June 3, 2016
Communicating is Critical on the Global Budget Update
The Health Services Cost Review Commission's decision on a global budget update for the coming fiscal year is just days away. Over the past month, work to increase that update from the original staff proposal of 1.2 percent to all hospitals has been intense. Our field is seeking a modest 1.12 percentage point increase to that proposal - to make sure that misguided concerns about the all-payer model's total cost of care guardrail don't derail the investments and progress you've been making in population health.
The advocacy work has come in the form of personal conversations with commissioners, letters to them and Executive Director Donna Kinzer, and your willingness to leverage relationships with the handful of people who are responsible for this decision.
I appreciate the efforts of those hospital leaders who submitted letters of their own, providing details of your work to transform the care delivery system to commissioners - some of whom are skeptical of the pace and breadth of hospitals' efforts so far. Your views represent a valuable, straightforward account of what's going on at the ground level, and what this update means for continued progress.
Still, the decision comes down to four votes, and while we believe that the right commissioners have heard hospitals' voices clearly, the outcome remains uncertain. This week, we provided hospitals with key messages for your use in the final push before a decision, along with recently-released data that show the way toward supporting MHA's proposal without fear that the total cost of care guardrail might be bumped.
This decision also is critically important because it will foreshadow the relationship between state regulators and hospitals ahead of sensitive negotiations with the Center for Medicare & Medicaid Innovation on the next phase of the all-payer model. A too-low update could easily throw into doubt the balance of fairness and collegiality that historically has marked Maryland's waiver.
Less than a week after this historic decision is made, HSCRC Chairman Nelson Sabatini will join us at our annual membership meeting June 14 for an in-depth discussion about the decision, the future of the all-payer model, and his first few months in his new position. Governor Larry Hogan will be on hand to say a few words and introduce the new chairman and, the night before, during our welcome reception, we'll honor one of the architects of the original waiver, retiring U.S. Senator Barbara Mikulski. There's still time to register and we hope you'll join us.

