February 3, 2017
Eyes on the Prize
I can't remember the last time a congressional committee had one party boycott a vote and the other suspend its rules to advance confirmation of an appointee - but that of course happened this week when the Senate Finance Committee voted on U.S. Rep. Tom Price's Health and Human Services nomination. These days, it's easy to get caught up by a seemingly ceaseless whirlwind of activity and its meaning and consequences.

Based on the past few weeks, Washington is moving quickly, and this alacrity was a major point of discussion last weekend at a meeting of the American Hospital Association Board, on which I sit. The speed, however, is overshadowed by the uncertainty of what it all means for health care and hospitals. Still, here's a point worth your consideration: the issues at the moment may be polarizing, but because of our democratic nature and our system of checks and balances, the issues will begin to move toward the center.

It may be hard right now to believe this, but it has always proved true. So it is understandable that the current environment, on the heels of a divisive election year, can be polarizing. But the dust will settle, and hospitals must not lose sight of their core principles, despite a hurricane of activity. Our focus needs to be, and our advocacy needs to center on what we need to provide care in our communities: broad-based, continuous health care coverage, high-functioning insurance markets, and value-based incentives for providers.

These are the tenets that will take health care in Maryland, and across the country, to a workable future and the more we can help policymakers develop a framework for reform built on these concepts, the more people will come together. That promises to be the foundation of your continued mission of service to your patients and communities.

AHA's ACA Repeal Impact Model Not Applicable in MD
An email sent to hospital CEOs by the American Hospital Association on repeal of the Affordable Care Act has caused some confusion. The email, sent by AHA's Regional Executives (Maryland's executive is Joan Lewis) to all AHA members across the country, asks CEOs to look at the financial impact of ACA repeal on their hospital as provided by AHA, and urge legislators to support simultaneous repeal and replace in order to maintain coverage levels. Because of Maryland's unique standing as an All-Payer state with uncompensated care included in hospital rates, AHA's model does not apply to Maryland. MHA's talking points remain in full effect as our message on the issue, including support for simultaneous repeal and replace, at least until we know more about how the Trump administration will approach specific policies.
Please feel free to contact your legislators, remembering that the financial impact in Maryland is very different from that in the rest of the country. 
At Work in Annapolis
With the General Assembly Senate bill introduction deadline today the House deadline is next week, a significant number of bills were introduced this week. MHA staff is vetting each to determine the potential effects on Maryland's hospitals. Several bills of concern are now in play, including legislation requiring hospitals to include on their annual community benefits reports the value of their tax exempt status, and a bill that would triple the cap on non-economic damages in cases of wrongful death. MHA is supporting a bill introduced this week that would remove restrictive language for innovative models of care such as patient medical home monitoring or collaborative care. Read more in this week's Advocacy Dashboard.
MHA Asks Gov. Hogan to Reinstate Spend-down
This week, MHA President & CEO Carmela Coyle sent a letter to Governor Hogan indicating the hospital field's disappointment with his decision to delay the $25 million spend-down of the Medicaid hospital tax for fiscal year 2018. The letter acknowledges Governor Hogan's continued commitment to preserving Maryland's All-Payer Model, but explains that the tax hinders the model by counting against the metric that compares Maryland hospital spending to the nation's. Additionally, given the uncertainty of federal health care policy, reducing the tax is an action that the state can take to help maintain the model. MHA is working with legislators to reinstate the spend-down for the coming fiscal year. 
All-Payer Model Meeting or Exceeding All Metrics
In a submission to Health Affairs, published January 31, state health care regulators wrote that: "The current model, with its focus on hospitals, creates a foundation for health care payment and delivery transformation for all patients and payers." The piece notes, however, that the current model does not have the full set of tools needed to address total cost of health care statewide. "As 2016 ended, Maryland submitted a  progression plan to CMS to extend the model beyond hospitals. ... The progression plan lays out strategies to further improve outcomes, reduce potentially avoidable utilization in higher acuity settings, and reduce costs. Strategies include the continued development and scaling up of support for complex and high needs patients; new efforts to support chronic care management and prevention; and further transformation of the payment and delivery system to align goals."
Sabatini Scholarship Fund Established
A memorial service for Michael Sabatini, the son of HSCRC Chairman Nelson Sabatini, has been set for February 25. The family has asked that, in lieu of flowers, contributions be made to the Alexa and Adam Sabatini Scholarship Fund at American Savings Bank, 66-197 Kamehameha Hwy., Haleiwa, HI 96712, 808-637-5042.
MHA Releases Updated PQI Reports
This week, MHA released hospital-specific patient quality indicator reports to clinical and quality leaders. The reports, stratified by payer, are an updated version of reports that were released last year and provide a historical look at hospital-specific trends for each of the indicators. The measures are important to track as part of Potentially Avoidable Utilization payment policy, and can help describe conditions occurring outside hospitals, which are essential to understand for effective population health management. Please contact Justin Ziombra with any questions.
ED Diversions in the News
Last week, MHA held its weekly member call on the latest statistics on emergency department diversions, and concerns raised by HSCRC staff about a spike in diversions. An ABC 2 News story that also was discussed has run and is on their website. Attached are our talking points on the issue that we distributed earlier, and Carmela Coyle's piece from last week's Update newsletter. Coyle was interviewed today for a follow-up story that is expected to appear during the station's 5:30 p.m. newscast.
AHA Webinars Offered on Violence in Health Care
The American Hospital Association and the American Society for Healthcare Risk Management will hold the next webinar in their "Hospitals Against Violence" series February 15 at 3 p.m. In this session, Promoting and Creating a Culture Shift to "Universal Precautions," participants will be provided a framework and some practical strategies to assist in making the necessary shift to a culture that is "zero" tolerant for patient aggression and establishes universal precautions for staff. Click here to register. Please note that all access information, including toll free dial-in number and call passcode, will be provided via email after you register. For additional resources, please visit AHA's new Hospitals Against Violence webpage.
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 January 25; slides and video from the webinar and past webinars in the series are available on the MHA website. The fifth webinar, Highlighting Early Successes, is February 15; participants can register on our website.
Contact: Nicole Stallings
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AHA Brief Examines How Hospitals Are Holding the Line on Costs
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Wednesday, February 8
Health Services Cost Review Commission meeting

Thursday, February 9
MHA Financial Technical Work Group meeting
Carmela Coyle presents to Howard County General Hospital Board of Trustees
The Washington Post, By Michael Ollove, January 30
Baltimore Business Journal, By Morgan Eichensehr, January 27
The Baltimore Sun, By Michael Dresser, January 31
ABC 2 News, By Mallory Sofastaii, February 2
The Baltimore Sun, By Meredith Cohn and John Fritze, February
Delmarva Now, By Gray Hughes, February 3
The Washington Post, By Lynh Bui and Clarence Williams, February 3
The Baltimore Sun, By Meredith Cohn, February 2