October 7, 2016
CMMI Standing Behind Maryland Model

You know the history well.
 
Forty years ago, Maryland, along with a handful of other states, began a demonstration project with the federal government to bring Maryland higher payments for health care services provided to Medicare recipients, in exchange for us clamping down on cost increases. That demonstration became law and for decades, the system helped control costs and ensure parity by requiring that everyone pay the same price for the same service at the same hospital.
 
Since then, Maryland has become the sole state remaining with a Medicare payment waiver and now, a new demonstration project. CMS is looking to our hospitals to be the pioneers of a modern health care system that can bring to life the goals of the Triple Aim: reduced per capita costs, healthier communities, and improved patient experiences. We're now two-and-a-half years into Maryland's grand health care experiment - the modernized All-Payer Model - and while the progress has been solid, you know firsthand that it hasn't come without the significant organizational challenges of revamping hospital infrastructure and staff under global budgets.
 
That's why I'm pleased to share some of the positive feedback we received last week from senior leaders at CMS and the Center for Medicare & Medicaid Innovation - Dr. Patrick Conway, Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, CMMI Deputy Director Amy Bassano, and Dr. Stephen Cha, Director of the State Innovations Group. Also attending this second annual meeting on the status of the model were: Gene Ransom of MedChi, Donna Kinzer, Nelson Sabatini, John Colmers, and Joe Antos of HSCRC, Joseph DeMattos of the Health Facilities Association of Maryland, and Secretary Van Mitchell and Deputy Secretary Dr. Howard Haft of DHMH.)
 
After Maryland's hospital leaders discussed our perspective and, more importantly, shared the powerful stories of how you and your colleagues have transformed health care in Maryland, Dr. Conway and Dr. Cha noted that CMMI is pleased with the performance related to the five key financial and quality metrics, including the projection that we are on track to save Medicare $600 million, well beyond the prescribed $330 million over five years.
 
Perhaps more important is that Dr. Conway and Dr. Cha described CMMI and CMS as allies, with a deep investment in Maryland's health care transformation efforts. And they suggested that the relationship with Maryland moving forward would be one built on collaboration and some flexibility, a contrast with the previous year. In response to my question about meeting metrics and the Maryland model operating on a "hair trigger," Dr. Conway offered: "...when stuff is promising and trending in a positive direction, we want to keep it going."
 
That said, both Conway and Cha emphasized that to preserve the All-Payer Model, Maryland must excel at managing the total cost of care, not just the hospital component. The strategic plan for the next phase of the model is due December 31, and work is underway to complete that on schedule. In addition, Dr. Conway stated that the innovation center would like to see a majority of physicians under an advanced Alternative Payment Model by 2018 and 100 percent of physicians by 2019, so that physician care is fully aligned with hospitals' efforts.
 
This will take an unprecedented level of collaboration over the next few years, but the message last week from CMMI was clear: we're with you, and we want you to succeed.

HSCRC Schedules Webinars on All-Payer Model Amendment and Care Redesign
HSCRC staff have scheduled seven webinars to provide hospitals with detailed information on the amendment to the All-Payer Model and on care redesign programs. The amendment, approved earlier this month:
  • Gives hospitals and their care partners access to comprehensive Medicare data across the care continuum that supports care coordination and a focus on controlling total cost of care
  • Creates the next steps toward total cost of care and delivery system transformation 

Under the amendment, the first two care redesign programs are:
  • the Complex and Chronic Care Improvement Program (CCIP)
  • the Hospital Care Improvement Program (HCIP) 

Seven webinars are scheduled:
  • Webinar 1: (1 p.m. Friday, October 21) - Amendment Overview and Implementation Timeline of Care Redesign Programs
  • Webinar 2: (9 a.m. Tuesday, October 25) - Care Partner Approval Process
  • Webinar 3: (9 a.m. Wednesday, November 2) - CCIP Program Template and Implementation Protocol
  • Webinar 4: (9 a.m. Friday, November 18) - HCIP Program Template and Implementation Protocol
  • Webinar 5: (9 a.m. Wednesday, November 30) - Comprehensive Medicare Data Process and Use
  • Webinar 6: (9 a.m. Wednesday, December 7)  - Care Redesign Program Monitoring
  • Webinar 7: (9 a.m. Friday, January 13) - Care Partner Agreements 

