April 6, 2018
Encouraging Progress Under
the All-Payer Model
Last week's report from RTI International offered some promising findings about how Maryland's hospitals have transformed care delivery while controlling costs and improving quality. Among the highlights, which draw data from the first three years under the All-Payer Model:  
  • Inpatient admissions dropped significantly - 5 percent for Medicare beneficiaries and 4 percent for commercially insured individuals
  • Medicare spending declined $679 million, a 2.7 percent reduction
From the report: "Hospitals made significant strides in adapting to global budgets ... [the] All-Payer Model continued to reduce both total expenditures and total hospital expenditures ... without shifting costs to other parts of the health care system outside of the global budgets."
In other words, the model is working very much as intended, driving efficiency and cooperation across the care continuum, and improving quality while holding costs in check. Still, the report suggests several important opportunities to improve. These include mixed effectiveness of the strategies to reduce avoidable utilization, and a need to improve coordination of care with community providers after discharge.
The assessment from RTI is markedly different from that of Harvard researchers, who published an article this week in Health Affairs. They contend that the All-Payer Model has not generated notable changes in hospital use or hospital activity to reduce avoidable utilization.
That research, however, focused on the years 2011-2013, prior to the implementation of the All-Payer Model in 2014, and just on the seven rural hospitals under Total Patient Revenue. So the findings are not really relevant or helpful.
The RTI findings a testament to the impressive work you've done to upend traditional models in favor of a system that prioritizes value over volume - work that will be the linchpin to Maryland's success at the leading edge of innovation.

