August 25, 2019
Toward Better Health will not be published on Sept. 1 due to the holiday – look for the next issue on Sept. 8

Hospitals Power Maryland’s Economy
Every day thousands of committed health care professionals come to work in your hospitals to ensure we deliver the highest quality care to patients.

That puts you among the state’s largest employers — directly employing 107,000 people, supporting 113,000 related jobs, and contributing more than $30 billion each year to our state’s economy.

Health care is a key economic driver nationwide, too, with health care recently surpassing manufacturing and retail to become the largest source of jobs in the U.S.

In listening to you, though, and probing the data, we understand there are challenges. Right now, your hospitals and health systems are coping with more than 6,000 vacancies. Many of these openings are in critical areas, like your emergency departments and behavioral health units.

The problems will compound as our population ages – the share of Marylanders aged 65 or older will rise from about 15% today to 20% in 2030 – just as the pipeline of well-prepared caregivers may narrow.

That’s why MHA’s strategic plan has as one of its pillars to build a “robust, diverse, inclusive and engaged healthcare workforce.” This will manifest in our legislative priorities going into the Maryland General Assembly’s 2020 session. And, it’s evident in the work of the Workplace Violence Steering Committee and the newly formed Diversity and Inclusion Advisory Group.

We look forward to helping the field collectively to solve these challenges.

Please enjoy a safe and happy Labor Day holiday next week.

Bob Atlas
President & CEO
CMS Finalizes IPPS Rule
CMS finalized new technology add on payments for new anti-microbial resistance drugs and for “breakthrough” devices. Although this does not directly affect Maryland hospitals, it supports our requests for additional revenue for new drugs and technology.

Also completed are two new quality measures in the final Inpatient Prospective Payment System (IPPS) rule related to the Inpatient Quality Reporting (IQR) program. The new measures are a hybrid readmissions measure that uses data from the electronic health record (presenting vital signs) to supplement risk adjustment; and Safe Use of Opioids – Concurrent Prescribing electronic clinical quality measure. In the IQR program, hospitals must report measures to CMS or face penalty, but there is no penalty/reward based on performance. The measures are publicly displayed. For further details see the CMS final IPPS and Long Term Acute Care Hospital (LTCH) rules
Report Considers Link Between Demographics, Readmissions 
A recent Annals of Internal Medicine report authored by several Health Services Cost Review Commission (HSCRC) staff and a former HSCRC commissioner demonstrates that living in a neighborhood with a high deprivation index and receiving care at a hospital with a high proportion of patients residing in highly deprived neighborhoods are independent predictors of readmission. An infographic shows the results. As HSCRC considers updates to its readmissions policy, their readmissions subgroup is considering how to account for these types of risk that are beyond a hospital’s control. 
HSCRC: New Care Redesign Program Recommended to Launch in 2021
The Health Services Cost Review Commission (HSCRC) announced Monday it would recommend that Maryland Health Secretary Robert Neall push back the launch of the Post-Acute Care for Complex Adult Patients (PACCAP) care redesign track to January 2021. This track is intended to address "hard-to-place patients" and support hospitals and post-acute care providers partnering to move those patients to a more appropriate setting of care. It had been expected to launch next year, but hospitals requested additional time to partner with skilled nursing facilities. The HSCRC also will convene a subgroup of the Care Transformation Steering Committee to work on developing PACCAP and related issues. For information on how to join this subgroup or other related inquiries, contact hscrc.care-transformation@maryland.gov
Key Dates for Care Redesign Program Announced by CRISP & HSCRC
Chesapeake Regional Information System for our Patients (CRISP) and the Health Services Cost Review Commission (HSCRC) released a calendar of key dates for participation in both the Hospital Care Improvement Program and the Episode Care Improvement program for calendar year 2020. In the same message to hospitals, CRISP outlined new program participation costs. Important dates are posted below, and the full letter can be found here.

  • September 6, 2019 - Notice of Intent to Participate
  • September 16, 2019 - Care Partner Vetting List
  • October 31, 2019 - Implementation Protocols
  • December 31, 2019 - Participation Payment

For questions or more information contact care.redesign@crisphealth.org.
AHA Releases Summaries on Post-Acute Care Final Rules
Earlier this week, the American Hospital Association released summaries of the Inpatient Rehabilitation Facility (IRF), Skilled Nursing Facility (SNF), and Long-Term Care Hospitals (LTCH) Prospective Payment System (PPS) final rules. The rules continue CMS’s movement towards value-based payment in post-acute care. MHA commented on the Inpatient Rehabilitation Facility proposed rule. Notable provisions from the final rules include:

  • IRF PPS: Increase in IRF payments by 2.5%, along with rebasing and revision of the IRF market basket using more recent data. CMS will implement an unweighted motor score to assign patients to CMGs beginning with FY2020 and is adopting the new definition for whether a physician qualifies as a rehabilitation physician.
  • SNF PPS: Increase in overall SNF payments by 2.4% in FY 2020, with larger updates for hospital-based SNFs, and standardizing of measures for patient assessment. 
  • LTCH PPS: Increase in overall LTCH payments by 1.0% and for standard rate cases by 2.7%, but with decreased payments for site-neutral cases by 4.9%.

