October 21, 2016
Care Transformation's Long and Winding Road
No one said that a complete overhaul of Maryland's health care system would be easy.
Wednesday's HSCRC meeting illustrated the notable gaps between how hospitals and state regulators view the implementation of the modernized All-Payer Model, and the meeting's sometimes heated tone underscored one example of the hard work ahead if we are to realize a shared vision of care transformation.
My thanks to the hospital leaders who were on hand to testify about hospitals' deep commitment to care transformation and to all of the activities associated with providing additional support to high-risk patients. Providing their perspectives were: Frederick Memorial Hospital President & CEO Thomas Kleinhanzl, University of Maryland Medical System Chief Medical Officer Dr. Walter Ettinger, and MedStar Health Chief Medical Officer Dr. Stephen Evans.
This first line of testimony - in which hospital leaders shared powerful stories of how they have changed their policies, practices, staff, cultures, and more in order to reduce avoidable utilization and manage the total cost of care - delivered an important message about the truly impressive scope of hospitals' investment in, and dedication to, these transformation activities. Yet, HSCRC staff remain focused on one thing - care management plans for high-risk Medicare patients - a critical ingredient to be sure, but one of many that are needed to continue the broader transformation that is underway.
In a second conversation, my thanks to those who shared with commissioners the critical need for fiscal stability in a health care environment that is already undergoing tremendous upheaval. Testifying were: Johns Hopkins Hospital President Dr. Redonda Miller, MedStar Health Executive Vice President of Insurance and Diversified Operations Eric Wagner, Meritus Health President & CEO Joseph Ross, UMMS President & CEO Robert Chrencik, and Tom Kleinhanzl.
Frustrations took center stage during this discussion, which centered on the HSCRC staff's proposal to retroactively alter the fiscal 2017 Quality-Based Reimbursement program, a move that would reduce the statewide adjustment from a net positive $27.1 million to a net negative $9.9 million. While the loss of that funding would certainly diminish your team's capability to invest in care transformation activities, the objection is to retroactive policy-making - a bad precedent. The change is being proposed after the end of the performance period and after the start of the fiscal year.
The focus was on still-lagging patient satisfaction scores and other quality measures. We all agree that there is much, much more work to be done here. But we shouldn't look at quality through a pinhole, and we certainly shouldn't change the rules and incentives after the fact.
This week's reminder of the challenges that remain comes about two months before the state's deadline to submit to CMS a blueprint for the next phase of the all-payer model. That's a brief time to come to terms with and address the gaps between hospitals' and regulators' perspectives, but we will continue working to that end. With so much at stake, it once again means that Maryland's hospital field must unite behind the guiding principle that has brought us so far in the past two-and-a-half years: keeping our patients and communities at the forefront of the change we're creating. 

