September 11, 2015
Public Process and Reasonable Rates
When Maryland's insurance regulators began their consideration of requests for increases in health coverage premiums a few months back, hospitals immediately questioned the rationale for such drastic spikes - some requests were for increases of more than 30 percent.
 
The insurers' requests simply didn't jibe with what hospitals were experiencing in terms of spending growth. Over the 30-month period that ended June 30, 2016, total growth in hospital spending, including inpatient and outpatient hospital care, was a very low 5.2 percent. And with hospital costs accounting for roughly 40 percent of the medical expenses insurers pay for, something wasn't adding up.
 
In late June, MHA co-authored an op-ed in The Baltimore Sun with the Maryland Women's Coalition for Health Care Reform that questioned the need for such large increases and called for greater transparency in the rate-setting process. MHA also testified before Maryland Insurance Administration Commissioner Al Redmer on what we saw as discrepancies in some insurance companies' cost assumptions, provided additional data that we thought relevant to the issue, and again made the case for additional transparency.
 
That work has paid off. Last week, MIA approved increases in health insurance rates that are $66 million below the insurance companies' initial requests. This is important not only for consumers' bottom lines, but also for their potential understanding of the calculations behind insurers' annual rate increase requests. While some insurers' requests are still high, the process and outcome are important steps in the right direction.
 
It's also a sign that state regulators like Commissioner Redmer want to make the regulatory process more transparent. That's a goal that MHA has pushed, and we applaud his willingness to be a part of such an effort. We have a long way to go before the public feels a part of such a complex process, but our experience this go-round shows promise.

Hospitals to See Net Rise Due to Pay-for-Performance
Maryland's hospitals as a group will see global budget revenues raised by 0.12 percent in fiscal year 2016 as a result of their performance on Maryland's three quality payment programs that put at risk 3.6 percent of total revenue. Maryland is exempt from national pay-for-performance programs as long as the state's programs are of equal or greater scope and results meet or exceed national results. Federal regulators have interpreted "equal or greater" to require that aggregate amounts of Maryland all-payer revenue at risk meet or exceed national Medicare at risk amounts across all pay-for-performance programs. To mitigate this extraordinary risk, MHA successfully advocated that the state modify the structure of Maryland's programs so that they differ from national Medicare programs. Unlike national pay-for-performance, Maryland sets performance targets and ties payment directly to scores, whereas national programs make no attempt to set performance targets, but instead rank hospitals' performance from best to worst and then penalize hospitals in the lowest performing quartile. All but one of the national pay-for-performance programs are designed to create "cost savings" in the form of penalties to the Medicare program in addition to the savings generated by reduced utilization. In fiscal year 2017, all of Maryland's pay-for-performance programs can result in positive adjustments.
 
Contact: Traci La Valle
HSCRC Hears Employment Proposal, QBR Recommendation
Hospital representatives outlined a health employment opportunity program at this month's Health Services Cost Review Commission (HSCRC) meeting. As reported in Newsbreak, commissioners also heard a draft recommendation on the fiscal year 2018 update to its Quality Based Reimbursement Program, and received reports and recommendations from its Consumer Engagement and Consumer Outreach task forces.
Legislative Committee, MHA Group Address Behavioral Health 
The first meeting of the Joint Committee on Behavioral Health and Opioid Use Disorders was held September 9 in Annapolis. The committee, established via legislation, is made up of five senators and five delegates and will examine and develop solutions to address holes in the state's behavioral health safety net. On a parallel track, an MHA task force of hospital executives will provide strategic guidance on how to best address behavioral health issues and to influence the work of the committee. The task force held its initial meeting September 10 at MHA's offices and will meet again November 18. For more information, contact Nicole Stallings.
AHA Supports Continuation of IMD Demonstration
Following a request from MHA, the American Hospital Association has agreed to support U.S. Senate Bill S.599, the Improving Access to Emergency Psychiatric Care Act. Passage of this bill, expected in the Senate within the next few weeks but facing challenges in the House, would extend the life of the Centers for Medicare & Medicaid Services' demonstration that for Maryland, 10 other states and the District of Columbia provided Medicaid funds for stays in Institutions for Mental Diseases (IMDs) for Medicaid enrollees age 21-64. The demonstration was ended by CMS in July, causing an as yet unaddressed gap in the Maryland Department of Health & Mental Hygiene's budget for that care in the state. In response, DHMH changed its policy on such care by capping the number of patients that can be treated at Maryland's three IMDs and forcing acute care hospitals with psychiatric inpatient beds to pick up the slack - a move that, because it was made without notice, MHA believes violates the Administrative Procedures Act. MHA also is pursuing a waiver with CMS that would free up funding for these patients.
Medicaid Announces RAC Orientation
Medicaid and the Office of the Inspector General have contracted with a new Recovery Audit Contractor (RAC) that will conduct charge audits of hospitals and other providers. An orientation seminar introducing Chesapeake Healthcare Recovery Group, LLC will be held September 22 at:
 
Bowie State University Student Center
Wiseman Ballroom
14000 Jericho Park Road
Bowie, Maryland 20715
 
Registration opens at 8:30 a.m. with the program starting at 9:30 a.m. The program will include a question and answer period and is expected to run approximately 2.5 hours. To attend or register for the live webinar broadcast option, RSVP by going to http://chrgportal.com/.
DHMH Bringing 'SCOPE of Pain' Curriculum to Md
The Maryland Department of Health and Mental Hygiene is working with Boston University and other state and national partners to bring the 'SCOPE of Pain' curriculum to Maryland. This will be a free, half day conference on October 17 at the BWI Airport Marriott. The training focuses on safe and effective opioid use for chronic pain management and is geared toward physicians, nurse practitioners, physician assistants and pharmacist. Continuing education credits are available. Click here for more details. Related to opioid use, if your organization has not yet signed its commitment letter to adhere to the new Opioid Prescribing Guidelines, it can be downloaded here. Contact Nicole Stallings with questions.
MHEI Creating Accountability and Results Through Leadership Engagement
 
MHEI's CORELeadership Program concentrates on helping managers become leaders by teaching strategies on how to engage health care employees in a manner that will help them accept accountability for the actions and results needed.

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AHA Contrasts Hospital Realignment, Insurance Deals at Hearing
 
Testifying this week at a House Judiciary subcommittee hearing, AHA President and CEO Rick Pollack drew a sharp contrast between the realignment taking place in the hospital and health system field and the consolidation proposed in the health insurance industry.
 
 
You can also read about how Hospitals Have Appealed Half of RAC Claim Denials by following the READ MORE link above.
THE WEEK AHEAD
Thursday, September 17
MHA Council on Financial Policy meeting
Carmela Coyle presents to the Maryland-National Capital Homecare Association in
   Baltimore on the Medicare waiver

TOP NEWS FROM THE WEEK
The Baltimore Sun, By Carmela Coyle and William Jaquis, September 8
 
The Baltimore Sun, By Andrea K. McDaniels, September 4
 
Modern Healthcare, By Bob Herman, September 4
 
The Baltimore Sun, By Meredith Cohn, September 9
 
The Baltimore Sun, By Andrew Michaels, September 8