which has served Marylanders well for years, is under direct attack in the General Assembly, with a well-funded push to loosen the regulations and allow medical oncologists to both own radiation therapy and CT services and refer patients to those services in which they have a direct financial interest.


To be blunt, this is an uphill battle for hospitals to fight - partially because supporters of the change are arguing their point on an emotional, rather than factual level. They are focusing on individual stories of cancer patients who testify about access problems, and they are claiming they are asking for only the narrowest of exceptions. Of course, with nearly four dozen hospitals statewide that offer radiation therapy services (not to mention a slew of other providers), the access concern is entirely a straw man argument.


But that doesn't mean it's not compelling for legislators unfamiliar with the issue.


We've been working to counter that sentiment with hard facts about how loosening these regulations actually generates suspect, unnecessary care. Numerous studies show that physician self-referral leads to increased utilization of services that may not be medically necessary, poses potential harm to patients and costs the health care system millions of dollars each year.


A few examples from recent reports from the federal Government Accountability Office:

  • Medicare spent $109 million more in 2010 than it would have without self-referral incentives
  • From 2004 to 2010, the number of self-referred MRI services increased by more than 80 percent, compared to a 12 percent increase for non-self-referred MRI services.
  • Increased self-referrals in 2010 led to more than 900,000 unnecessary referrals

There was a hearing on this bill earlier this week and the testimony from our panel was both merit-based and powerful. While some legislators seem supportive of our position, nothing is certain until the votes are counted.


As with dozens of other important issues we are fighting for and against in Annapolis, this one will come down to the wire. And, as Gen. Douglas MacArthur once said, " win or lose, live or die - and the difference is just an eyelash."
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In This Issue
At Work in Annapolis

March 23 marks cross-over day when bills from each chamber with favorable votes make their way to the opposite chamber. MHA will aggressively monitor and move bills of importance through the process. Following is a snapshot of important issues from this week's action.


On Monday, MHA testified in strong opposition to HB683 Health Occupations-Magnetic Resonance Imaging Services and Computed Tomography Scan Services-Patient Referrals, which would provide an exception to the state's prohibition on physicians and other health care providers referring patients to facilities in which the provider has an ownership or financial interest. This bill is similar to HB944-SB539, but not limited to radiation therapy. MHA also testified in strong opposition to HB944-SB539 Patient Referrals-Oncologists Radiation Therapy Services and Nondiagnostic Computer Tomography Scan Services. This bill alters the definition of "in-office ancillary services" to include specified oncology group practices or offices of oncologists who provide specified radiation therapy services or computer tomography services, in order to exempt them from the state's prohibitions on self-referral. The ability of a provider to refer a patient to a facility owned in whole or in part by that provider has long been prohibited in both federal and state law, for good reason. Decisions about patient care should be made strictly in the best interests of the patient, not potentially sullied by that provider's potential financial gain.


Also on Monday, MHA, along with several panels, testified in support of SB585-HB553 Maryland No-Fault Injured Baby Fund, 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. This bill was jointly assigned to both the House Judiciary and Health and Government Operations committees.


On Tuesday, MHA testified in opposition of HB1101-Department of Health and Mental Hygiene-Health Program Integrity and Recovery Activities, which would substantially amend current law governing hospital and other health care provider participation in the Medical Assistance Program ("Medicaid") by imposing a substantial risk of recoupment of paid claims not based on identified claims errors - those found not to be eligible for reimbursement - but instead to be based on an extrapolation. In addition, it would require the posting of a substantial bond for each "location" in which care is rendered, leading to the imposition of a substantial financial burden on hospitals and other health care providers simply to be eligible to provide services to Medicaid beneficiaries. Rather than encouraging and facilitating care to the indigent population eligible for Medicaid benefits, this legislation imposes excessive burdens on providers of care.


MHA provided supportive written and oral testimony on Tuesday for HB71-SB56 Creation of a State Debt-Maryland Consolidated Capital Bond Loan of 2015, which authorizes the creation of a state debt in the amount of $1.068 billion, the proceeds to be used for various capital projects. MHA's project requests are over $3.6 million to provide an array of expanded and enhanced services with a focus on improving patient safety, expanding access to care, and reducing unnecessary admissions and readmissions. Although the program is authorized to request up to $5 million, the fiscal year 2016 request falls slightly short of this limit. The changing and uncertain landscape of hospital financing under the new hospital Medicare waiver has resulted in a conservative request by hospitals to begin new capital projects. Moving forward, we expect that funding requests will be at the $5 million appropriation level and higher in 2019, 2020.   


On Thursday, MHA offered written testimony in opposition of HB969-SB688 Labor and Employment-Fair Scheduling Act, which requires an employer to provide employees with a specified work schedule within a specified time period, notify employees of specified changes, and provide employees with a new work schedule within 24 hours after making a change to the initial schedule; requiring an employer to conspicuously post at each work site specified work schedules; requiring an employer to pay specified predictability pay under specified circumstances. The very nature of hospital work dictates that hospital leaders must have flexibility in scheduling workers. Sickness, illness, accidents, and catastrophes do not occur on regular schedules. Requiring 21 days of notice for an employee's work schedule, as the bill does, and mandating that a worker begin his schedule on the same day of each week, is simply not tenable in the fast-paced and quickly-changing environment of hospital care.