Commissioners Debate Retroactive QBR Proposal
In a lengthy public meeting this week, the Health Services Cost Review Commission debated a draft staff proposal to retroactively amend its fiscal year 2017 Quality-Based Reimbursement policy, reducing the potential net reward of $27 million to a net penalty of almost $10 million. As further detailed in this month's edition of Newsbreak, commissioners also received a progress report from the field on care transformation activities, and took final action on the Baltimore city hospitals' Population Health Workforce Collaboration program.
MHA Participates in Health Care Transformation Forums
MHA representatives spoke this week about the evolution of health care at public forums in Baltimore County and Montgomery County. MHA staff informed attendees about the Breath of Fresh Care campaign, which aims to empower health care consumers with valuable information about how to navigate the health care system. The forums, organized by the Maryland Citizens' Health Initiative, are designed to inform the public about changes to Maryland's health care system brought about by the modernized All-Payer Model. The forums also provide a venue for health care providers and local community organizations to connect on common goals. Two more forums are scheduled in Howard County October 20 and in Prince George's County November 10.
CMS Issues Emergency Preparedness Requirements
The new emergency preparedness requirements for Medicare and Medicaid-participating health care facilities, published by CMS in September, have an implementation date of November 15, 2017. The final standards require health care facilities to conduct risk assessments using an all-hazards approach; develop emergency preparedness plans, policies, and procedures, including distinct communications plans; and establish training and testing programs. Hospitals, critical access hospitals and long term care facilities will also be required to have emergency and standby power systems that reflect their emergency plans. More information can be found here.
Children's Environmental Council Seeks Applicants
The Department of Health & Mental Hygiene's State Children's Environmental Health and Protection Advisory Council, formed in 2000, is seeking applicants to fill three council seats. The council identifies environmental health issues for children and seeks to protect children in Maryland from exposure to environmental hazards. DHMH is seeking the following applicants:  
  • A licensed health care provider with expertise in the field of children's environmental health
  • A parent or guardian whose child has been clinically diagnosed as having been exposed to environmental health hazards, including lead paint or pesticides
  • An economist skilled in measuring the cost of illness and the benefits of prevention 
The council meets every other month on a weekday morning in the Baltimore/Annapolis area. There is a call-in option for members to participate by phone. The deadline for applications is November 14. Interested applicants may submit an application online.
Nursing Home Board Seeks to Fill Seat
The Governor's Appointments Office and DHMH are soliciting applications for a seat on the Board of Examiners of Nursing Home Administrators. The seat is reserved for a physician or nurse practitioner who specializes in geriatrics. Board members are appointed by the governor. The term will begin in the spring of 2017 and runs for four years. All applications must be submitted via the link on the GAO website. The application deadline is January 1.
HSCRC Webinars Underway
The first of seven webinars with HSCRC staff to provide hospitals with detailed information on the amendment to the All-Payer Model and on care redesign programs was held today; the schedule for the remain webinars is below. The amendment, approved earlier this month:  
  • Gives hospitals and their care partners access to comprehensive Medicare data across the care continuum that supports care coordination and a focus on controlling total cost of care
  • Creates the next steps toward total cost of care and delivery system transformation
Under the amendment, the first two care redesign programs are:  
  • the Complex and Chronic Care Improvement Program (CCIP)
  • the Hospital Care Improvement Program (HCIP)
The remaining webinars are:  
  • Webinar 2: (9 a.m. Tuesday, October 25) - Care Partner Approval Process
  • Webinar 3: (9 a.m. Wednesday, November 2) - CCIP Program Template and Implementation Protocol
  • Webinar 4: (9 a.m. Friday, November 18) - HCIP Program Template and Implementation Protocol
  • Webinar 5: (9 a.m. Wednesday, November 30) - Comprehensive Medicare Data Process and Use
  • Webinar 6: (9 a.m. Wednesday, December 7) - Care Redesign Program Monitoring
  • Webinar 7: (9 a.m. Friday, January 13) - Care Partner Agreements
During each webinar, participants can ask questions of HSCRC, the Center for Medicare & Medicaid Innovation, MHA, and CRISP. For those who cannot attend, webinar recordings will be posted on the HSCRC website. Click here to find the registration links for each webinar. If you have any questions or comments, send an email to hscrc.care-redesign@maryland.gov.
MHEI Facilitates
Whether your desire is to use an "independent third party" to assist with patient/family or other consumer groups, or you are looking for a temporary addition to your human resources, education or organizational development staff to assist with employee focus groups or departmental team building, MHEI can help.

Accelerate Collections by Capturing Missing Charges and Lost Revenue
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Study: 11.7 Million Uninsured Eligible for Medicaid or Marketplace Tax Credits
An estimated 11.7 million uninsured Americans are eligible for Medicaid or tax credits to purchase coverage through the Health Insurance Marketplaces, according to a report released this week by the Kaiser Family Foundation. 

Thursday, October 27
Carmela Coyle presents at the Howard County Health Care Transformation Forum
Carmela Coyle presents at Dimensions Healthcare System's Board of Directors Annual Meeting
The Baltimore Sun, By Staff, October 14
The Baltimore Sun, By Andrea K. McDaniels, October 14
Capital Gazette, By Amanda Yeager, October 17
The Star Democrat, By Josh Bollinger, October 18
Kaiser Health News, By Martha Bebinger, October 19
The Baltimore Sun, By Meredith Cohn, October 20
The Baltimore Sun, By Andrew Michaels, October 20