August 14, 2015
Tracking Quality, Quality's on Track
Back in the 1980s, Ford Motor Company had one of the simplest yet most imaginative slogans ever dreamed up by an ad man: "Quality is Job 1." Car company slogans come and go, but for hospitals, quality is always Job 1. Tracking how we're doing on quality is more important than ever: across the country, hospitals are seeing their payments boosted or penalized based on quality measures, and of course our revised Medicare waiver requires us to achieve concrete quality improvements.
 
But you can't track progress without data, so allow me to say a big Thank You! - every hospital in our state has agreed to share with MHA the quality data you are reporting to the state via the CDC's National Health Safety Network. We know you're submitting a lot of data to a lot of places, and adding us to the mix is no simple task. But with your help we are better able to advocate for you as we demonstrate to the public, policymakers and the legislature just how seriously you take Job 1. With this expanded portfolio of data, MHA will soon develop monthly trend reports that track statewide performance on national goals and metrics that the Centers for Medicare & Medicaid Services is using to gauge our progress under the waiver. Aggregate data will also be used in a quarterly report and provided to the American Hospital Association's Health Research & Educational Trust and in MHA's annual quality report that we share with legislators, state regulators and the media.
 
And what are those reports likely to show? Progress of which you can be proud: 
  • You're continuing to reduce Potentially Preventable Complications (PPC). Last year, hospitals collectively reduced PPCs by 26 percent; early data for 2015 indicate that hospitals are on track to meet the 30 percent reduction target mandated by the waiver.
  • Central Line Associated Blood Stream Infections (CLABSI) are down. An average of 92 percent of the units that report data are reporting zero CLABSIs in the most recent 12-month window for which we have data.  
  • Catheter Associated Urinary Tract Infections (CAUTIs) are dropping. There were fewer CAUTIs reported in April, the most recent month for which we have data, than in any of the previous 12 months. 
  • Hand Hygiene compliance remains consistently high. Hospitals have designated observers - secret shoppers of a sort - to catalogue how often staff wash their hands when entering and exiting patient rooms. This data is reported to MHA and, since January of 2014, hand hygiene compliance has been at 90 percent or better. 
All of this shows real progress, and it proves that, for hospitals, Quality is Job 1 is no mere slogan; it drives everything we do. 
Hospitals Asked to Commit to Opioid Prescribing Guidelines for ED
In an effort to stem the statewide misuse of opioids, including heroin, MHA has requested that all of Maryland's acute care hospitals commit to implementing the Maryland Emergency Department Opioid Prescribing Guidelines. The guidelines, developed by MHA's Council on Clinical & Quality Issues and informed by the work of the Massachusetts Hospital Association and the Maryland Chapter of the American College of Emergency Physicians, standardize prescribing practices for emergency departments. It is expected that the implementation of these guidelines will be included among more than a dozen recommendations that the Maryland Heroin and Opioid Emergency Task Force will release later this month. The task force was created in February and has been working to find solutions to Maryland's opioid epidemic - last year, nearly 900 Marylanders died from opioid misuse (including 578 from heroin alone), figures that account for more than 85 percent of all intoxication deaths throughout the state.
 
Contact: Nicole Stallings
MHA Asks Hospitals for Help on Air Ambulance Issue
CEOs this week received a Member Alert from MHA asking for their assistance on an issue with air ambulances. Maryland Insurance Commissioner Al Redmer and state Delegate Pete Hammen have raised concerns about reports of balance billing by air ambulance companies, and the Maryland Insurance Administration (MIA) has asked us to help them better understand the issue. The email from MHA to CEOs lists seven brief questions, the answers to which will allow us to respond effectively to MIA. We remind CEOs to please respond to the email by Tuesday, August 18.
 
Contact: Jennifer Witten
Coyle Elected to AHA Board of Trustees
MHA Board Chair Mark T. Jensen announced to Maryland's hospitals this week that MHA President & CEO Carmela Coyle has been elected to a three-year term on the American Hospital Association Board of Trustees. "This is quite an honor, and a real testament not only to Carmela's leadership at the state level, but also to her reputation at the national level," Jensen said. The Board of Trustees is the policy-making body of the AHA and has ultimate authority for the governance and management of its direction and finances. Jensen continued, "With all eyes on Maryland's unique all-payer system, this position also offers us a chance to bring Maryland's perspective to the national discussion, and the national perspective home."
HSCRC Identifies $21 Million in State Medicaid Savings
The Health Services Cost Review Commission (HSCRC) has identified $21 million in savings to the state's Medicaid program in fiscal year 2016, surpassing the $16.7 million the agency was required to save by the state legislature in this year's Budget Reconciliation and Financing Act. The savings, achieved through a combination of reductions to uncompensated care and other decisions made by the commission as part of the global budget update during its June meeting after working with MHA to ensure that planned savings would be counted, means that additional actions will not be needed in order to secure the required savings. The projected $21 million in savings to the Medicaid program is further evidence of the progress that Maryland's hospitals have made under the all-payer model to reduce the state's health care costs, which also contributed to the legislature's willingness to reduce by $25 million a year the Medicaid hospital tax during this year's General Assembly. A copy of HSCRC's letter to Department of Health and Mental Hygiene and the Department of Budget and Management outlining the savings is here.
Per Capita Hospital Revenue Grows 1.85 Percent in FY 2015
At this month's Health Services Cost Review Commission (HSCRC) meeting, HSCRC staff provided a report on the all-payer revenue growth for the full 12 months of fiscal year 2015, noting that the total per capita growth of 1.85 percent was 0.50 percent below the amount approved by commissioners for the fiscal year. Commissioners also received a number of other updates on Certificate of Need activity, the Consumer Engagement Task Force, and CRISP development activities at this month's meeting. More details can be found in this month's edition of Newsbreak. 
MHCC Upgrades Quality Reports Website
The Maryland Health Care Commission (MHCC) this week introduced the revamped Maryland Health Care Quality Reports website, whose goal is to focus Maryland's health care providers on delivering better care, spending health care dollars in a wiser manner, and helping people stay healthy. This consumer-friendly resource brings together three consumer guides (on hospitals, long-term care and ambulatory surgery centers) as well as the quality report on health benefit plans. Click here for MHCC's release on the upgraded site.
MHEI Assisting "A" List Employees Become Leaders
 
Working with those employees who have potential to move into management and leadership positions is critical to the future of all of our organizations.

Prime Presents Revenue Opportunity for Member Hospitals
 
The Mainsail 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 that is supportive of a health system's mission of care.

CMS Extends Two-Midnight Partial Enforcement Delay
 
As urged by the AHA, the Centers for Medicare & Medicaid Services earlier this week extended through Dec. 31 the partial enforcement delay of the two-midnight policy.

THE WEEK AHEAD
Tuesday, August 18
- Council on Financial Policy meeting
TOP NEWS FROM THE WEEK
The Baltimore Sun, By Meredith Cohn, August 7
 
The Daily Record, By Daniel Leaderman, August 7
 
The Washington Post, By Julie Zauzmer, August 10
 
Healthcare Dive, By Julie Henry, August 10
 
The Frederick News-Post, By Patti Borda Mullins, August 11
 
WTOP, By Mark Lewis, August 11
 
Baltimore Business Journal, By Sarah Gantz, August 12
 
Kaiser Health News, By Jenny Gold, August 13