July 21, 2019
Ensuring Access to Affordable Coverage
Affordable health care coverage is essential for people to have access to the care they need. It is particularly important in Maryland, where our success under the Total Cost of Care Model rests on improving the health of the state’s entire population. We can’t prevent unnecessary hospital use unless more Marylanders can afford coverage.

Last week, the Maryland Insurance Administration (MIA) held its public hearing on 2020 insurers’ premiums. In the individual market the average rate reflected a 2.9% decrease. This is good to see, though it is almost entirely attributable to the effects of the reinsurance program begun last year. For the small group market, it was a 4.3% increase. MIA will decide on rates ahead of the new rate year in January.

Your Maryland Hospital Association testified at the hearing and wrote to the MIA outlining several concerns:

  • Payers’ requests, in some cases, were not based on accurate hospital trend data, which is discernible under the HSCRC’s global update process.
  • Savings under the Model are not being passed to consumers, who are experiencing higher out-of-pocket costs. This finding is backed by independent analysis and published in May’s issue of MHA Insight.
  • Reliance on the reinsurance program to subsidize high-cost patient claims is not sustainable. Payers need to invest in meaningful care management.

We continue to urge insurance regulators to review rate requests holistically These efforts are working. MIA is starting to gather data on insurers’ care management programs to gauge their effectiveness. MIA is also looking into the spike in out-of-pocket costs.

These are promising steps toward ensuring that all Marylanders can afford health care. We will continue to push for more insurer accountability.
Bob Atlas
President & CEO
Maryland Medicare Quality Scores Affected by Billing Requirement
The way that Maryland’s hospitals are required to bill Medicare for long stay patients causes aberrations in Medicare quality scores that could be skewing hospitals’ quality data reported on Medicare’s Hospital Compare website, CMS Star Ratings and other organizations that use Medicare data such as Leapfrog, and US News & World Report.

Health Services Cost Review Commission (HSCRC) data, HSCRC quality scores and global budget adjustments are not affected.

At issue is interim claims often submitted for patients who are in the hospital longer than a month. To bring revenue in the door while the patient is still an inpatient and before they’re discharged, the hospital can submit a bill to Medicare at the end of each month. In all other states, the hospital then submits a final summary bill that includes all the diagnosis and procedure codes in the correct order so that the most important ones are listed first. This ensures that the case is assigned to the most appropriate DRG. Maryland’s hospitals are instructed by Medicare not to include everything on the last bill.

In calculating quality scores in Maryland, Medicare looks only at the last bill that is submitted — not earlier interim bills. As a result, a complication that occurs earlier in the stay may be missed, cases may be improperly included or excluded in the measurement, or cases may be assigned to the wrong diagnosis group or service line. The magnitude of the impact depends on how many interim bills a hospital submits. A hospital’s performance could appear to be better or worse than it is.

MHA will meet with state and federal regulators to alert them to the issue and propose steps to address the inaccurate measurement. MHA will also draft a letter alerting Leapfrog, and US. News & World Report to the issue.

For questions, contact Traci La Valle .
MDH Seeks Nominations for Community Options Advisory Council
The Maryland Department of Health is seeking nominations for members of its Community Options Advisory Council. The council membership is mostly represented by consumers, but also includes health policy professionals, direct service or health care providers, provider representatives such as labor unions or professional organizations, law makers and other interested community members. A nomination form is available, which lists the qualifications. Nominations should be submitted to the department ( dhmh.cfc@maryland.gov ) by August 30.
MHA to Host Series of Statewide Forums on Workforce
Your Maryland Hospital Association (MHA) is hosting the first in a series of statewide workforce forums August 1. The forum will focus on workforce development practices and challenges – particularly as they relate to allied health professionals and nursing. It is also an opportunity to hear success stories and strategies that are already improving outcomes in our state. The information and feedback shared at the forum will guide the work of the association to further support your future workforce needs. We encourage every member hospital to designate a representative from your HR and CNO staff to attend.
Registration is open . For details, contact Jane Krienke .
Registration Open for MHEI Healthcare Leadership Conference
Registration is open for the Maryland Healthcare Education Institute’s Healthcare Leadership Conference. The conference, October 18 in Ellicott City, features keynote speaker Kedar Mate, MD, chief innovation and education officer for the Institute for Healthcare Improvement. The conference is the region’s top opportunity to network and build partnerships with leaders at all levels from a wide variety of healthcare organizations. Read the conference brochure for a full lineup of speakers.
Atlas: Using Telehealth to Meet People Where They Are
Health care only works if you can connect to it. Using the power of technology, your hospitals continue to find ways to advance health care and the health of all Marylanders. In his most recent WYPR commentary , Bob Atlas, President & CEO of the Maryland Hospital Association, shines a light on the telehealth trend and how it is expanding access to health care for Marylanders.
The 2019 America’s Health Rankings® Senior Report provides a comprehensive look at the health of seniors across the nation and on a state-by-state basis. Thirty-four core measures of health are used to create the senior health state rankings.

Based on those measures, Maryland is:

Want to receive your Toward Better Health
newsletter via text message?
Click here to sign up.
Maryland Hospital Association | www.mhaonline.org