December 8, 2017
Emergency Preparedness is Community Preparedness

Hurricane Harvey, Houston.
Hurricane Irma, Florida.
Hurricane Maria, Puerto Rico.
These are just a few of the 17 named storms in the 2017 Atlantic hurricane season, making it the fifth most active on record. And each time, hospitals have been at the forefront of recovery and response.

There are any number of other types of natural and man-made catastrophes to which hospitals respond, providing much-needed refuge and care to people in the direst of circumstances. For the women and men tasked with ensuring that hospitals are prepared, the focus has long been on the resilience of each facility. Are employees properly trained? Do they have enough medication? Are backup generators working properly?
At last week's annual National Healthcare Coalition Preparedness Conference in San Diego, Dr. Charles Miramonti, Medical Director of the Emergency Department at Eskenazi Health in Indianapolis and Chief, Indianapolis EMS, challenged hospitals to think a bit differently about emergency preparedness, to bring the concept beyond the four walls of the hospital. He questioned: Can we build community resilience in advance, recognizing that in disasters, it is often communities themselves that play the most important role?
Miramonti offered five determinants of community resilience: physical and psychological health, social and economic well-being, effective risk communication, integration of organizations, and social connectedness.
Sound familiar? These are concepts with which all of Maryland's hospitals are quite familiar, and their core tenets mirror those of population health: the most important being to strengthen your communities so they will be less reliant on the health care system as a whole, ensuring valuable resources will be available for those who truly need them.
In your push toward improving the health of communities, you've fostered new and unexpected partnerships, identified vulnerable and isolated patients and neighborhoods, and found new ways to reach out to people who have never stepped foot in your hospital. In this way, you've laid the foundation for not only healthier communities, but more resilient communities.
Can the same principles be applied to emergency preparedness? Could a hospital offer layman training for response, as it now offers healthy diet coaching? Could a hospital work with social services agencies to identify and track people who might not have communication in an emergency, similar to the way hospitals now track dialysis patients should disaster strike? Could a hospital help with infrastructure projects to prevent floods, the way some hospitals now invest in housing or other community improvements? And more.
The integration of population health, emergency preparedness, and community resilience can make a day-to-day difference in your communities and your hospitals. And it could make a real difference the next time disaster strikes.

MHA Testifies Before Insurance Protection Commission
MHA Senior Vice President Mike Robbins testified Tuesday before the Maryland Health Insurance Coverage Protection Commission on the evolution of the state's All-Payer Model and the importance of health coverage to ensure the success of the model. State Health Secretary Dennis Schrader also offered a presentation on the next iteration of the model, expected to begin in January 2019. The insurance protection commission was established during the 2017 General Assembly session to assess the effect of changes to the Affordable Care Act on Marylanders and examine strategies to prevent or mitigate any adverse effects associated with changes to the ACA, the Maryland Children's Health Program, Medicaid, Medicare, and the All-Payer Model.
Webinar Scheduled on Medicare Performance Adjustment 
MHA and HSCRC will host a Medicare Performance Adjustment Methodology webinar on Thursday, January 11, at 1:45 p.m. HSCRC Director, Clinical and Financial Information, Chris Peterson, and Health Policy Analyst, Laura Mandel, will review the methodology in detail with opportunities for questions from attendees. The session will be of particular interest to hospital executives responsible for managing total cost of care, including financial leads, population health leads, chief medical officers, and others. To participate in the live presentation at MHA, please RSVP to Tracy Blanchard by Monday, January 8, 2018. To view the presentation remotely, register here
Final Forum Held on ED Protocols for Substance Abuse, Overdoses
Representatives from more than 30 Maryland hospitals convened for the third and final Clinical Conversations forum November 29 to develop a consensus on recommended emergency department (ED) discharge protocol components for substance use disorder and opioid overdose patients. The forums yielded the following recommendations for ED discharge protocols:
  1. universal screening for substance use disorders among patients who enter the ED
  2. providing access to naloxone by prescription, or by directly dispensing
  3. making referrals to treatment, ideally using a facilitated referral approach
  4. incorporating non-clinical personnel into the discharge process
These recommendations may be a helpful resource for hospitals that are developing their ED discharge protocols in order to comply with the state HOPE Act of 2017. Consideration and implementation of these recommendations should be done in collaboration with medical staff, clinical leadership, and legal counsel.
As hospitals prepare their protocols, they should consult SUD Resources, a SharePoint site MHA has developed for members to share studies, resources for funding, information about grants and training, and examples of discharge protocols. Contact Shamonda Braithwaite to gain access to the site, and for more information about the Clinical Conversations forums.
Materials on Opioid Crisis Available
MHA, in partnership with the Maryland Department of Health, hosted a five-part webinar series titled Hospitals' Role in Addressing the Opioid Crisis. The webinars featured emergency department interventions that can be implemented to help address the opioid crisis. Participants also heard from hospitals using specific interventions and their experience to date. The webinar topics were:
  • New Opioid-Related Requirements Impacting Hospital-based Providers
  • Naloxone Prescribing and Dispensing
  • Alcohol and Drug Use Screening
  • Overdose Survivors Outreach Project
  • Buprenorphine in the Emergency Department 
Slides and webinar recordings for each are available on MHA's website.
Strategy a Key Strength for Physician Leaders
When it comes to designing the future of any health care organization, the need for input from physician leaders has never been greater.

Prime's Value to Member Hospitals
Prime is the shared service/group purchasing subsidiary of the Maryland Hospital Association. Its goal is to help our member hospitals reduce the cost of care.

AHA Recommends FDA Actions to Ease Regulation, Improve Device Security
AHA again urged the Food and Drug Administration this week to allow health system pharmacies to distribute compounded products to other system facilities located more than one mile away. 

Tuesday, December 12
MHA Medicare Performance Adjustment Work Group meeting
MHA Certificate of Need and State Health Plan Work Group meeting
Maryland Healthcare Education Institute Board meeting

Wednesday, December 13
Health Services Cost Review Commission meeting

Thursday, December 14
MHA Technical Work Group meeting
CBS Local, December 4
The Washington Post, By Jay Hancock, et al, December 4
The Baltimore Sun, By David Anderson, December 5
The Frederick News-Post, By Kate Masters, December 4
WMDT, By Justina Coronel, December 4
The Baltimore Sun, By Michael Dresser, December 6
Washington Business Journal, By Tina Reed, December 5
WBOY, December 5
WYPR, By Rachel Baye, December 6