June 23, 2017
Containing Costs for Consumers
This week, the Maryland Insurance Administration held its public hearing on insurers' requested premium rates for 2018 - requests that we believe are largely inaccurate and misleading.
The size of some insurers' requests suggests a basic lack of understanding of Maryland's unique health care system. For example, UnitedHealthCare attempts to justify an average 10-13 percent increase for its small group market by claiming there is a cost shift from public to private payers. This is a boilerplate, national argument commonly used to justify increases, but as we all know, Maryland's All-Payer Model allows no such cost shift - and hasn't for four decades.
MHA testified during Wednesday's hearing and submitted a letter to the insurance administration outlining these and other concerns, namely that the filings:  
  • ignore $230 million in fiscal year 2018 savings provided to insurers through the Health Services Cost Review Commission's decision on shared savings with payers
  • use inaccurate hospital spending and utilization growth trends
  • do not demonstrate a commitment to maintain and improve the individual market, given its recent stabilization due to the influx of new enrollees beginning to level off 

During the hearing, MHA testified that there is no indication of whether the nearly $350 million in shared savings to payers that has been generated under the All-Payer Model over the past two years are, in fact, being passed on to consumers. We also expressed concern that the submitted rate requests will make care less affordable and less accessible, pushing Marylanders to disenroll from coverage, and upending a fragile stability in the individual and small group markets.
That could jeopardize the All-Payer Model, because broad-based coverage is essential to making sure Marylanders receive the right care, at the right time, in the right setting.
The Maryland Insurance Administration will make its decision on rates sometime before the start of the rate year in January. In recent years, following MHA's testimony, the administration has begun to examine HSCRC data on hospital spending to inform their decision. That needs to continue.
It would be  a sign that regulators are listening, and are willing to take the steps necessary to ensure that Maryland's unique hospital payment system does more than save money for payers, but also provides real help for the Marylanders for whom health insurance should be a comfort, not a burden.

MHA, AHA Respond to Better Care Reconciliation Act
MHA yesterday issued a statement to the media by President and CEO Carmela Coyle shortly after the Senate released its draft of the Better Care Reconciliation Act. "The Better Care Reconciliation Act of 2017, released by the Senate today, would cause real pain for real people," she said. "It would take coverage away from millions of Americans and thousands of Marylanders, especially our most vulnerable. And it would likely trigger deep cuts to the Medicaid program. The Senate bill's aim in short seems to be less about helping people and more about attracting votes. We anxiously await the Congressional Budget Office's estimates of the bill's actual budget and coverage cuts." Click here to read the entire statement.
American Hospital Association President and CEO Rick Pollack also issued a statement . "From the onset of this debate, America's hospitals and health systems have been guided by a set of key principles that would protect coverage for Americans," he said. "Unfortunately, the draft bill under discussion in the Senate moves in the opposite direction, particularly for our most vulnerable patients. The Senate proposal would likely trigger deep cuts to the Medicaid program that covers millions of Americans with chronic conditions such as cancer, along with the elderly and individuals with disabilities who need long-term services and support. Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance. We urge the Senate to go back to the drawing board and develop legislation that continues to provide coverage to all Americans who currently have it."
Click here for a summary of the bill based on AHA's initial review of the draft legislation. A Congressional Budget Office estimate of the impact of the draft is not yet available but is expected early next week. A vote in the Senate is anticipated next week and at 3 p.m. Monday, AHA will host a members-only advocacy call to discuss next steps. Click here to register.
Health Disparities Data Available
As part of their continued work to help hospitals reduce health disparities, MHA and the Maryland Healthcare Education Institute have provided stratified data on readmissions, mortality and infections to attendees of recent Equity of Care meetings. Additional meetings are being planned for the fall, but if you are involved with efforts to reduce health disparities and have not received either invitations for meetings or hospital-specific data stratified by race, ethnicity, and language, please contact Mark Rulle or David Simon.
MHA, DHMH Offer Webinars on Opioid Crisis
MHA, in partnership with the Maryland Department of Health and Mental Hygiene, is hosting a five-part webinar series titled Hospitals' Role in Addressing the Opioid Crisis. The webinars will feature emergency department interventions that can be implemented to help address the opioid crisis. Participants will hear from Maryland hospitals using specific interventions and their experience to date. The webinars and their topics are:

September 12 at 8:30 a.m.
Alcohol and Drug Use Screening

October 11 at 8:30 a.m.
Overdose Survivors Outreach Project

Registration is required for each webinar. Click each title for the registration link.  
Contact: Nicole Stallings
CMS Proposes Updates to MACRA
The Centers for Medicare & Medicaid Services this week issued a proposed rule updating the requirements of the quality payment program (QPP) for physicians and eligible clinicians mandated by the Medicare Access and CHIP Reauthorization Act of 2015. The QPP includes two tracks - the default Merit-based Incentive Payment System and advanced alternative payment models. The rule proposes key policies for the QPP's 2018 performance period, which will affect clinician payment in 2020. "[The] proposed rule continues the incremental, flexible implementation approach called for by hospitals, health systems and the more than 500,000 employed and contracted physicians with whom they partner to deliver care," AHA Executive Vice President Tom Nickels said in a statement. CMS will host a webinar Monday, June 26 at 1 p.m. on the proposed rule. To register, click here.
Videos Available on Rural Workforce Insights
One challenge to rural hospitals is workforce planning. To help address this problem, the American Hospital Association's Health Career Center has developed four videos to assist rural hospitals with the issues of shortages, an aging population and the changing health care environment. The videos focus on team building, retention, leadership, and behavioral health, and are available here.
Improving the Patient Experience
Dr. Thomas Lee, chief medical officer for Press-Ganey, says that hospitals that can create an "epidemic of empathy" will move the patient experience needle enough to realize significant gains in patient satisfaction scores within the new "value-based" health care environment.

PRIME Offers Capital and Construction Solutions
Prime, through its affiliation with MedAssets, would like to introduce you to MedAssets Capital and Construction Solutions, which deliver end-to-end capabilities to help you complete successful, on-time and on-budget construction or renovation projects.

IHF Award Nominations
Due July 1
The International Hospital Federation is accepting nominations through July 1 for its 2017 International Awards, which recognize excellence, innovations and outstanding achievements in global health care leadership and management. 

Thursday, June 29
Emergency Department Summit
The Baltimore Sun, By Meredith Cohn, June 18
The Baltimore Sun, By Andrea K. McDaniels, June 17
Baltimore Business Journal, By Morgan Eichensehr, June 20
The Baltimore Sun, By Pamela Wood, June 20
The Washington Post, By Joel Achenbach and Dan Keating, June 20
The Daily Record, By Ricardo Alonso-Zaldivar, June 20
The Baltimore Sun, By Meredith Cohn, June 21
The Baltimore Sun, By John Fritze, June 21