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August 2, 2020
COVID and the Maryland Model
We are by no means finished with COVID-19, so it may be premature to try to answer this question: Does the Maryland model of health care financing protect our hospitals against pandemic shock in ways not found in other states?

Independent commentators have weighed in, arguing global budgets such as we have in Maryland are a boon to hospitals. They see the purported guarantee of a preset amount of annual revenue as a near-perfect antidote to the deep loss of revenue that came about when hospitals lost volume in the spring.

We here in Maryland know the global budgeted revenue mechanism does not guarantee revenue to a hospital unconditionally. The system is designed to handle volume swings in the single-digit percentages, allowing hospitals to adjust prices up to 5%, sometimes as much as 10%. But the double blow of the shutdown of elective procedures and patients’ fears of seeking care caused usage for several months to fall about 30% for inpatient care and 60% for outpatient services.

Fortunately, the Health Services Cost Review Commission (HSCRC) did use its authority to grant hospitals extra relief. The commission raised the allowable percentage for price increases and extended the time period over which the augmented prices may run.

Though, not unreasonably, HSCRC says federal relief payments hospitals receive must be considered in measuring net revenue shortfalls. MHA staff are working with members and HSCRC staff to iron out the details of that accounting. Importantly, with COVID caseloads rising again now and possible future waves coming, members tell us the end of rate year 2020 is much too soon to settle up.

Maryland hospital and health system leaders who’ve spoken with peers in other states tell us it does appear the financial damage in our state will be less harsh, thanks to the model and to the way the regulator has employed its powers.

We truly hope the model does indeed hold up as a buffer that enables the magnificent work of our hospitals to endure through COVID and well beyond.
Bob Atlas
President & CEO
HHS Updates COVID-19 Hospital Daily Data Reporting Guidance
The Department of Health and Human Services (HHS) updated its guidance and frequently asked questions (FAQs) regarding the agency’s request for daily COVID-19-related hospital data reporting. The most notable changes are detailed below, and the updated guidance is effective immediately.
 
HHS makes two significant changes to the process of reporting certain supply data:

  • Hospitals may reduce the frequency of reporting supply-related data fields—i.e., items 26-32 in the guidance document’s table—from daily to three times per week. Specifically, HHS is asking hospitals to report these data on Mondays, Wednesdays and Fridays.

  • For the data fields asking hospitals for the days of on-hand supply (i.e., items 27 and 28 in the guidance document’s table), hospitals now have the option of selecting a range of days, rather than calculating a specific number.

HHS began to deploy “Hospital Data Liaisons” last week. These teams work collaboratively with states to obtain information about barriers to reporting complete data, and over time, are expected to help states and hospitals get clarification and guidance around reporting requests.
 
For more information, contact Katie Eckert .
MHA, State to Establish Steering Committee to Guide PPE Efforts
Since the outset of the COVID-19 public health emergency in Maryland, MHA facilitated conversations with the Maryland Department of Health and hospital supply chain leaders and emergency management to improve the supply chain of personal protective equipment in our state, including during future surges of the virus. Based on these conversations, MHA engaged KPMG to create a framework for hospitals and the State to reimagine the PPE infrastructure on a statewide level—and ultimately crate an appropriate safety net of PPE for the hospital field. In addition to engaging members on calls, we received feedback from the State on their goals and expectations.

The initial framework includes:
 
  • Appropriate cache levels for different partners
  • Trigger points for accessing caches
  • Rotation, delivery and maintenance of caches
  • Transparent request and reporting capabilities
 
MHA will share the initial framework with the field this week for additional feedback. Our next step is to bring that framework to a steering committee that includes hospital supply chain leaders, MDH, MHA, and our regional health care coalitions to determine how the structure will work. The committee also will offer guidance as the state establishes local Maryland manufacturing programs. MHA will reach out to members for involvement on the steering committee and potential subgroups.
 
