March 18, 2016
What We Need to Sustain Maryland's Model
"There are no facts, only interpretations." - Friedrich Nietzsche
With HSCRC's fiscal 2017 global budget update vote less than three months away, your MHA is working hard to secure an increase that provides hospitals with the resources necessary to extend the progress made in the first half of the five-year all-payer experiment. That progress is noteworthy. In addition to significant improvement on quality metrics over the first three years, on the financial side, Maryland's hospitals have: 
  • Maintained all-payer hospital spending below the annual 3.58 percent growth ceiling (cumulative projection through calendar year 2015 is 3.5 percent below)
  • Generated Medicare savings faster than the $330 million required over five years (cumulative projection through calendar year 2015 is $240.2 million) 
But the problem with these data, as Nietzsche astutely points out, is that what really matters is one's interpretation of the facts. To give you a flavor of the philosophical gap MHA is working to close, here are a few of the critical positions held by key staff at HSCRC that we're trying to alter: 
  • Hospital margins are more than sufficient to sustain a lower update (our view: point-in-time margins do not tell the whole story, and there's still great uncertainty about the actual costs to transform care delivery)
  • The update should be at least 1 percent less than the annual 3.58 ceiling (our view: because the savings are cumulative, and hospitals have far exceeded the requirements in the first two years, a larger update is warranted - hospitals need to continue expensive investments in care transformation)
  • The return on investment of current funding for care transformation is unclear (our view: transformation has been an enormous expense, and even more is needed to sustain the early achievements) 
There are others, but the fundamental difference lies in that the HSCRC seems to believe that hospitals can absorb smaller global budget updates without sacrificing the progress thus far.
We couldn't disagree more.
Beyond the minimum resources needed to continue to invest in care transformation, a healthier update will provide predictability and stability for hospitals as they continue to venture into uncharted territory on population health. It should also be noted that our disparate position from that of HSCRC staff further underscores the need for rich, reliable data to inform important funding decisions.
At the midpoint of the five-year contract with the Centers for Medicare & Medicaid services, this global budget update is an important one. An adequate increase is essential to ensure that the progress you've already made is not curtailed. Even more important, it's critical that Maryland's hospitals and their regulators share both a vision and the path to achieve it - to prove that our achievements are truly, according to a November 2015 New England Journal of Medicine article co-authored by HSCRC members and staff, "a meaningful foundation for sustainable delivery reform in Maryland and a model for the rest of the country."

At Work in Annapolis
This week was "crossover week" in Annapolis. By Monday, each chamber must send to the other chamber bills that it intends to pass this session without having to go through the rules committees. The Senate passed the fiscal year 2017 state budget with little debate this week, and the House Appropriations Committee made its final decisions on the budget. The full House of Delegates will debate the budget next week, and then a conference committee will be appointed to address differences between the House and Senate versions. A bill requiring hospitals to report tax exemptions in a hospital's community benefit report - SB 601/HB 1189 - will not pass, as the Senate version received an unfavorable report by the Finance Committee and the House version was withdrawn. More in this week's Advocacy Dashboard.
2015 Report on Quality Released
MHA's 2015 Report on Quality in Maryland's hospitals is now available. The report, which details hospitals' quality- and safety-related accomplishments in the past year, has been distributed to media outlets statewide and to hospital PR leads. MHA will be mailing hard copies of the report next week to each hospital. An op-ed on hospital quality from MHA President & CEO Carmela Coyle appears today in Center Maryland. The report also received coverage in the Washington Business Journal.
County Health Rankings Available
The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute have released the 2016 County Health Rankings, which measure several factors to determine the overall health of a county, such as: smoking and obesity rates, teen births, sexually transmitted infections, and others. The goal of producing the rankings, according to RWJF, is to raise awareness about the many factors that influence health. The rankings are developed from public data sources including vital statistics compiled by the Centers for Disease Control & Prevention and the National Center for Health Statistics.
Former Mercy CFO Passes
Frederick Furst III, who retired as the CFO of Mercy Medical Center in 1991 after 17 years there, died March 9. He was 85 years old. Furst, who worked for Johns Hopkins Medicine prior to his time at Mercy, also assisted MHA with the implementation of its annual capital bond financing program, which allocates state funds to hospital capital projects.
Quarterly Financial, Utilization Reports Available
The financial reports for the fourth quarter of 2015 are now available. To access the Accounts Receivable and Combined Financial Trends and Utilization reports, click here. Reports are available only to members.
AAMC Honored for Toxic-Free Approach to Pest Management
Anne Arundel Medical Center has been honored for its outstanding achievement in adopting a "green pest management" approach that eliminates the use of toxic chemicals in managing pests. The Integrated Pest Management in Health Care Facilities Project is a partnership between the Maryland Pesticide Network and Beyond Pesticides. More in the press release announcing the award.
Helping Physicians Lead
Two years ago, the Maryland Healthcare Education Institute launched an initiative aimed at helping physicians become better leaders.

Reduce Lighting Energy Costs Up to 50 Percent
Lighting accounts for 30 to 60 percent of annual electric costs for many facilities, and many advances in lighting technology can help your organization conserve energy and save money.

CMS Issues Medicare Disparities Mapping Tool

The Centers for Medicare & Medicaid Services' Office of Minority Health has released a tool showing geographic, racial and ethnic variation in hospitalizations, emergency department visits and readmissions for Medicare beneficiaries with certain chronic conditions, as well as variation in the prevalence and average cost of those conditions.

Tuesday, March 22
Maryland Healthcare Education Institute Board meeting
Baltimore Business Journal, By Sarah Gantz, March 11
The Baltimore Sun, By Lauren Loricchio, March 12
The Frederick News-Post, By Paige Jones, March 15
Baltimore Business Journal, By Sarah Gantz
The Baltimore Sun, By Harriet Ryan, March 15
Modern Healthcare, By Steven Ross Johnson, March 15
Baltimore Business Journal, By Sarah Gantz, March 16
My Eastern Shore MD, By Trish McGee, March 16