October 6, 2019
Blue Skies Ahead?
To best position Maryland hospitals and health systems for the future, partnering with state and local agencies is key. To that end, MHA participates in a group Secretary of Health Robert Neall convenes to help ensure the Maryland Model reaches its aims of better care and better health.

On Thursday, at my suggestion, MHA hosted the Secretary’s Vision Group, plus select guests, for a “Blue Sky” exercise at our office in Elkridge. Mr. Neall was there along with Secretary of Aging Rona Kramer, three deputy secretaries from the Department of Health, and leaders from the Maryland Department of Human Services, Maryland Health Care Commission, Health Services Cost Review Commission, Maryland Community Health Resources Commission, Maryland Health Benefit Exchange, and CRISP. CareFirst and Medicaid also joined us along with associations representing nursing facilities, home health and hospice.

We began with a quick poll on the top barriers to good care. Social determinants of health were the chief concern followed closely by the care delivery structure, workforce and costs.

We had a robust discussion around new opportunities. Multiple initiatives were floated pertaining to workforce (financial support for physicians’ educational debt, updating scope of practice rules), ways to prevent non-emergency use of emergency departments, leveraging resources of state and local aging and social services agencies, and methods to eliminate bottlenecks in the care process. Follow-up work will fashion the ideas into a workable plan of action.

It was striking to see people in the room discover that there are resources and innovations happening in adjacent spaces that they didn’t know about. Participants agreed it’s vital that we all work together to address statewide health system improvement. And, the highest levels of leadership at our state agencies are committed to keep these conversations going.

We’ll continue to represent your interests with the Secretary’s Vision Group, to push for progress, and to bring together public and private sector partners to make the Maryland Model a phenomenal success.
Bob Atlas
President & CEO
MHA Insight: Reducing Admissions, Readmissions and Mortality
Maryland’s hospitals are reducing admissions, readmissions and mortality faster than the nation. In the new issue of MHA Insight , we note the tremendous success you’ve attained despite the rapidly rising complexity of the patients you’re admitting.

  • Data show that hospitals statewide have:
  • Cut Medicare inpatient admissions more than two times faster than the nation
  • Lowered [30-day] readmissions four times more rapidly than the nation
  • Reduced the rate of Medicare beneficiary [30-day] mortality twice as quickly as the nation

Many of you told us that our first issue of MHA Insight  helped you educate stakeholders on our success controlling health care spending and usage. Please keep sharing MHA Insight with community leaders and other influencers so that we may continue to demonstrate the value of the Maryland Model and the collective performance of Maryland’s hospitals. 
HSCRC Requests Feedback on Strategic Vision
Recently the Health Services Cost Review Commission asked MHA to participate in an environmental scan it is conducting of the Maryland health care delivery and financing system. Individual hospitals and health systems are also encouraged to reply by close-of-business tomorrow, October 7. This input will inform the commission’s strategic vision.

HSCRC asked for input in three areas—top priorities, biggest challenges and opportunities for the state and the commission to foster delivery system reform. Last week, MHA responded with the following:

1. What are your organization’s top three strategic priorities or goals for the next five-to-10 years? MHA’s governing body in late 2018 set out the following strategic aims for the association:
  • Strengthen the health of Marylanders by fostering integrated, holistic care and supports
  • Ensure the success of the Maryland model of health care financing
  • Promote the long-term vitality of Maryland’s hospitals and health systems

2. What are the biggest challenges or obstacles to realizing those priorities?
  • Accountability. All stakeholders need to be aligned, with shared accountability to deliver success under Maryland’s Total Cost of Care Model.
  • Time. Health care transformation takes time, both to get it done and to realize its impact. Hospitals and health systems, with both leadership and support from MHA, need time to prove the transformational effects of our Model.
  • Resources. Funding of health services—not just of hospitals but of services across the continuum—is vital for the Model’s success.
  • Transparency. Hospitals need to know what the Centers for Medicare & Medicaid Services (CMS) and HSCRC want of them.

3. What should the state/HSCRC consider doing to foster continued delivery system reform?
  • Engage all Maryland partners to align for better health care and better health.
  • Work with CMS to ensure that timelines and expectations are reasonable.
  • Focus on policies that are pivotal to Model success and remove those that are not. Clearly define the 3-5 key goals the commission wishes to reach at the five-year mark.
  • Streamline processes to redesign and reconfigure services, allowing hospitals and health systems to fulfill the Model’s promise.