For questions, contact Meghan McClelland .
Gov. Hogan Renews Emergency Declarations
Gov. Larry Hogan on Thursday renewed the State of Emergency and Catastrophic Health Emergency declarations. The order renews the declarations for 30 days. The initial state of emergency and catastrophic health emergency order was issued March 5 in response to the COVID-19 outbreak.
CMS COVID-19 Medicare Snapshot Reveals Disproportionate Impact on Black, Native American Populations
The Centers for Medicare & Medicaid Services (CMS) released new data detailing the cumulative impact of COVID-19 on Medicare beneficiaries ( data ; FAQ ; CMS Administrator Seema Verma blog post ). Overall, CMS states the data show that older individuals and those with chronic health conditions are at the highest risk for COVID-19. The data also speak to racial disparities in the health care system and their resulting effects on minority populations. 
HSCRC August Meeting Canceled
The Health Services Cost Review Commission will not hold its August meeting . The commission’s next meeting is scheduled for Sept. 9.
Clinical Learnings on COVID-19 Webinar Series
The Northeast Hospital Associations and the Jefferson College of Population Health will hold weekly webinars through Sept. 22 focused on approaches to and solutions for the clinical dilemmas that arose during COVID-19 surge. The sessions, led by physicians from states that first experienced COVID-19, are limited to the first 500 attendees. Recordings of the webinars will be made available to all hospitals on the Jefferson Digital Commons
New Competition Aims to Improve Postpartum Mental Health in Rural Communities 
The federal Agency for Healthcare Research and Quality (AHRQ) will host a webinar Aug. 5 from 2-3 p.m. to discuss their latest challenge competition aimed at improving postpartum mental health care for rural families. AHRQ is collecting success stories and proposals that demonstrate innovative planning for community action to improve postpartum mental health with the goal of sharing these solutions with health care systems, health care professionals, local and state policymakers, federal partners, and the public. Winners of the competition will receive $15,000 each, and winners in the program proposal category can receive up to $50,000 to support implementation. Submissions are due Sept. 15. More information is available on the AHRQ website
HHS Hosting Series of Telehealth Webinars for Community-Based Organizations
The Department of Health and Human Services will host a series of webinars on providing telehealth services in community-based organizations. The goal of the series is to help community-based organizations effectively leverage telehealth. The August webinar will focus on at-risk and disadvantaged populations. Additional information and webinar registration can be access through the HHS website .
Notice of Funding Availability Released for Maryland Child Sex Trafficking Regional Navigator Program
Applications for the Child Sex Trafficking Screening and Services Act Regional Navigator Program are now available. The Governor’s Office of Crime Prevention, Youth, and Victim Services will award up to $1 million in federal grant funding to expand the newly launched Regional Navigator Program. The goal of the program is to provide comprehensive services for child victims of sex trafficking in Maryland, a requirement under the Child Sex Trafficking Screening and Services Act of 2019. The state law requires law enforcement and local departments of social services to notify a Regional Navigator when they encounter a youth they believe may be a victim of sex trafficking. The Regional Navigator is responsible for providing or connecting the identified youth with the appropriate services. Youth up to age 24 are eligible for these services. Online applications must be submitted by Aug. 20. More information is available in the Notice of Funding Availability . Questions can be directed to the program manager, Angela Cromwell .
HFMA Hosts Free Webinar on Diversity, Inclusion, Telehealth
The Maryland chapter of the Healthcare Financial Management Association will host a free webinar Aug. 14, which includes an interactive diversity and inclusion workshop and a panel discussion on telehealth in Maryland during the COVID-19 pandemic. Panelists include Emily Yoder, of the Centers for Medicare & Medicaid Services; Bill Sheahan, vice president of MedStar Health, and Gene Ransom, CEO of MedChi.
AHA Dick Davidson NOVA Award: Baltimore City Hospitals
The American Hospital Association (AHA) will honor five programs with the AHA Dick Davidson NOVA Award for their hospital-led collaborative efforts that improve community health. The winning programs are Supportive Housing for the Homeless, Baltimore City Hospitals ; Eagle Valley Behavioral Health, Vail Health, Vail, Colo.; Hackensack Meridian School of Medicine at Seton Hall University, Edison, N.J.; Healthy Roanoke Valley, Carilion Clinic, Roanoke, Va.; and Mothers in Recovery, Memorial Healthcare System, Hollywood, Fla.

Through a partnership between Baltimore City’s 10 hospitals, the nonprofit Health Care for the Homeless, and the city of Baltimore, eligible individuals and families who are experiencing or at risk of homelessness are placed in permanent sustainable housing, with wraparound supportive services to help ensure their success. The city connects individuals and families with housing, and Health Care for the Homeless, a federally qualified health center, helps individuals in need access care and navigate the supportive housing process. The city-based hospitals provide the Medicaid matching funds that enable Baltimore City government to take advantage of the Assistance in Community Integration program, a Medicaid Waiver opportunity. The hospitals also refer patients for housing placements. The supportive housing program was established in 2018 and expanded in 2019 to help meet a critical community need for housing. That need was identified as a priority during a citywide community health needs assessment, conducted by all city hospitals in collaboration with the Baltimore City Health Department.
MHA Launches Prime Advisory Group
MHA will launch a Prime Advisory Group. Prime is MHA’s regional group purchasing affiliate. The Prime Advisory Group will consist of hospital supply chain leaders to engage on local, racially equitable purchasing. Recently, MHA’s Executive Committee published our Commitment to Racial Equity, asking hospital and health systems to consider equity and inclusion of marginalized groups in making purchasing decisions. We would like the Advisory Group to advance this commitment through supply chain initiatives by sharing best practices and identifying and developing contracts with diverse, local Maryland suppliers.

Another element of MHA’s Racial Equity Commitment was to work toward policies and practices that promote racial equity in social, economic, environmental and other domains. We believe we can improve economic access to marginalized groups by continuing to invest in our local communities. We would like to engage the Advisory Group to find local business to contract with who are committed to increasing job opportunities in the community in a socially and racially equitable way. During a time of financial uncertainty, MHA Prime would like to continue to find local contracts to help hospitals lower costs and would like the Advisory Group to offer priority areas and target suppliers for these contracts. This new resource is designed to support you and your organizations in your local supply chain efforts.

MHA will contact supply chain leaders to ask them to participate in the group. For more information, contact Meghan McClelland .
National Group Buys Program Offers Savings for MHA Members
MHA members are eligible for Vizient’s National Group Buys through MHA Prime. The program offers opportunities to realize substantial savings and enhanced contract value on select products and services. To date, Vizient’s capital equipment group buys have saved hospitals more than $421 million. Group buys are available in 45 major categories, including biomedical engineering, imaging, business office, cardiology, laboratory, central supply, emergency room, medical records, and surgery. For more information contact your MHA Prime Client Executives: Joy Money at 240-856-3303 or Diane Bruno at 410-790-8031.  
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