January 26, 2018
Reducing ED Wait Times

Culture change and accountability.
 
Appropriate options for non-emergent patients.
 
New departmental roles and collaboration, laser- focused on improved emergency department wait times.
 
These are just some examples of the innovations that are driving reduced wait times in Maryland's hospitals, and in turn directing patients to the right care, at the right time, in the right setting. At MHA's ED Throughput Redesign Summit yesterday, speakers from Anne Arundel Medical Center, MedStar Health and the University of Maryland Medical Center shared these and other strategies with nearly 100 representatives from hospitals throughout the state.
 
Maryland's emergency department wait times rank among the worst in the nation and are related to an increase in ED diversions over the past four years. While many factors contribute to this problem - the behavioral health crisis, Medicaid expansion, more comprehensive clinical screenings, a nursing shortage, and patients who don't truly need emergency care - this is a concern that hospital leaders want to tackle head-on.
 
And now, along with the impact on patients and hospital staff, lengthy emergency department wait times carry financial consequences for hospitals, as the Health Services Cost Review Commission has incorporated ED wait time metrics into Maryland's Quality-Based Reimbursement program.
 
To help hospitals reduce ED wait times, MHA has compiled several resources and best practices, along with data analyses of the root causes of delays. In addition, video from yesterday's summit will be available in the coming weeks. Stay tuned for an announcement of how to access it.
 
Improving wait times, on a fundamental level, will take three things, according to yesterday's presenters: the right culture, the right systems, and the right people. Over the past four years, as you've implemented massive care delivery changes, you've demonstrated that Maryland's hospitals have each of these in abundance. That will be our collective strength as we work together to improve wait times.

At Work  in Annapolis
Following the field's strong opposition, this week Maryland Delegate Angela Angel withdrew a bill that would have questioned hospitals' tax exempt status by requiring an itemization of the value of their tax exemptions on annual community benefits reports. Also this week, MHA's Senior Vice President for Rate Setting Mike Robbins briefed the House Health & Government Operations Committee on the implications of federal health insurance policy on Maryland's All-Payer Model. Nicole Stallings, MHA's Vice President for Policy & Data Analytics, provided the Senate Finance Committee with MHA's plan to address the behavioral health crisis (see next article). And on Monday, the General Assembly started its work on the governor's proposed fiscal year 2019 budget, beginning with a comprehensive fiscal briefing by the Department of Legislative Services.
 
