February 23, 2020
In Search of the Right Care
Hospitals in Maryland deliver care to every person who comes through their doors. But it seems for some of our patients, those doors only swing in one direction.

A recent National Public Radio piece on this issue caught my attention. It points out dozens of children in Maryland’s foster care system are languishing in hospitals when they no longer need hospital-level care. Sadly, we often face barriers transitioning young patients – particularly those with behavioral health concerns to facilities or community-based services better suited to their needs.

This takes a toll on these children and has ripple effects for your organizations—filling much-needed bed space and crowding your emergency departments.

Last year a comprehensive study of your organizations found 42% of behavioral health emergency department patients were delayed during discharge or transfer. Data show children and teens are more likely to be delayed and their delays are twice those for adults.

A study of inpatient units found behavioral health patients were delayed during discharge 13 days on average, and 60% of delays were caused by lack of bed space in a preferred setting. The foster children identified in the NPR piece are particularly vulnerable to this problem as they navigate a complicated government system as part of their discharge process.

We are pleased to see legislators sponsoring House Bill 1382 to bring this issue to light and appreciate their elevating the topic. There are no simple solutions, but we are committed to collaborating with all who care to solve this complex problem.
Bob Atlas
President & CEO
Have You Joined the #Caring4Md Conversation?
Maryland hospitals are anchor institutions in their communities. This week’s #Caring4Md social media content is focused on how hospitals meet the needs of the communities they serve. All of the #Caring4Md content is here . For questions or to learn more, contact us at mha@mhaonline.org .
MHA Comments on Draft Recommendation for Readmissions Reduction Incentive Program
In a comment letter Wednesday, MHA shared its concerns with HSCRC about its draft recommendation for the Readmissions Reduction Incentive Program for rate year 2022. MHA advised not including a disparity measure in the payment policy until it can be evaluated and opposed a specific disparity reduction target in the Statewide Integrated Health Improvement Strategy. For more information, contact Traci La Valle .
Performance Measurement Work Group Update
The Health Services Cost Review Commission’s (HSCRC)  Performance Measurement Work Group (PMWG) convened February 19. Members and staff engaged in a robust conversation about whether to add avoidable emergency department (ED) utilization to the Potentially Avoidable Utilization (PAU) measure. Staff presented a definition using an algorithm created in the 1990s by New York University. They also discussed to what extent hospitals can work with their communities to ensure patients receive care and understand their options for urgent care in a more appropriate setting than the ED. MHA cautioned that ED use can vary by community and reflect conditions outside of the control of the hospital, such as adequate access to primary care. Staff agreed to consider the various feedback at the March PMWG meeting.

HSCRC staff discussed the purpose and goals of the Quality-Based Reimbursement (QBR) Redesign Subgroup, including ensuring alignment of the measures and incentives with the Total Cost of Care Model. Members also suggested modifications to the components of the policy. The subgroup is expected to convene in March.

Additional materials from the meeting are here . For questions or additional information, contact Brian Sims .
Leapfrog Opens Hospital Safety Grade Review Period for Spring 2020
Hospitals can review their data used to calculate their spring scores from now until March 9. Leapfrog will host a call Feb. 24 from 1-2 p.m. to explain changes to the methodology and data review period. Register here for the call. After March 9, hospitals can view their grade in advance of the public announcement in late April/early May.
Annapolis Update
Friday marked the halfway point of the 2020 legislative session. Last week, MHA testified in support of three top hospital priorities: raising the standards for expert witness testimony in medical liability cases, expanding access points for people in a behavioral health crisis beyond emergency departments, and reducing the Medicaid Deficit Assessment. This week, the Department of Legislative Services (DLS) recommended the General Assembly remove Governor Hogan’s $15 million reduction to the Medicaid Deficit Assessment in the state’s fiscal year 2021 budget. DLS further recommended the state maintain the assessment at its current level indefinitely.
MHA also testified last week in support of legislation to expand telehealth and to implement recommendations from the Health Insurance Coverage Protection Commission . For more information on bills MHA is tracking, click here
MHA Hosts Learning Session on EQIP
MHA will host a learning session on the Episode Quality Improvement Program (EQIP), a proposal the Health Services Cost Review Commission (HSCRC) is proposing to CMMI for a January 2021 launch. The program would allow for certain non-hospital providers to participate in risk-sharing arrangements with the Centers for Medicare & Medicaid (CMS) not available in Maryland—similar to the intent of the national BPCI-A program. At this meeting HSCRC will detail the proposal and answer questions, including how this program will interact with the current Episode Care Improvement Program. The meeting will be March 2 at 10 a.m. at MHA’s office, 6820 Deerpath Road, Elkridge, Md. RSVP to Pat Ross .
Commission on Mental, Behavioral Health Convenes in Columbia
This week, MHA attended the seventh regional meeting of Lt. Governor Boyd Rutherford’s Commission to Study Mental & Behavioral Health in Columbia. The commission reviewed the work its subcommittees have done over the past year and discussed the 2019 Annual Report submitted last December. Public comments focused on network adequacy, crisis services, and current legislative efforts in Annapolis to address these issues. MHA continues to be engaged with this commission and will share updates of its work. For more information, contact Brian Frazee .
Nominate a Health Care Hero
The Daily Record is calling for nominations for its Health Care Heroes awards . MHA is an event partner for the awards, which honor organizations and individuals who have made an impact on the quality of health care in Maryland. Nominations are due March 4. For more information and to fill out a nomination form or application, click here
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Maryland Hospital Association | www.mhaonline.org