January 15, 2016
What's Next for Maryland's Medicare Waiver?
Earlier this week, Health Services Cost Review Commission Executive Director Donna Kinzer shared some valuable insights about hospitals' progress on the goals outlined in the Medicare waiver, and offered a glimpse of her vision for what comes next.
Among the highlights of Kinzer's report: 
  • Since the modernized waiver went into effect in January 2014, hospitals have cumulatively saved Medicare nearly $190 million
  • Maryland's cumulative growth on total cost of care is 0.6 percent below the national trend
  • Potentially preventable complications continue to plummet, dropping an additional 19 percent in 2015 compared to 2014
  • Still, inpatient hospital growth in 2015 is 1.4 percent per beneficiary, compared to a national reduction of 0.2 percent
  • Also, Maryland is trending above the nation on hospital spending in calendar year 2015 compared to 2014 
So, what do these trends mean for the HSCRC? For your MHA? For your hospital?
Let's start with HSCRC. Kinzer and commission staff have been working to develop policies and infrastructure to ensure that Maryland will not fall out of compliance with the waiver's mandates. In their role as hospital regulators, they are focused on ensuring that the gains made in these first couple of years are enhanced, and believe it or not, sped up in the second half of the five-year contract with the Centers for Medicare & Medicaid Services (CMS).
What you've accomplished thus far is the result of incredible transformation and upheaval - of business models, staffing, physical space, pre- and post-acute partnerships, and more. That's a point MHA emphasizes repeatedly as we continue to meet with Kinzer and her staff. Getting the roadmap right on Maryland's model is not as simple as pressing harder on the gas pedal. There needs to be time to digest what we've learned so far, so we can accurately assess the correlation between hospitals' initiatives and the subsequent metrics; there needs to be time to demonstrate that what has been achieved early on can be sustained in the long term.
Which brings us to what's next for MHA. An internal work team, with guidance from three Executive Committee designees and the consultation of our Total Cost of Care Work Group, has been working on a multi-year strategy to prepare for coming negotiations with HSCRC and CMS on the next phase of the waiver.
What does all of this mean for hospitals? For now, to be straightforward, it means we can't rest on the laurels of the first year's performance.
So, as we near the midpoint of our five-year experiment in cost containment and quality improvement, you can be proud of your achievements. And you can be assured that your MHA will remain front and center as we all work together to preserve the state's unique hospital payment system, and create the right path forward, so that you can continue being leaders in the transformation of care both nationally and in your communities.

At Work in Annapolis
The 2016 legislative session is off to a busy start. Already more than 1,600 bill requests have been received from delegates and senators. With several sophomore lawmakers eager to introduce bills during their second year in office and since the governor's administration has had time to craft its legislative priorities, we are expecting a very busy session. Additionally, several task forces and commissions have now finished their interim work and published final reports with recommendations that MHA will consider. In addition to our top three priorities, MHA will be focusing on a number of issues, such as the Prescription Drug Monitoring Program, network adequacy, removing barriers to hospitals through physician alignment, freestanding medical facilities and the AARP Care Act. MHA looks forward to keeping you informed with our assortment of online tools, like the Advocacy Dashboard. Each week we will provide updates via a new "advocacy dashboard" (expect the first one next week), which outlines the bills introduced that week, our position and any action we've taken. This tool, combined with our new text messaging alerts for government relations leads and our bank of materials available on our website, will keep you updated on the latest from Annapolis.
Contact: Jane Krienke
HSCRC Discusses Infrastructure Spending Reports and Care Coordination Plans
Highlighting a busy agenda at its January 13 public meeting, Health Services Cost Review Commission (HSCRC) members received summary reports from staff on hospital infrastructure investment reports, strategic transformation plans and regional transformation plans that had been filed in December. Commissioners also heard concerns about growth in hospital and non-hospital Medicare spending per beneficiary, and took final action on the Maryland Hospital Acquired Condition (MHAC) program for fiscal year 2018 (calendar year 2016 performance year). More details can be found in this month's Newsbreak.
Stopping Sepsis in Long-Term Care Collaborative Launched
Reducing sepsis has been identified as a priority across the health care spectrum. Since 2014, the Maryland Patient Safety Center (MPSC) has been leading the Improving Sepsis Survival Collaborative with 21 hospitals across the state. To broaden the scope of this work, MHA, MPSC and VHQC (Maryland and Virginia's Quality Improvement Organization) this week launched a new collaborative, "Stopping Sepsis in Long-Term Care." Thanks in part to recruitment efforts by Maryland's hospitals, the collaborative will include roughly 30 skilled nursing facilities that frequently send septic patients to hospitals enrolled in the Improving Sepsis Survival Collaborative. The two year project aims to reduce mortality rates, hospitalizations and health care costs by implementing infection prevention strategies and treating infections before residents become septic. Please contact Justin Ziombra with any questions.
ICD-10 Coding Basics Review Available
The Medicare Learning Network (MLN) has created an MLN Connects video to revisit ICD-10 coding basics. In the video, Sue Bowman from the American Health Information Management Association and Nelly Leon-Chisen from the American Hospital Association discuss the unique characteristics and features of the new coding system. Some of the items covered include:
  • What is a valid code
  • Guidelines for coding and reporting
  • Coding process and examples
  • How to submit coding questions
  • Resources for coders 
The ICD-10 Medicare Fee-For-Service Provider Resources webpage has additional links to resources on ICD-10.
Webinar on Hospitals and Faith Organizations in Community Health
The American Hospital Association's Hospitals in Pursuit of Excellence (HPOE) is offering a webinar on the collaboration between hospitals and faith organizations to improve community health. This webinar will focus on two hospital-interfaith collaborations, one in Memphis that has been in existence for nine years and another in Maryland that is in its earliest stages. Since these collaborations have enormous potential to promote health, especially among at-risk populations, and to help avoid unnecessary re-hospitalizations, the potential for creating such collaboratives in different communities across the country will be explored. Carmela Coyle, president & CEO of Maryland Hospital Association and Vincent DeMarco, president, Health Care for All in Maryland and the Maryland Citizens' Health Initiative, will be two of the speakers. This webinar is free but registration is required. To register, click here.
Population Health - "Thriving" vs. Surviving
The National Institutes of Health (NIH) has awarded a grant to Dr. Bryan Sexton, associate professor, Duke University, to study "resilience" among care givers. The Maryland Healthcare Education Institute (MHEI) has arranged for Dr. Sexton to address health care leaders and assist them in developing plans for building resilience among their care givers.

Prime Presents Revenue Opportunity
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 supports a health system's mission of care.

MedPAC Finalizes 2017 Payment Recommendations For Hospital Services
The Medicare Payment Advisory Commission this week recommended that Congress update payments for hospital inpatient and outpatient services in 2017 as outlined under current law, which would provide an estimated 1.65 percent increase.

Tuesday, January 19
MHA Council on Financial Policy conference call
Carmela Coyle to present at Maryland Organization of Nurse Executives Board meeting

Thursday, January 21
MHA Capacity, Certificate of Need and Capital Funding Task Force meeting

Friday, January 22
MHA Mental Health Work Group meeting
Carmela Coyle to participate in panel discussion on population health improvement
  at Trivergent Health Alliance Retreat
The Baltimore Sun, By Erin Cox and Michael Dresser, January 9
Fierce Healthcare, By Zack Budryk, January 8
The Daily Record, Bryan P. Sears, January 11
The Washington Post, By Josh Hicks, January 12
The Daily Record, By Bryan P. Sears, January 12
The Baltimore Sun, By Michael Dresser and Erin Cox, January 13
Baltimore Business Journal, By Sarah Gantz, January 14