May 13, 2016
A Critical Juncture for the All-Payer Model
In less than a month, the Health Services Cost Review Commission (HSCRC) will make one of its most important decisions, at one of the most critical junctures to date in our all-payer waiver experiment.
 
The decision at hand is how much of a global budget update to provide to hospitals at the midpoint of the five-year agreement. After factoring set-asides for things like unknown adjustments, and funds available only for some hospitals through complex application processes, the current staff proposal is for all hospitals to receive an average increase of just 0.60 percent per capita.
 
That's incredibly skimpy given how much is at stake. Patients and communities are just starting to reap the benefits of hospitals' early investment in care delivery transformation, and hospitals are only beginning to scratch the surface in understanding how to manage the health of entire populations.
 
While several HSCRC commissioners remain focused on two things - the fear of approaching the statewide total cost of care guardrail and the pace of hospitals' progress on reducing avoidable utilization - the progress on both cost-control and quality improvement is undeniable. All-payer spending growth is more than $1 billion below the cumulative 11.7 percent goal; cumulative Medicare savings of $251 million are five times above the second-year target; readmissions rates are well on pace to meet or drop below the national average; and hospital-acquired conditions are down by more than one-third, already surpassing the five-year target.
 
To ensure that these gains are sustainable for the remainder of the five-year experiment and beyond, MHA has proposed an alternative global budget update that increases the HSCRC staff proposal by a modest 1.12 percent. This funding level would accommodate the projected 2.49 percent inflation rate for the coming year, and support your efforts to continue the care coordination and population health activities that are critical to the model's success.
 
The fundamental question that HSCRC commissioners will be wrestling with is one of timing. Hospitals share with commissioners a desire to provide care in the most efficient manner, and it's reasonable to expect that as care improves, savings would be realized in the later years of the agreement. But it's simply unwise to require hospitals to scour their balance sheets to find funding for these important care needs, particularly when we entered this new model in the wake of a long series of inadequate rate updates.
 
In other words there's still much to learn about this experiment, and to once again provide an annual update below the rate of inflation is a surefire way to sabotage our nascent success.
 
MHA will continue over the next month to persuade commissioners and HSCRC staff that the current proposal is pennywise but pound-foolish (stay tuned in the coming days for a field-wide Member Alert that will ask you to share with commissioners stories about your investments, progress, and challenges). With one voice, we will all remind commissioners that, ultimately, we share the same goals, but to reach those goals demands the cooperative and aspirational spirit we shared when the Medicare waiver agreement was signed two and a half years ago.

2016 Annual Membership Meeting
June 13 & 14
Four Seasons Hotel Baltimore
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Hopkins Appoints Miller as President
Dr. Redonda Miller, chair of MHA's Council on Clinical & Quality Issues, was named Thursday as the first female president of Johns Hopkins Hospital. She will assume the role on July 1, taking over for Ron Peterson, who will maintain his titles as president of the health system and executive vice president of Johns Hopkins Medicine. Miller, currently senior vice president of medical affairs for the Johns Hopkins Health System and vice president of medical affairs for the Johns Hopkins Hospital, began as a medical student at Hopkins and has served on dozens of administrative, medical education, system innovation and quality improvement councils and committees.
Commissioners Debate Update Recommendation
During a lengthy public meeting, the Health Services Cost Review Commission (HSCRC) this week considered the staff draft recommendations on updates to hospitals' global budget revenues, and revenues not under global budgets. MHA's response was led by MHA President & CEO Carmela Coyle, University of Maryland Medical System President & CEO Robert Chrencik, and MHA Senior Vice President Mike Robbins, who presented MHA's recommendation to increase the staff proposed update from 1.49 percent per capita to 2.60 percent. Discussion also included draft recommendations on the commission's quality-based payment programs, and HSCRC staff's recommendations to approve nine of the 22 competitive grant applications. Read more in this month's Newsbreak.
HSCRC Hosts Webinar on GBR Infrastructure Template
The Health Services Cost Review Commission (HSCRC) will host a webinar at 10 a.m. May 17 on the Global Budget Revenue Infrastructure Reporting Template. Due to technical constraints, hospitals are asked to limit the number of separate log-ins to one or two representatives per hospital. Click here to register. After registering, you will receive a confirmation email containing information about joining the webinar.
MIA Releases Proposed Insurer Rates
The Maryland Insurance Administration today released insurers' proposed premium rates for 2017, with increases in the individual market ranging from 8.1 percent to 29.8 percent, and in the small group market from a 0.1 percent reduction to a 7.4 percent increase. The comment period begins Monday and runs through June 16. As we did last year, MHA will analyze the justifications for the rate requests and put together a comment letter that we will share with you; we also will testify at the July 6 public hearing MIA will hold to discuss the rates. Decisions about the requests are expected to come from MIA in late summer. Click here to see the MIA press release.
Department of Aging to Conduct Town Halls on State Plan
The Maryland Department of Aging, under the Older Americans Act, is required to develop and implement a State Plan on Aging, to begin in October and be carried out until September 2020. The plan will provide a framework for programs, activities, and services for older adults. To assist in its development, older adults, caregivers, advocates, employers and service providers are invited to offer feedback, input and comments on the draft plan. Four Town Hall meetings will be held May 19 to June 1 in Easton, Bowie, Hagerstown, and Towson. To read the state plan, find specific details on each town hall meeting, or learn how to submit comments by taking a survey or reaching out directly by email or letter, visit the Maryland Department of Aging's website.
Rural Maryland Council Providing Grants
The Maryland Agricultural Education and Rural Development Assistance Fund (MAERDAF) of the Rural Maryland Council (RMC) awards grants to rural-serving nonprofit organizations that promote statewide and regional planning, economic and community development, and agricultural and forestry education efforts. For fiscal year 2017, RMC is particularly interested in proposals that address the following:  agriculture, energy, rural broadband, health care, youth engagement and workforce/economic development. The Grant Review Board will give full consideration to any application. Please visit their website to access instructions and the application. Applications are due by July 15.
Preparing Physicians for Leadership
 
By now we all recognize the advantage of having physicians prepared and trained to assume leadership positions in our organization. While some of the need is specific to any given hospital, there is a body of knowledge, developed over many decades, that pertains to all leaders everywhere. 

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 is supportive of a health system's mission of care.

AHA Shares Global Budget Payment Model Recommendations with CMS
 
The American Hospital Association (AHA) supports the Centers for Medicare & Medicaid Services' efforts to explore the feasibility of global budget payment programs in geographically defined communities, the association told the agency this week, but called it "a challenging undertaking" and urged the agency "to proceed in a thoughtful and deliberate manner."

THE WEEK AHEAD
Tuesday, May 17
MHA Council on Financial Policy meeting

Thursday, May 19
MHA Capacity, Certificate of Need and Capital Funding Task Force meeting
TOP NEWS FROM THE WEEK
Washington Business Journal, By Tina Reed, May 6
 
Modern Healthcare, By Jaclyn Schiff, May 7
 
The Frederick News-Post, By Lindsay Powers, May 9
 
WMDT 47, By Lili Zheng, May 9
 
Modern Healthcare, By Steven Ross Johnson, May 10
 
U.S. News & World Report, By Steve Sternberg, May 10
 
The Baltimore Sun, By Rachael Pacella, May 10
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