In addition, we requested that HSCRC help to educate the public about the benefits of health care transformation under the Maryland Model. For further details, contact MHA’s Brett McCone .
CMS Releases Final Rules on Discharge Planning
The Centers for Medicare and Medicaid Services finalized rules this week on revisions to requirements for discharge planning for hospitals. The final rule includes specific elements that must be addressed in the discharge planning process:
  • Hospitals must regularly reassess their discharge planning process
  • Discharge plans must be developed or supervised by a registered nurse, social worker, or other qualified health personnel
  • Discharge planning process must require regular re-evaluation of the patient’s condition to identify changes that prompt modification of the discharge plan
  • Any discharge planning evaluation must be made on a timely basis
The rule refrains from including requirements for prescription drug monitoring program (PDMP) use and does not finalize proposed discharge to home language. A summary of the changes prepared by the Joint Commission is here . The full rule can be read here .
HSCRC Releases Details on Revamped Regional Partnership Grants
The Health Services Cost Review Commission recently released details to revamp its Regional Partnership Grants to focus on behavioral health and diabetes initiatives.

Here is an outline of the plan:
  • Remove all RP funding currently in hospitals’ rates at the end of FY 2020. We believe this is about $11 M in FY 2020
  • Offer new funding up to 0.25% of statewide revenue, approximately $40 M statewide for FY 2021. This is the same percentage limit as original grant funds
  • HSCRC will be very prescriptive about types of activities they’ll fund
  • Diabetes Prevention Program OR Diabetes self-management and Medical Nutrition Therapy
  • Behavioral Health. Exact models TBD, depending on evidence-based models submitted by October 18. They strongly favor crisis services
  • Funding 4 years, contingent on achieving targets set by HSCRC and
  • DPP must be self-sustaining after 4 years
  • Self mgt/MNT and BH must be self-sustaining OR produce TCOC savings ROI. More details (slide 32)

  • October 9: Draft recommendation released. Comment period on policy open until October 23
  • October 16: Commission meeting
  • October 18: Stakeholder suggestions due for behavioral health proposals
  • October 23: Comment period closes
  • November 13: Commission meeting-final recommendation, issue Requests for Applications (slide 40)
  • April: Awards made
  • July 1: Funding begins

More details can be found in this document from HSCRC’s Regional Partnership Forum held September 18. Please share any behavioral health models or comments on the policy you plan to submit with MHA’s Traci La Valle
MHA Briefs Congressional Staff on Maryland Model, Federal Priorities
On Friday, your MHA briefed congressional staff from the Maryland Delegation and key health care committees on the Maryland Model. In addition to answering questions about the mechanics of the model, MHA staff discussed the impact issues at the federal level have on the model’s success and shared the field’s federal priorities to ensure the success of Maryland’s unique model, protect and expand access to care and foster a robust and inclusive health care workforce.

Contact: Jennifer Witten
MHA to Host Nurse Leaders Forum
Later this month, MHA will host a Nurse Leaders Forum to discuss nursing issues that have the potential to be raised during the next General Assembly session. Maryland’s Chief Nursing Officers have been invited to share their expertise and insight, which will guide MHA’s work as we prepare for the 2020 Legislative Session. For more information, contact Nicole Stallings .
Registration Open for Trauma-Informed Advocacy for Sexual Assault Service Providers
The Maryland Coalition Against Sexual Assault will host training on Trauma-Informed Advocacy for Sexual Assault Service Providers October 15 at University of Maryland, College Park. Tracy D. Wright, a national expert from the North Carolina Coalition Against Se xual Assault, will lead the full-day training. Participants will learn how to work with survivors who have experienced past or re peated trauma using trauma-informed strategies. Click here for more information and to register.

Contact: Jane Krienke
President Trump Issues Executive Order on Medicare
Last Thursday, President Trump issued an executive order calling for policy changes to Medicare. The order is intended “to protect and improve the Medicare program by enhancing its fiscal sustainability through alternative payment methodologies that link payment to value, increase choice, and lower regulatory burdens imposed upon providers.”

The order directs the Department of Health and Human Services to propose new policies related to Medicare Advantage, including incentives for enrollees to be able to share in savings; new plan designs and payment models to increase access to supplemental benefits; and improvements in network adequacy. The order also includes provisions to address administrative burdens on providers and to give consumers better cost and quality data. Finally, the order directs HHS to study fee-for-service prices and approaches to transition the traditional Medicare program to true market-based pricing.

The order calls for the Secretary of HHS to issue recommendations or proposed regulations within 180 days for some elements and within one year for other elements. So, few actual changes will occur soon.

Given Maryland’s exemptions from the Medicare payment system for hospitals and relatively low Medicare Advantage penetration, it is unclear what direct impact the contemplated policies may have in our state. MHA is analyzing the implications of the order for Maryland’s hospitals, and we will share analyses and guidance in coming weeks.
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