Countdown to Sine Die

Over the remaining weeks, the General Assembly has one priority: pass a balanced state budget, which must be approved by April 6. With hearings completed on bills of interest to hospitals, MHA staff are now working to ensure the appropriate outcome of the bills we supported, amended, or opposed. We also, of course, remain focused on maximizing our opportunities to reduce hospital assessments and mitigating any negative impact that final budget negotiations may have on hospitals.
HSCRC Data Available for RFPs

The Health Services Cost Review Commission (HSCRC) on Wednesday released several data packages to support hospital-led responses to the Regional Partnerships for Health System Transformation Request for Proposals. HSCRC will host a brief webinar to review the data on Tuesday, March 24 at noon. Click here to register. As much as $400,000 will be provided to each of five or more partnerships across the state. As MHA stated in a February 12 Member Alert, the funding was included in last year's state Budget Reconciliation and Financing Act to spur the collaborations needed to meet the goals of Maryland's revised all payer hospital rate setting system and transform care delivery. To accelerate this transformation, the state will fund regional partnerships to collaborate on analytics, delivery of care coordination and services based on patient and population needs, and population health improvement approaches. Awardees will be responsible for developing a Regional Transformation Plan that outlines a concept for a delivery and financing model. Applications are due April 15 and awards will be announced in early May. The Request for Proposals and other supporting information is available here.


Contact: Nicole Stallings
Report: Readmissions Dropping
The American Hospital Association's latest Trendwatch report, on the hospital readmissions program was released Thursday at a Capitol Hill briefing in which hospital leaders called for changes in Medicare's Hospital Readmissions Reduction Program. During the briefing, panelists urged Congress to support the Establishing Beneficiary Equity in the Hospital Readmission Program Act, which would require the Centers for Medicare & Medicaid Services to account for patient sociodemographic status when making risk adjustments to the readmissions penalties. The Trendwatch report shows that the national readmission rate is declining, but reducing readmissions is a "complex undertaking because not all readmissions can or should be prevented; indeed, some are planned as part of sound clinical care."
Registration Open for Statewide Readmissions Meeting

MHA's statewide meeting on reducing Medicaid readmissions will be held on Wednesday, April 1, at Turf Valley. This meeting marks the conclusion of a Learning Network to implement AHRQ's Hospital Guide to Reducing Medicaid Readmissions. During the meeting, hospitals will build on the core components of the Guide and learn about additional strategies that will help accelerate progress on improving care transitions and reducing avoidable readmissions. Speakers include Dr. Amy Boutwell, co-founder of the Institute for Healthcare Improvement's STAAR ( STate Action on Avoidable Rehospitalizations) initiative as well as leaders of Maryland's Medicaid program. In addition, hospitals and community partners will highlight activity at the local level to reduce readmissions for the Medicaid population. Register here. Also, please note that 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
Nearly 200 Attend Value Based Emergency Medicine Summit
MHEI new logoLast Friday, the Maryland Healthcare Education Institute and Emergency Medicine Associates hosted nearly 200 emergency physicians and hospital administrators at the Value Based Emergency Medicine Summit. As emergency departments are responsible for more than 50 percent of all hospital admissions, the optimization of these departments could be the key to unlocking success under the revised Medicare waiver. This summit served as an opportunity to join together to discuss best practices and innovative strategies. "It is exciting to see emergency physicians and hospital management come together to discuss how to collaboratively improve both quality and value," said Dr. Jay Schuur, one of the summit's speakers.  As health care moves toward population health, all organizations will need to deliver better, faster and less expensive services in a coordinated effort. The speakers and topics addressed how an efficiently- and effectively-managed emergency department can help achieve these goals and ultimately reduce readmissions.
The Week Ahead

Tuesday, March 24

MHA Council on Legislative & Regulatory Policy conference call

Maryland Healthcare Education Institute Board meeting


Wednesday, March 25

Transitions: Handle with Care Readmissions Learning Network webinar


Thursday, March 26

- MHA CEO Small Group meeting


Friday, March 27

- Special MHA Executive Committee conference call

In Case You Missed It

AHA Offers Price Transparency Toolkit

The American Hospital Association has released the Achieving Price Transparency for Consumers: A Toolkit for Hospitals. The toolkit takes hospitals step-by-step through the process to become more transparent and highlights a number of best practices that some hospitals have adopted. In addition, a Healthcare Financial Management Association task force in which AHA participated has released price transparency recommendations for health plans, health care providers and others, and a guide to help consumers estimate the cost of care.
Top News from This Week


Rural Hospitals, Beset by Financial Problems, Struggle to Survive
The Washington Post, By Guy Gugliotta, March 15


Inviting Patients to Help Decide Their Own Treatment
Kaiser Health News, By Anna Gorman, March 16


Affordable Care Act Adds 16.4 Million to Health Insurance Rolls
The Washington Post, By Lenny Bernstein, March 16


What Patients Prefer to Know
The New York Times, By Denise Grady, March 16


Intensive Care Gets Friendlier with Apps, Devices
The Wall Street Journal, By Laura Landro, March 16


Families, Advocates and Addicts Tell State Heroin Task Force Their Stories
The Baltimore Sun, By Meredith Cohn, March 17


Here's What We Know About the 289,000 Maryland Health Exchange Enrollees
Baltimore Business Journal, By Sarah Gantz, March 17


Goodbye Miss McAbee: After 50 Years of Caring For Sick Children, Awesome Nurse Retires
The Washington Post, By John Woodrow Cox, March 19