During each webinar, participants will have the opportunity to ask questions of HSCRC, the Center for Medicare & Medicaid Innovation, MHA, and CRISP. For those who cannot attend, webinar recordings will be posted on the HSCRC website.
If you have any questions or comments, send an email to [email protected].
PDMP Registration Deadline Delayed
DHMH has delayed until July 1, 2017 the requirement for individuals to register with the Prescription Drug Monitoring Program before being issued a new or renewal Maryland CDS Prescribing Permit from the Office of Controlled Substances Authority (formerly Division of Drug Control). The deadline was changed from October 1, 2016. The requirement that all CDC prescribers and pharmacists be registered with the program by July 1, 2017 remains. Providers can register for PDMP access through the state-designated health information exchange, CRISP, at www.cripshealth.org. Additional information is in the Version III PDMP Legislation Fact Sheet and a letter about the change from the DHMH Behavioral Health Administration Executive Director, Dr. Barbara Bazron and DHMH Deputy Secretary Dr. Howard Haft.
Webinar Aims at Opioid Prescribing Outcomes
Several Quality Improvement Organizations, among them the Virginia Health Quality Center, are offering a webinar: "Understanding Opioids to Improve Outcomes and Safety" Thursday, October 27 at noon. Objectives are to: identify the relative effectiveness of common pain medications, describe common side effects of available pain medications, and examine alternative treatments for pain both inpatient and outpatient that will improve clinical outcomes and reduce costs. Download a flyer with more details and register here.
Governance Can Help Improve Community Health
An article in this month's Great Boards newsletter summarizes findings from a recent study - Learnings on Governance from Partnerships that Improve Community Health. Conducted by the American Hospital Association's Center for Healthcare Governance, the study focuses on collaborative governance as a model that unites organizations and boards with common interests and common missions as hospitals work with partners to improve the health of their communities. Click here to download the article. 
Hopkins Launches Anesthesia Technology Program
The Johns Hopkins Department of Anesthesiology, in partnership with the Community College of Baltimore County (CCBC), has launched a two-year Associate of Applied Science Degree in Anesthesia Technology program through a combination of classroom, clinical and didactic experiences. Students complete their required classroom courses in the first year at CCBC and spend their second year at the Johns Hopkins Hospital clinical facilities. Classes are expected to begin in February 2017 and the program is currently accepting applications. For more information, contact Cheryl McNamara.
CANDOR Conference Postponed
Taking Action with CANDOR, the October 20 and 21 conference sponsored by the MedStar Institute for Quality & Safety and the Collaborative for Improvement and Accountability, has been postponed. CANDOR, short for "Communication and Optimal Resolution," was developed by the Agency for Healthcare Research and Quality to help break down the walls that tend to get built when an error occurs by encouraging full disclosure and an apology following an adverse event. When the conference is rescheduled, we will let you know in Update.
Can MHEI Help Me Accomplish Fill in the Blank?
 
One statement we seem to hear over and over again is, "I didn't know MHEI did that." Even individuals whose organization has been a MHEI member for many years express surprise and delight in knowing that MHEI is involved in providing services other than education programs in Elkridge.

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.

AHA Survey: 60% of RAC Reviewed Claims Did Not Have An Overpayment
 
Hospitals continue to appeal Recovery Audit Contractor claim denials, according to the latest report from the AHA's quarterly RACTrac survey. Hospitals report appealing 45% of all RAC claim denials, and 60% of claims reviewed in the second quarter of 2016 were found to not have an overpayment. 

THE WEEK AHEAD
Tuesday, October 11
- MHA Behavioral Health Hospital-Community Partnership Statewide meeting

Thursday, October 13
- MHA Medicaid Payor Relations Task Force meeting

Sunday, October 16 and Monday, October 17
- MHEI Annual Leadership Conference
TOP NEWS FROM THE WEEK
The Baltimore Sun, By Sarah Gatnz, October 1
 
The Baltimore Sun, By Meredith Cohn, October 1
 
The Baltimore Sun, By Sarah Gantz, October 3
 
Herald-Mail Media, By Tamela Baker, October 3
 
The Washington Post, By Arelis R. Hernandez, October 4
 
The Washington Post, By Zoe Sagalow and Joe Antoshak, October 4
 
The Baltimore Sun, By Andrea K. McDaniels, October 5
 
The Baltimore Sun, By Luke Broadwater, October 5