Throughout the legislative session, you can track MHA's activities via our dashboard that provides an overview of the previous week and a look at important hearings and events coming the following week.
MHA Presents Behavioral Health Roadmap
In a presentation last week before the Maryland House Health & Government Operations Committee and yesterday before the Senate Finance Committee, MHA Vice President Nicole Stallings discussed recommendations from MHA's Behavioral Health Task Force (formed by MHA in 2015 to identify and address key behavioral health issues affecting Maryland's hospitals and the communities they serve) for an essential, comprehensive behavioral health care system . The goal of the recommendations, the result of more than two years of work by the task force, is to guide and support efforts to strengthen the behavioral health care workforce and expand access to crisis services. The roadmap calls for immediate action by state government, clinical providers, community partners, payers, and consumers to join in support of the investments needed to ensure the health care infrastructure can meet the needs of those with behavioral health illnesses.
Save the Date - Gawande to Speak at Annual MHA Meeting
One of Time Magazine's 100 Most Influential Thinkers and former New York Times #1 bestselling author Atul Gwande, M.D. has been confirmed as the keynote speaker at this year's MHA Annual Membership Meeting, June 11 and 12 at the Four Seasons Hotel in Baltimore. A renowned surgeon and researcher, author of Being Mortal: Medicine and What Matters in the End, professor, Harvard T.H. Chan School of Public Health and Harvard Medical School, and Executive Director, Ariadne Labs, Gawande's bold visions for improving performance have made him one of the most sought-after speakers in medicine. He sees through the complexities of health care to the needs of real people, the values that make for a healthy society, the science and technologies waiting over the horizon and how to reform systems to make it all work. His innovations in medical practice have saved countless lives worldwide. Be on the lookout for the brochure and registration information coming soon from MHA. Contact Kathy Gotwalt if you have any questions.
Comment Letters Sent on CON, MHAC
MHA this week sent a response , incorporating feedback from hospital members, to the Maryland Health Care Commission on a series of questions to help identify Certificate of Need (CON) issues for the commission's work group to address. As MHA's hospital member work group reviews issues related to CON and the State Health Plan, specific and more detailed recommendations will be shared with the commission. For more information, contact Brett McCone or Jennifer Witten . Information on the commission's stakeholder process can be found here . MHA also sent a response this week to the Health Services Cost Review Commission on its draft recommendation for the Maryland Hospital-Acquired Conditions Program for rate year 2020. If you have questions, contact Traci La Valle .
Quarterly Financial, Utilization Reports Available
The financial reports for the third quarter of 2017 are now available for MHA members. To access the Accounts Receivable and Combined Financial Trends and Utilization reports, click here . Reports are available only to members. If you have questions, contact Brian Sims .
MDH Launches Opioid Awareness Campaign
The Maryland Department of Health has begun two multi-media advertising campaigns to help combat the state's opioid epidemic. The first, "Less Judgment. More Compassion," is an anti-stigma campaign stressing that opioid addiction is not a moral failing to be judged, but rather a chronic disease that requires treatment. The second, "Talk to Your Doctor," stresses the importance of speaking candidly with your health care provider when being prescribed an opioid pain medication because these medications can be highly addictive. Both campaigns incorporate:  
  • Public service announcements on radio and television;
  • Movie screen advertising in theatres throughout the state;
  • Targeted advertising in county newspapers and electronic media;
  • Geo-targeted messaging on mobile devices.
HSCRC Names New Commissioner
Dr. James N. Elliott, Medical Director at Doctors' Community Hospital, has been named as the newest commissioner of the Health Services Cost Review Commission. Elliott began his medical career as a pathologist at George Washington University Hospital and previously worked at St. Joseph's Hospital in New York. He is a Clinical Assistant Professor of Pathology at George Washington University Medical School.
CMS to Reschedule Medicare Beneficiary Identifier Call
The Centers for Medicare & Medicaid Services canceled its January 23 conference call for Medicaid providers and agencies on the transition to the new Medicare beneficiary identifier. The call will be rescheduled at a later date. The agency plans to begin mailing new Medicare cards to beneficiaries in April, which will replace the Social Security-based number on the current cards with a new Medicare beneficiary identifier.
AHRQ Program Addresses Surgical Care, Recovery
The Armstrong Institute, in collaboration with the American College of Surgeons, is recruiting hospitals for a national program to improve clinical outcomes, reduce lengths of stay and improve the patient experience. The program is funded and guided by the Agency for Healthcare Research and Quality (AHRQ). The next 12-month cohort, which begins March 1, will focus on hip and knee replacement, hip fracture, and colorectal surgery. Informational webinars will be held February 1 at 3 p.m. , February 5 at 4 p.m. , and February 8 at noon (click link to register for that webinar and learn more). Participation is free and the deadline to enroll is February 15. This is the second of five planned cohorts. Future cohorts will focus on gynecologic surgery (March 2019), emergency general surgery (March 2019) and bariatric surgery (January 2020). Hospitals may participate in multiple cohorts. Email ISCR@facs.org with questions.
Studies Highlight Cost Burden of Liability System
According to a series of reports released this week by the American Medical Association, the average cost of administering or adjudicating a medical liability claim was $54,165 in 2015, 65 percent more than in 2006. The AMA found that more than two-thirds of claims were dropped, dismissed or withdrawn, but still cost an average $30,475 to defend. Only 7 percent of claims were decided by a trial verdict, and the vast majority were won by the defendants. Despite increasing stability in liability premiums, more premiums have increased than decreased since 2015, the association found. "Information in this new research paints a bleak picture of physicians' experiences with medical liability claims and the associated cost burdens on the health system," said AMA President David Barbe, M.D. "The reports validate the fact that preserving quality and access in medicine, while reducing cost, requires fairness in the civil justice system. Every dollar spent on the broken medical liability system is a dollar that cannot be used to improve patient care."
Getting the Most From Your MHEI Membership
 
At MHEI we want you to maximize the value of your membership. That is why we are interested in working with each member individually to ensure you're taking advantage of all of your membership benefits.

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.

FDA Extends Shelf Life of Certain IV Solutions in Short Supply
 
Hospitals may use certain intravenous solutions made by Baxter Healthcare Corp. beyond the labeled expiration date due to the ongoing shortage of IV solutions used in critical care, the Food and Drug Administration announced this week.

TOP NEWS FROM THE WEEK
WCBC Radio , January 19
 
The Baltimore Sun , By David Anderson, January 22
 
The Baltimore Sun , By Andrea K. McDaniels, January 23
 
The Baltimore Sun , By Michael Dresser, January 23
 
Capital Gazette , By Chase Cook, January 23
 
The Washington Post , By Lena H. Sun, January 25