September 15, 2019
CMS Demands Value
Last week AHA held a biennial national meeting of all nine Regional Policy Boards. CMS Administrator Seema Verma spoke on the final day, delivering strong words on the federal government’s push toward value-based payment.

“We must move past the status quo, and past a fee-for-service payments to a system in which we’re paying providers to keep people healthy, reduce costs and deliver better outcomes,” she noted.

And with hospital care representing one-third of all health expenditures, she continued, “… for our health care system to drive down total costs, our models will have to get at hospital spend. So, make no mistake—if your business model is focused merely on increasing volume rather than improving health outcomes, coordinating care and cutting waste, you will not succeed under the new paradigm. As the market moves to more value-based payment, and as participants demonstrate success, at some point models will no longer become optional and will become standard payment policy.”
Don’t those remarks sound like an affirmation of the Maryland Model? With global budgeted revenue, quality-based payment, and incentives on total cost of care, our model fills the bill–in the hospital space–and it is already standard policy across Maryland.

Administrator Verma also sent some warnings hospitals across the nation should heed. “Americans are fed up, not only are they paying more, but they aren’t being treated fairly. Like when they go to a hospital they think is in-network, and then receive bills from out-of-network providers. One in six patients have experienced surprise bills after a hospital stay, even when they have insurance. This is simply not fair to patients.” Also, “… certain not-for-profit hospitals…are referring patients to debt collectors, garnishing wages, placing liens on property, and even suing patients into bankruptcy. This is unacceptable. Hospitals must be paid for their work, but it’s actions like these that have led to calls for a complete Washington takeover of the entire health care system.”

So, let’s redouble our ongoing efforts to ensure patients also feel the benefits when their bills come due. At the same time, let’s be proud of what we’ve accomplished in Maryland and continue to educate policy-makers on the value of our model.
Bob Atlas
President & CEO
MHA Administering Hospital Preparedness Program
At the request of the Maryland Department of Health, MHA took over the state’s administration of the Hospital Preparedness Program (HPP) in July. The program provides grant funding to states from the Department of Health and Human Services. MHA’s role in overseeing the program will ensure that hospitals receive about $3 million in funds more quickly. That includes:

  • More than $1 million in direct funding to Maryland hospitals; each individual hospital can apply receive $25,000
  • Over $1 million in funding to the four health care coalitions in the state (National Capital Region, Western Maryland, Central Maryland and Eastern Shore)
  • About $1 million in funding to MHA to support all the health care coalitions in statewide planning, exercise and logistics support

Taking guidance and direction from our hospitals and health care coalitions, MHA will form an HPP team that will help our regions and the state be better prepared to respond to emergencies. MHA’s goals in the administration of the HPP program are:

  • Ensure timely funding to the hospital and health care coalitions for emergency preparedness activities
  • Offer needed administrative support to the largely volunteer health care coalitions and hospitals
  • Coordinate and utilize funding to ensure we leverage ideas and resources as prioritized by hospitals and health care coalitions

MHA is planning regular calls with hospitals and health care coalitions, monthly meetings with coalition leads and educational programming to help meet these goals. MHA received applications from hospitals and health care coalitions and will begin distributing those funds this month. Our goal is to have the funds approved and distributed no later than mid-October. For more information, contact Meghan McClelland .
HSCRC Staff Propose MPA Framework Draft Recommendation
The Health Services Cost Review Commission (HSCRC) presented a draft recommendation Wednesday on the Medicare Performance Adjustment (MPA) framework, which includes two components: MPA savings (MPA-SC) and MPA reconciliation (MPA-RC). The MPA-SC could be used, if needed, to reduce Medicare payments to meet the Medicare total cost of care savings target in lieu of reducing the all-payer update. The MPA-SC essentially replaces the MPA efficiency component originally proposed at HSCRC’s April public meeting. HSCRC staff are not proposing to use the MPA-SC in rate year 2020, noting Maryland is well-positioned with more than $273 million of savings as of 2018. More information on this and other topics discussed at the September 11 HSCRC public meeting is available in this week’s Newsbreak .
Pilot Program Helps Hospitals Reconcile Outstanding Claims
MHA is hosting a UnitedHealthcare(UHC) pilot program to offer in-person assistance from UHC to help hospitals reconcile outstanding claims. The program will be October 29-30 at MHA’s office, at 6820 Deerpath Road, Elkridge, Md. For details contact Diana Hsu .
Frosh Considers Whether Employers Can Apply Absence Control Policies to Prevent Abuse of Sick, Safe Leave
As a result of advocacy efforts during the 2019 legislative session, Del. Dereck Davis, chairman of the House Economic Matters Committee, requested that Attorney General Brian Frosh provide an opinion on whether the Maryland Healthy Working Families Act permits certain employers to apply absence control policies to prevent abuse of “sick and safe” leave. The opinion was recently released publicly. MHA is assessing implications of the opinion on the hospital field and on other Maryland employers. The opinion states, in part:

“In our opinion, the Act does not permit an employer to apply an absence control policy, including one that assigns points to an employee’s absence, in a way that could lead to or result in adverse action for the legitimate use of sick and safe leave taken in accordance with the Act. An employer may, however, apply an absence control policy (or some other disciplinary policy) to penalize the actual abuse or improper use of leave under the Act, such as when the employer can demonstrate that the employee used leave for reasons not permitted under the Act or that the employee otherwise engaged in a pattern of abuse of leave under the Act.”

For more information, contact Neal Karkhanis , Director, Government Affairs.
NSP II Program Evaluation Previewed
The Maryland Higher Education Commission (MHEC), the Health Services Cost Review Commission (HSCRC) and the Nurse Support Program II (NSP II) evaluation team hosted a meeting with nurse leaders and other interested stakeholders to discuss the evaluation of the NSP II program. The goal of the program is to increase the number of nurses in Maryland. The program funds initiatives that focus on expanding the capacity to educate nurses by increasing faculty and strengthening nursing education programs in Maryland. The discussion focused on ensuring the NSP II program is properly implemented and funding opportunities are well promoted. The full draft evaluation will be presented to the HSCRC in November and for final approval in December. For more information contact Erin Dorrien .
Certification for Community Health Workers Available
The application process for a voluntary, grandfathering Community Health Workers’ certification is available now through March 31, 2020. We encourage that your CHWs consider using this process for certification. The certification is free, and additional details can be found here . The CHW advisory committee also is seeking additional members. For questions or assistance with the certification process, contact the CHW Certification team at 410-767-5971 or MDH.CHWApplications@Maryland.gov .
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