September 25, 2015
Fighting for Fairness

Lord's Cricket Ground in London - commonly referred to as the "Home of Cricket" - famously slopes toward its south end, with a drop of more than eight feet compared to the north side. Professional cricket players, depending on their hitting stance or pitching style, use this topographical feature to their advantage whenever possible.


The slope, and similar ones at other sports venues, offers insight into the origins of the modern phrase - "Leveling the playing field." The thinking goes that all athletes should be afforded the same playing conditions, so that the outcome of an event is truly based on skill and not on random, external factors.


An unleveled playing field is at the heart of a major problem with how the Centers for Medicare & Medicaid Services (CMS) is judging hospital quality - and the field's slope is affecting Maryland's ratings.


Here's the issue: CMS' star quality rankings for hospitals do not account for the unique way Maryland's hospitals report data. Maryland's hospitals operate under a more stringent quality program, but historically were not required to submit certain inpatient and outpatient data or present-on-admission codes to CMS until 2014. As a result, Maryland's hospitals appear to lag on quality measures when in fact, the problem is that the playing field isn't level. And with more national publications, like U.S. News & World Report, relying on CMS data for their own hospital rankings, the flawed rankings gain even greater exposure.


So, what are we doing to rectify the situation? MHA has submitted comments to CMS requesting that Maryland's hospitals be exempt from the proposed star rating program until all data constituting the ratings contain the proper present-on-admission codes and, therefore, are appropriately comparable to hospitals in other states. We are also seeking a joint meeting with CMS and the Health Services Cost Review Commission (HSCRC) to determine how to address the problem. HSCRC has also submitted comments to CMS echoing MHA's concerns.


In addition, MHA has submitted a letter to U.S. News & World Report's Health Rankings Editor outlining the biases in the current comparison and requesting that the publication make those discrepancies clear so that readers are not misled by unfair analyses.


There are also things hospitals can do to help level the playing field. Hospitals must work to ensure that data submitted to CMS are as clean as data submitted to the Health Services Cost Review Commission.


Every hospital leader wants their patients to be well informed and empowered to take charge of their health care. But if the information presented to them is based on biased data, their health care choices can suffer. That's why it's so important that CMS, U.S. News & World Report and others who make use of biased data act swiftly to correct an inaccuracy that, until addressed, will continue to distort the quality improvements you and your team have worked so hard to achieve.

Registration Open for MHA Fall Briefing
MHA's annual fall briefing for government relations and legislative advocacy leads, public relations staff and others with an interest in the hospital field's advocacy agenda is set for Wednesday, November 4, from 9 - 11:30 a.m. Sharing the strategies behind MHA's legislative priorities for the coming year, members of MHA's leadership team will present an overview of the resources being developed to achieve our shared legislative goals. Attendees will hear from longtime Annapolis insider Mike Johansen on how 2016's political landscape will affect those efforts. The session also will include an update on the Medicare waiver. The briefing is free, but registration is required. Contact Kathy Gotwalt with questions.
MHCC Seeking Input on HIE Regulations
The Maryland Health Care Commission (MHCC) is updating privacy and security regulations for the state's health information exchange (HIE). As part of the update, MHCC is seeking input on draft amendments to the HIE regulations in advance of the formal promulgation and public comment process. The amendments pertain to the privacy and security of protected health information obtained or released through a HIE, and are either additions in italics, or deletions in brackets. The regulations, COMAR 10.25.18, Health Information Exchanges: Privacy and Security of Protected Health Information, went into effect in March 2014. 
Please submit comments in writing by 5 p.m. Friday, October 16.  Comments may be submitted:
  • Via mail, to MHCC, Attn: Christine Karayinopulos, Center for Health Information Technology and Innovative Care Delivery, Maryland Health Care Commission, 4160 Patterson Avenue, Baltimore, MD 21215
  • Via email, to 
Comments should specifically cite the subsection of the regulation to which the comment pertains.
Infrastructure Reporting, Competitive Transformation Deadlines Approaching
The Health Services Cost Review Commission (HSCRC) Global Budget Revenue Reporting on Investment in Infrastructure reports are due September 30 for fiscal years 2014 and 2015. The report will include the types of investments Maryland's hospitals have made, and how effective they have been in improving population health. This is an important opportunity for hospitals demonstrate a return on the funds previously provided in fiscal 2014 and 2015 global budgets for infrastructure and care coordination. Based on previous comments from commissioners, the quality of the information contained in these reports could impact the fiscal year 2017 annual update negotiations.
Additionally, for fiscal year 2016, HSCRC is seeking proposals for competitive implementation grants to supplement related existing infrastructure initiatives. Successful applicants should demonstrate a return on investment, measurable objectives, and care coordination and population health models currently underway. The total amount available is up to 0.25 percent of statewide revenue. Applications are due December 7 with the award announcement anticipated for January 2016. These permanent increases will be added to fiscal year 2016 rates.
MHA Meetings Help Hospitals Plan for ICD-10
MHA recently hosted two meetings to connect hospitals with regulators and payers to answer questions and provide information to help smooth the transition to ICD-10, scheduled for October 1. The first (September 8) featured panelists from selected private payers as well as representatives from Novitas, Medicare's administrative contractor, and Maryland Medicaid. The discussion provided the financial staff, billing leads and coders in attendance details about various payers' billing processes during the transition.  A meeting summary is available here (you must log on to the MHA site to access it). A second meeting (September 11) featured representatives from the Health Services Cost Review Commission along with 3M, discussing how the ICD-10 transition would affect the calculation of potentially preventable complicatinos within the Maryland Hospital Acquired Conditions payment program. Meeting materials can be found here.
Adventist Conference Focuses on Infant Mortality
The Adventist HealthCare Center for Health Equity and Wellness 9th Annual Fall Conference, "Before the Bough Breaks," will focus on reducing disparities in infant mortality. The conference is October 8 in Hyattsville and will feature speakers addressing the causes and complexities of infant mortality. Click here for more information.
MHEI Speaker Requests More Time and Interaction
Simon Sinek, this year's keynote speaker at the Maryland Healthcare Education Institute's fall conference in October, has asked to spend more time with our conference participants and to use that time in discussion and Q & A. 

Improve Patient Access Management
With increasingly changing reimbursement models and high-deductible health plans forcing patients to shoulder more payment liability, health systems must improve their registration and financial clearance to ensure up-front cash collections, reduce front-end denials and improve patient registration efficiencies to maintain patient satisfaction.

ONC updates five-year federal plan for health IT
The Department of Health & Human Services' Office of the National Coordinator for Health Information Technology this week updated the federal government's five-year plan for using health IT to improve health care quality and health, lower costs and engage patients.

Thursday, October 1
Capacity, Certificate of Need, and Capital Funding Task Force meeting
Baltimore Business Journal, By Sarah Gantz, September 18
Baltimore Business Journal, By Sarah Gantz, September 21
The Baltimore Sun, By Andrea K. McDaniels, September 21
Baltimore Business Journal, By Andy Medici, September 22
The Washington Post, By Fenit Nirappil, September 22
Baltimore Business Journal, By Sarah Gantz, September 22
Baltimore Business Journal, By Sarah Gantz, September 23
The Baltimore Sun, By Andrea K. McDaniels, September 23