April 22, 2016
High Stakes
In less than two months, a reconfigured Health Services Cost Review Commission (HSCRC) will vote on a global budget update - the percentage by which your hospital's budget will increase.
Last year's 3.3 percent average per capita increase totaled more than $500 million, the largest hike in more than six years. But things are different this year because several dynamics are making the upcoming decision unique. To start, the HSCRC has two new members - Chairman Nelson J. Sabatini, a former Maryland health secretary, and Victoria W. Bayless, President & CEO of Anne Arundel Medical Center. And now that he is no longer chairman, John Colmers, Vice President of Health Care Transformation and Strategic Planning for Johns Hopkins Medicine, will take a more active role on each vote.
I met with the new chairman earlier this week. My impression of his approach to his new role: he is political and practical. And he understands the importance of keeping the waiver in Maryland. It was also clear that he has an understanding of the business pressures associated with managing large health care operations.
That said, the fight for the resources you need is challenging, as HSCRC staff have in the past months repeatedly raised concerns about the potential for Maryland to exceed the total cost of care guardrail outlined in the all-payer model contract. As commissioners continue to hear this total cost of care drumbeat from staff, MHA is responding with messages to counter their argument.
A brief summary of our points made in a recent letter to commissioners: 
  • By all meaningful measures, hospitals are exceeding the targets outlined in the all-payer agreement and this progress has only been possible due to supportive funding decisions from the HSCRC
  • Implementing what amounts to a corrective action by approving an unnecessarily low update to prevent a total cost of care infraction is not only premature, but would undercut the stability needed to ensure the model's long-term success
  • True care transformation takes time to mature; the new model is barely more than two years old
  • The all-payer agreement makes clear that total cost of care should be addressed in the next phase of the model; remedying any perceived issue by penalizing hospitals now is akin to placing the burden of an entire bridge on just one support beam - it can't hold the weight 
Both HSCRC and MHA staff are examining the same sets of data and coming away with very different conclusions, but the decision ultimately rests with seven commissioners who will be swayed one way or another by the merits of the arguments. When we as a field speak with one voice before the commission, our position is strengthened with each appearance, each conversation and each statement. 
At the midpoint of our state's experiment in health care transformation, the stakes are high for this update, and it's imperative that commissioners understand that without investment now, success later is in jeopardy.

Register for MHA's Annual Membership Meeting
MHA's 2016 Annual Membership Meeting - A Breath of Fresh Care - will be held June 13 & 14 at the Four Seasons Hotel Baltimore and is designed for senior leaders of Maryland' hospitals, from CEOs and trustees to chief medical officers, chief nursing officers and others. Invitations have been mailed.  
Some of the highlights we have planned include our reception at 6 p.m. Monday, June 13, where we will celebrate the important work underway to transform health care in Maryland. And, as always, we have some captivating speakers lined up for the general session on Tuesday, June 14. 
  • New Health Services Cost Review Commission Chair Nelson Sabatini will share his views on the Medicare waiver's next steps, a new global budget update, and more
  • The Honorable Patrick Kennedy, former member of the U.S. House of Representatives and a leading mental health champion, will address this important topic that is at the center of so many challenges in our state and the nation
  • Election analyst Larry Sabato, founder and head of the University of Virginia Center for Politics, will provide his expert insights on the upcoming presidential election 
Click here to view the annual meeting brochure.

Contact: Kathy Gotwalt
Zika Awareness Week Begins April 24
Governor Larry Hogan has issued a statewide proclamation declaring April 24-30 "Zika Virus Awareness Week" in Maryland - a time for residents to take simple but important steps to prevent the spread of the mosquitoes that carry the Zika virus. It is critical that Maryland residents survey their properties and their communities and eliminate or treat mosquito breeding sites. The Department of Health & Mental Hygiene plans to raise awareness across the state through partnerships with local health departments, which will be scheduling activities in their respective communities. Hospitals have an opportunity to help raise awareness as well. To assist with DHMH's efforts, here are three ideas for your organization to consider during Zika Awareness Week: 
  • Promote stories and information about the Zika virus through your social media outlets
  • Feature Zika virus resources prominently on your website, including information about hospital readiness
  • Contact your local health department to see if hospitals can assist with, or participate in, any local activities
Maryland Hospitals Receive an "A" on Palliative Care
The Center to Advance Palliative Care has awarded Maryland's hospitals an "A" in its 2015 State-by-State Report Card on access to palliative care in hospitals. The report card, which builds on previous versions, tracks the growth of hospital palliative care programs and identifies areas where persistent gaps in access remain. Drawing data from the American Hospital Association (AHA) Annual Survey Database from fiscal years 2012 and 2013, and the National Palliative Care Registry, the report examines the prevalence and geographic variation of palliative care in U.S. hospitals. 
CMS Drops Two-Midnight Rule's Inpatient Cuts
The Centers for Medicare & Medicaid Services announced this week it will not continue to impose an inpatient payment cut to hospitals under the two-midnight rule. The policy was intended to reverse a trend toward higher rates of observation stays. The decision followed ongoing criticism and a legal challenge. CMS will provide a one-time bump to hospitals to offset the cuts.
CMS Delays Release of Star Ratings
The Centers for Medicare & Medicaid Services announced Wednesday that it will delay until at least July 2016 the release of overall hospital quality "star ratings" on its Hospital Compare website. The ratings were originally scheduled to be released yesterday. The American Hospital Association and others, along with a majority of Congress, had urged CMS to delay the release and re-evaluate whether the methodology provides a fair, accurate and meaningful representation of hospital performance. CMS also announced that it is delaying its regularly scheduled update of data on individual Hospital Compare measures until May 4. Maryland legislators signing the letter were Sens. Barbara Mikulski and Ben Cardin, along with Reps. Elijah Cummings, John Delaney, Andy Harris, Dutch Ruppersberger, John Sarbanes and Chris Van Hollen. 
Helping Staff with the New Health Care Consumer
Aside from population health, the role of consumerism in health care affects the patient-provider relationship. Patients are now more in control than ever of not only their choices of health care providers, but also their overall care.

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.

AHA Calls for Nominations for 2017 Circle of Life Awards
Does your organization have an innovative palliative and end-of-life care program? Make sure it gets the national recognition it deserves. The Circle of Life Awards will give top honors in 2017 to up to three programs or organizations.

Wednesday, April 27
MHA Total Cost of Care Work Group meeting

Thursday, April 28
MHA Financial Technical Work Group meeting
The Baltimore Sun, By Meredith Cohn, April 14
The Washington Post, By Ravi Parikh, April 18
The Baltimore Sun, By Pamela Wood, April 19
Modern Healthcare, By Steven Ross Johnson, April 19
Capital Gazette, By Christina Jedra, April 20
The Daily Record, By Daniel Leaderman, April 20
My Eastern Shore MD, By Daniel Divilio, April 21