January 27, 2017
ED Diversions in the Spotlight
The agenda for next month's meeting of the Health Services Cost Review Commission is expected to include an item on emergency department (ED) diversions, the growth of which has sparked concern for HSCRC Executive Director Donna Kinzer.
Kinzer is not the only one taking notice of a recent spike in diversions (statewide yellow alert hours have been rising steadily, from 12,745 in 2013, to 20,974 in 2014, to 28,612 in 2015). The Maryland Institute for Emergency Medical Services Systems has also flagged the increase, and there's been some buzz about media inquiries. To date, MHA has not received any media calls on this issue, but we've prepared some talking points in case you are contacted.
There are likely many factors that contribute to this recent trend, from an uptick in seasonal flu cases (Maryland's Department of Health & Mental Hygiene has been consistently recording "widespread" influenza activity, with some weeks showing more than 1,100 ED visits for flu-like illnesses) to a growing shortage of qualified nurses (due to retirements and other reasons, hospitals are having trouble finding and retaining specialty nurses like those who work in EDs and other areas where ED patients might be sent for appropriate care. The U.S. Bureau of Labor Statistics projects a need for more than 1 million new RNs). An 18 percent jump over the past three years in behavioral health ED visits, for which patients remain in the ED longer, makes the issue even more challenging.
As MHA continues to discuss these concerns with the HSCRC and others, it's important to remember that diversions can help ensure patients receive timely care when an ED is overwhelmed. And, directing patients to the right care setting is a pillar of the All-Payer Model and of the Triple Aim. It's also important to watch more than one metric to understand the impact on care. Other measures, like ED wait times and leaving the ED without being seen, should be looked at in combination.
Hospitals take diversions seriously. Mitigation of this trend will require a deeper understanding of the issues and drivers and could take several different forms. We'll keep you apprised of the conversations as they continue to evolve and, as always, we'll make clear that hospitals are equal and eager partners in ensuring quality, speedy care for all in need.

At Work in Annapolis
This week, MHA President & CEO Carmela Coyle briefed the Senate Budget & Taxation and Senate Finance committees on the All-Payer Model and implications of the forthcoming Affordable Care Act repeal and replace efforts. The Department of Legislative Services held a fiscal briefing for the Maryland General Assembly budget committees as the legislature began its work on the governor's proposed fiscal year 2018 budget. Additionally, MHA staff testified in opposition to legislation that would exacerbate Maryland's already challenging liability environment. Read more in today's Advocacy Dashboard.
Care Alert Webinars Continue; Recordings Available
A critical step to secure a full fiscal year update is to demonstrate to the Health Services Cost Review Commission that hospitals are making use of "care alerts." This can be done by uploading the alerts to the Chesapeake Regional Information System for our Patients (CRISP). To help, CRISP and MHA have introduced a "Care Alert Sprint," a six-month initiative to meet this recommendation using existing hospital personnel and resources. This Care Alert Sprint is aimed at population health, readmissions reduction, and emergency department leads.
The initiative's fourth webinar, Workflow Strategies for Population Health/Complex Care Teams, was held earlier this week; slides and video from the webinar and past webinars in the series have been posted on the MHA website. The fifth webinar, Highlighting Early Successes, is February 15; participants can register on our website.
Contact: Nicole Stallings
Engaging EVERY Leader
John Kotter is considered by many as the guru of change leadership. In his writings, he emphasizes that getting ready for change (his first four steps in the change process) is often overlooked or rushed through in order to "get to the end result."

Looking for a Cutting Edge Provider for Blood and Associated Services?
For more than 60 years, Blood Bank of Delmarva (BBD) has provided blood and blood components to hospitals throughout the Delmarva region, helping avoid blood shortages and saving thousands of lives with assistance from more than 150,000 current donors.

"Futurescan" Report Highlights Health Care Trends
The Society for Healthcare Strategy & Market Development this week released "Futurescan 2017-2022," its annual guide to health care trends for leaders and strategic planners. 

Tuesday, January 31
MHA Executive Committee meeting
The Baltimore Sun, By Andrea K. McDaniels, January 22
The Star Democrat, January 23
WBAL-TV, By David Collins, January 20
The Baltimore Sun, By Meredith Cohn, January 24
The Baltimore Sun, By Ian Duncan, January 24
Maryland Reporter, By Daniel Menefee, January 25
WTOP, By Kate Ryan, January 26
The Baltimore Sun, By Erin Cox, January 25