Bob Atlas
President & CEO

At Work in Annapolis
With only three days left in the 2018 legislative session, the field has had several very successful outcomes. A few outstanding issues may not be wrapped up until the very end, such as the 20 percent rule bill pertaining to expert witnesses in medical malpractice lawsuits. MHA is working with other stakeholders to advocate for an amendment that ties the rule to the year in which a case has been filed. When the clock strikes midnight on Monday, we will send a Member Alert that includes an At-A-Glance summary of the 2018 session. The following day, we will provide a more in-depth look at which bills passed, how they might impact the way you deliver care to your communities, and any action steps needed. We extend our sincere gratitude for your contributions. From testifying to submitting letters of support to contacting your legislators, you helped make this a successful session for the hospital field. You can track MHA's activities via our dashboard , which provides an overview of all of the work this session.
Warning Issued on Synthetic Cannabinoids
The Maryland Poison Center and the Maryland Department of Health are warning the public, first responders, and clinicians of the danger of bleeding that can be linked to use of synthetic cannabinoids, also known as spice, K2, or fake weed. The Maryland Poison Center at the University of Maryland School of Pharmacy was notified of a case in which a user of synthetic cannabinoids experienced bleeding and was hospitalized earlier this week. The symptoms in the Maryland case are similar to the description of dozens of cases in the Chicago region reported over the past three weeks to the Illinois Poison Center. People in the Chicago area reported recent use of synthetic cannabinoids prior to their illness and at least twoof those cases have resulted in death. The condition is known as synthetic cannabinoid-associated coagulopathy; clinical signs from the Illinois and Maryland cases include bruising, nosebleeds, bleeding of the gums, bleeding out of proportion to the level of injury, vomiting blood, blood in urine or stool, or excessively heavy menstrual bleeding and back pain.
MDH Asks for Help with Displaced Patients
In a letter sent this week to Maryland's physicians, the Maryland Department of Health asked physicians to contact them if they are willing and have the capacity to care for patients displaced by the closure of practices due to recent crackdowns on overprescribing. MDH is coordinating with the Maryland State Medical Society, the Board of Physicians, and MHA to provide guidance for physicians who may be able to treat displaced patients. The letter, co-signed by MHA President & CEO Bob Atlas, notes that emergency departments are ill-equipped to handle the needs of these patients, including helping patients manage the use of their prescribed opioids and other controlled medications. Contact the MDH Office of Public Health at 410-767-6525 if you are a willing provider and have the capacity to support continuity of care for displaced patients in your service area.
Contact: Nicole Stallings
PRMC to Discuss Nursing Mobile Strategy
Increased use of mobile devices has brought about a quieter, more peaceful environment throughout Peninsula Regional Medical Center's facility by reducing overhead paging and hallway conversations. On May 9 at noon, PRMC will give a presentation for the American Hospital Association's Health Forum webinar series on how its nurse leaders round with iPads for a better patient experience. Speakers Nat'e Guyton, Ph.D., Chief Nursing Officer at Spok, and Teresa Niblett, director of clinical informatics at PRMC, will discuss how PRMC leveraged technology to develop a successful mobile strategy for nurse leaders, and how they maximize nurse engagement and patient satisfaction. Click here for more information and to register.
Resource Available to Manage Injectable Opioid Shortages
The American Society of Health-System Pharmacists, in collaboration with the University of Utah Drug Information Service, has released a resource with suggestions for management and conservation of injectable opioids - including hydromorphone, morphine and fentanyl - that are critical to patient care and are in short supply for many health care setting. The document includes information on what clinicians can do to mitigate the impact, as well as strategies related to inventory control, pharmacy operations and infusion pumps/informatics. The American Hospital Association is actively advocating with Congress, the Food and Drug Administration, and Drug Enforcement Administration on this issue, including sending a February 27 letter together with other national pharmacy and medical organizations to DEA urging it to temporarily adjust the aggregate production quotas for certain injectable opioid medications in short supply to allow other manufacturers to supply product until the shortages resolve.
USDA Offers Opioid Grant
The United States Department of Agriculture (USDA) has announced a grant opportunity prioritizing opioid-related distance learning and telemedicine interventions in rural areas. Eligible applicants include government entities, federally-recognized tribes, non-profits, for-profit businesses, and others. USDA is reserving $5 million in the Community Facilities Grant Program and is giving priority to Distance Learning and Telemedicine Grant (DLT) Program applications proposing innovative projects to address the opioid epidemic in rural communities. The application deadline for both grants is June 4. Click here for details.
NQF Offers Opioid Stewardship Workshop
The National Quality Forum (NQF) is offering a workshop May 1 in Washington, D.C.: Driving Patient Safety and Quality through Opioid Stewardship. The workshop will provide concrete guidance on implementing the NQP Playbook™: Opioid Stewardship, a practical guide to support safe and appropriate prescribing of opioids. This educational opportunity is ideal for clinicians, quality professionals, and health care organization leaders committed to appropriate pain management strategies and opioid stewardship. Register at www.cvent.com/d/ltqbdy . This activity has been approved for 5 AMA PRA Category 1 Credit™ for physicians and five continuing credits for nurses and pharmacists.
Save the Date for MCASA's Victim Advocate Training
The Maryland Coalition Against Sexual Assault (MCASA) is offering a four day comprehensive victim advocate training session for those who work directly with survivors of sexual assault in any capacity. The training covers both introductory and advanced topics to provide a foundation for best practices for advocates in the field of sexual assault services. There is no cost; however, member rape crisis centers and staff will receive priority registration. The session is June 18-21 at The Women's Club in Hagerstown. Registration will open May 1. For more information, contact info@mcasa.org or call 301-328-7023.
Fueling Leadership - The Inexpensive Way
When physical plants, medical equipment and reimbursement systems are essentially the same regardless of which health care facility consumers use, the only real difference is your staff.

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.

Today is Deadline to Apply for Foster G. McGaw Prize
The AHA, along with Baxter International Foundation and the Health Research & Educational Trust, is accepting applications through April 6 for the 2018 Foster G. McGaw Prize.

Tuesday, April 10
- MHA Council on Clinical and Quality Issues meeting

Wednesday, April 11
Health Services Cost Review Commission meeting

Thursday, April 12
MHA Technical Work Group meeting
Baltimore Business Journal , By Morgan Eichensehr, March 30
The Frederick News-Post , By Kate Masters, March 31
The Frederick News-Post , By Kate Masters, March 30
The Baltimore Sun , By Michael Dresser, April 2
Baltimore Business Journal , By Morgan Eichensehr, April 2
CBS Baltimore , April 3
Herald-Mail Media , By Dan Dearth, April 3
The Baltimore Sun , By Scott Dance, April 4
The Baltimore Sun , By Andrea K. McDaniels, April 4