Letter to Commissioners Highlights New Information
With their critical global update decision less than a week away, MHA yesterday send a letter to Health Services Cost Review Commission (HSCRC) commissioners with new information that illustrates how a higher update than currently proposed by HSCRC staff can be achieved. Last week, data from Medicare's Chronic Conditions Warehouse (CCW) was released that indicate that Maryland Medicare spending per beneficiary hospital savings grew by an additional $74 million, bringing cumulative savings to $325 million over just two and a half years ... very close to the all-payer agreement's requirement of $330 million in savings over five years. The data also reveal that Maryland's total cost of care so far this year has been less than the national growth rate, by 0.75 percentage points. The letter points out that the data should relieve any concerns about Maryland bumping up against the agreement's total cost of care guardrail, and "provides a solid basis for your support of MHA's update proposal of 2.75 percent." See the letter and its accompanying charts here.
Contact: Mike Robbins
PQI Reports Sent To Maryland Hospitals
MHA this week sent each Maryland hospital a custom Prevention Quality Indicators (PQI) report. PQI, measures, developed by the Agency for Healthcare Research and Quality, are metrics that can be used to identify quality of care for "ambulatory care sensitive conditions," such as diabetes, heart failure and bacterial pneumonia. These are conditions for which good outpatient care could prevent the need for hospitalization, or for which early intervention can prevent complications or more severe illness. The reports will be updated and disseminated as MHA receives new data. They are meant to help population health leads with strategic planning for community-based initiatives, CFOs with determining how PQI measures interact with potentially avoidable utilization incentives, and quality leads with determining where resources should be focused. If you have questions, contact Elsa Haile at ehaile@mhaonline.org.
Webinar Explains Details of MACRA
A new webinar intended for American Hospital Association members explains how the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 will affect not only physicians, but also the hospitals and health systems with whom they partner. Hospitals that employ physicians directly may bear some cost from implementation of and ongoing compliance with the new physician performance reporting requirements, as well as be at risk for any payment adjustments. The law calls for the Centers for Medicare & Medicaid Services to implement a two-track payment system for physicians and other eligible professionals. The goal is to tie an increased percentage of physician payments to outcomes through the Merit-based Incentive Payment System and to encourage the adoption of "alternative payment models" (APMs). APMs move payment away from fee-for-service reimbursement, and instead pay providers based on the quality and cost of care for particular episodes (e.g., bundled payment), or defined patient populations (e.g., accountable care organizations). Hospitals may be called upon to participate in APMs so that the physicians with whom they partner can qualify for the APM track. The webinar is available here.
Dual Eligible Work Group Examining Integrated Care Model Strategies
The dual eligible work group convened by Maryland Medicaid and the Health Services Cost Review Commission (HSCRC) met Wednesday to continue discussion on the development of an integrated care model for "full duals," those eligible for Medicare Parts A and B, and all Medicaid benefits. The state is developing an integrated care model under a Centers for Medicare & Medicaid Services (CMS) State Innovation Model (SIM) grant, and must submit a report to CMS later this year. The report will detail the model's governance and structure, along with strategies for shared savings, to engage enrollees and providers and improve quality. Before the report can be produced, the work group must select a care delivery structure. The three structures currently being discussed are:
  • managed fee-for-service
  • duals accountable care organization
  • capitation
At Wednesday's meeting, the work group continued to debate these three options. MHA is advocating an approach to managing this population that can ensure the most success for patients, hospitals, and the state. Slides from Wednesday's meeting are available here.
VHQC Collaborative Enrolling New Participants
In January, VHQC (Maryland and Virginia's Quality Improvement Organization), in partnership with the Maryland Patient Safety Center (MPSC) and MHA, launched a new collaborative, "Stopping Sepsis in Long-Term Care." The collaborative broadens the scope of the "Improving Sepsis Survival Collaborative," led by MPSC with 21 participating hospitals. The goals of the two-year project are to reduce mortality rates, hospitalizations and costs by implementing infection-prevention strategies and treating patients before they become septic. The collaborative is still open to enrolling new facilities. Senior quality leaders and executives are encouraged to contact skilled nursing facility (SNF) partners, particularly those that may be a source of readmissions due to infections or sepsis, and encourage them to join if they haven't already done so. Interested SNF partners should contact Candace Hamner at chamner@vhqc.org.
MASHMM to Host Meeting on Consumer Engagement and Telemedicine
The Mid-Atlantic Society of Healthcare Materials Management (MASHMM) will host a meeting Friday, June 10 at 8 a.m. at the offices of MHA on the future of telemedicine. Michael B. Jackson from Accenture Interactive will discuss the road ahead and how innovative enterprises can seize telemedicine opportunities while overcoming the challenges. Interested hospital staff can send an email to mashmmpresident@gmail.com to RSVP for the meeting.
Creating Positive Change...and Trimming Costs
Whether change is seen as positive or negative is often a product of emotion instead of logic. What appears to be logical to senior leaders is not necessarily seen the same way by staff who emotionally are asking, "What's in it for me?" or "Why is this happening to me?" or "How will this impact my job, my income, and my family?"

Prime's Value to Member Hospitals
Prime is the shared service/group purchasing subsidiary of the Maryland Hospital Association. Its goal is to help our member hospitals reduce the cost of care.

NIH Program To Train Health Care and Other Workers on Infectious Disease Safety
Eight organizations have received grants to provide environmental infection control and hazard recognition training to health care and other workers with the potential for exposure to high-risk infectious diseases, the National Institutes of Health announced this week.

Wednesday, June 8
Health Services Cost Review Commission meeting

Thursday, June 9
MHA Financial Technical Work Group meeting
The Frederick News-Post, By Sylvia Carnigan, May 30
The Baltimore Sun, By Meredith Cohn, May 31
The Baltimore Sun, By Yvonne Wenger, May 31
WYPR, By Fraser Smith, May 31
The Baltimore Sun, By Meredith Cohn, June 2
The Frederick News-Post, By Sylvia Carignan, June 1
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