All three rules include adoption of two new quality measures: Transfer of Health Information to the Provider—Post Acute Care and Transfer of Health Information to the Patient—Post Acute Care. For more information, contact Diana Hsu, MHA Health Policy Analyst.
Atlas to Speak at HFAM Symposium
On Sept. 18, Health Facilities Association of Maryland will bring together providers from across care settings to discuss challenges and opportunities at the Maryland: Building Bridges of Quality Care Advancing the Maryland Model conference at Arundel Preserve. The symposium offers a unique opportunity for leaders from all sectors of healthcare to collaborate and discuss opportunities to better integrate care, improve outcomes and reduce costs. And, MHA President & CEO Bob Atlas will speak about Building a Model of Partnership with Maryland Acute Health Systems.
Use priority code MHA Sep. 18 when registering to receive $125 off the $350 non-member rate. Register using this link. For assistance registering, contact HFAM’s Patty DeGrasse at 410-290-5132.
Workplace Sexual Harassment Prevention Training
The Maryland Commission on Civil Rights is hosting a series of workshops on sexual harassment prevention in the workplace. The free training will cover topics such as current law, common workplace scenarios and best practices to prevent and respond to sexual harassment. The workshop is open to everyone, although focused on employees, managers, supervisors and human resource staff members.

September Workshop
Friday, Sept. 6, 9:00 a.m. - 1:00 p.m.
Maryland Public Television, Owings Mills, MD

November Workshop
Wednesday, Nov. 13, 9:00 a.m. - 1:00 p.m.
Anne Arundel Community College, Arnold, MD
Maryland Health Insurance Coverage Protection Commission Post 2019 Session Meeting
The Maryland Health Insurance Coverage Protection Commission held the first 2019 interim meeting last week. Chairs Senator Brian Feldman and Delegate Joseline Peña-Melnyk officiated the proceedings. MHA President Bob Atlas is a representative on this commission. The Commission reviewed its progress over the last two years in stabilizing the individual insurance market. Presentations included an update on the implementation of the Easy Enrollment Program, and information on the development of the Consumer Protections work group.

The Commission will meet two more times over the fall to determine if any legislative action needs to be considered to support broad-based health insurance coverage. Future topics will include Medicaid buy-in options and additional wrap-around subsides to increase coverage, particularly in the young adult population. The Commission will also deliberate whether state-level legislation should be introduced in 2020 to ensure that consumer protections currently in the Affordable Care Act remain intact in the state should the Act be deemed unconstitutional at the federal level. 
State’s Behavioral Health System of Care Workgroup Holds Second Meeting
Maryland Medicaid’s Behavioral Health System of Care Workgroup continued discussions on high-level principles and values to guide system of care design in the following areas: quality integrated care management, cost management, and behavioral health provider management and network adequacy. At an Aug. 22 meeting, Maryland Medicaid presented a flow chart illustrating the current condition of the state’s behavioral health system and highlighting the different areas through which patients could enter the system. The flow chart was intended to follow a patient through his experience with the Maryland behavioral health system and to identify how many patients are impacted at each stage. The next workgroup meeting is Sept. 26. 
Sexual Violence Prevention Conference: Call for Proposals 
The 14 th annual Maryland Women of Color Network’s sexual violence prevention conference, Hope: Navigating the Future without Violence, is on Nov. 8 at Bowie State University. The event sponsors, the Maryland Coalition Against Sexual Assault and the Maryland Department of Health, are accepting workshop proposal requests through Wednesday, Aug. 28. Selected presenters receive a $400 honorarium plus complimentary conference registration. For a list of the workshop priorities or to submit a proposal, click here. For more information about the conference, contact Gigi Marshall with WSC Associates, LLP at 301-423-5500.
Prescription Drug Affordability Board Appointments Announced
Maryland legislative leaders have begun making appointments to the newly established Prescription Drug Affordability Board. The Board is the first of its kind in the country and though funding of $750,000 was authorized by the Maryland General Assembly to hire staff, the funds have not yet been released by Governor Hogan. The following appointments have recently been made public:

  • Van Mitchell, Chair – Former State Health Secretary Van Mitchell was appointed jointly by Senate President Mike Miller and House Speaker Adrienne Jones.
  • Dr. George Malouf, Jr. – Dr. Malouf is a full-time practicing medical doctor and ophthalmologist. He was appointed by President Miller.
  • Dr. Eberechukuwu (Ebere) Onukwugha – Dr. Onukwugha is an Associate Professor in the Department of Pharmaceutical Health Services Research at the University of Maryland School of Pharmacy. He was appointed by Speaker Jones.
  • Gerard Anderson, Ph.D. – Dr. Anderson is the director of the Johns Hopkins Center for Hospital Finance and Management, and a professor of health policy and management as well as international health and medicine. He was appointed by Attorney General Brian Frosh.

The Governor also has an appointment, but has not made it yet, and alternate board members will also be appointed. Additionally, the Board will have a 26-member Prescription Drug Affordability Stakeholder Council to provide stakeholder input. The Stakeholder Council includes a diverse array of perspectives including representation allocated for Maryland’s hospitals. In its initial work, the Board is tasked with studying and reporting back to the General Assembly on the entire prescription drug supply chain and offer policy options to lower drug prices in addition to setting upper payment limits for state and local government health plans. For more information contact MHA’s Neal Karkhanis, Director, Government Affairs.
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