April 28, 2017
Face-to-Face on the All-Payer Model
In the lead-up to the modernization of Maryland's All-Payer Model three-and-a-half years ago, there were countless meetings, conference calls, emails, and negotiation sessions. This was not surprising given the magnitude of the seismic health care transformation that was being debated. But what made these talks successful was that the leaders of Maryland's hospitals were engaged not just in the outcome, but also in the process .
Now, as we negotiate the next steps for our state's unique hospital payment system, the packed room we saw Thursday at the first of several statewide meetings once again demonstrated your deep commitment to being a part of the process, and for that we thank you.
We reviewed the four key issues that will need to be addressed as the current round of negotiations continue, and we discussed the concerns about the pace of proposed change, considering the state's goal to have a completed term sheet by the end of May. A brief recap:  
  • The Medicare total cost of care annual savings target - What is a reasonable number?
  • Creating accountability for the total cost of care on a hospital-specific basis; no method yet exists for doing that - Can it be done well?
  • The use of a Medicare payment discount to address variances in Medicare savings - Could this fly in the face of the very definition of the "all-payer" model?
  • The addition of population health metrics to the list of quality-based metrics - Many factors to consider here, among them that hospitals, already spread thin as they focus on current improvement efforts, would alone bear the risk for improvement
Your feedback Thursday and throughout this process is appreciated.
In short, there are many questions and, as of now, too few concrete answers.
In the coming weeks, there will be much more activity on this issue:  
  • On May 2, MHA's Executive Committee will discuss a strategy to move forward;
  • On May 4, your care redesign implementation teams will meet with the Center for Medicare & Medicaid Innovation on the two available programs (register here)
  • On May 10, a second statewide meeting will bring you the opportunity to hear from Health Secretary Dennis Schrader and HSCRC Chairman Nelson Sabatini, Commissioner John Colmers and Executive Director Donna Kinzer. If you have not yet done so, you can register here.
Your hospital negotiating team will continue to meet weekly with the state, and MHA will of course continue to keep you in the loop via our Thursday Morning Member Calls.
Whatever course we, as a field, determine is best, rest assured it will be a course plotted with your help.
For all of this hard work together, you have my thanks and admiration.

CMS to Send Care Redesign Materials Next Week
The Centers for Medicare & Medicaid Services will be sending care redesign materials, including contracts for the initial performance period scheduled to begin July 1, 2017, to hospital care redesign teams on Monday. CMS had initially planned to distribute those materials this week. As a reminder, those participating in the performance period beginning July 1 must return their materials to CMS by June 1, 2017.  On May 4, hospital care redesign implementation teams can meet with the Center for Medicare & Medicaid Innovation on the two available care redesign programs (register here ).
Important Notice for 2017 Bond Program Applicants
Applications for the 2017 MHA Bond Program are being accepted through Friday, June 16. When submitting the request for a Certificate of Need non-coverage determination from the Maryland Health Care Commission and Health Services Cost Review Commission, please keep the following in mind:
  • The letter should be submitted as a Microsoft Word document only. Any other format will not be accepted. 
  • The letter should contain a concise project description, itemized costs, source of funds for the project and address whether bed capacity will change and/or if new services will be added.

The deadline for requesting the appropriate approvals/exemptions from the two commissions is Friday, May 19. If you have any questions or wish to apply to the program, please contact Brett McConeJennifer Witten, or  Jane Krienke. All application materials are available on our website www.mhaonline.org/bond
2017 Legislative Session Wrap-up Materials Distributed
Earlier this week, MHA sent a Member Alert to hospital leaders with wrap-up materials from the 2017 Maryland General Assembly session. Included were links to the " At-a-Glance" brief summary that was sent at midnight on Sine Die, as well as the following:
If you have any questions about the session or these materials, contact Jennifer Witten, Director of Government Relations. Please note that the materials on the website are for members only, so you must log on.
MHA Submits Readmissions Incentive Letter
MHA has submitted a comment letter to the Health Services Cost Review Commission on the draft recommendation for the Readmissions Reduction Incentive Program for Rate Year 2019. The letter supports the recommendation to maintain the "better of" improvement or attainment performance, with the attainment target set in the same manner as last year - best quartile of the base period with an additional 2 percent reduction. The letter also supports the staff's development of a modified cumulative target to handle the inconsistencies created by the ICD-10 transition.
Senator Cardin Visits Garrett Regional Medical Center
During a visit to Garrett Regional Medical Center last week, U.S. Senator Ben Cardin had the opportunity to see firsthand some of the care delivery transformation efforts that Maryland's hospitals have undertaken since the modernization of the All-Payer Model. Cardin praised the hospital as a "role model for rural health care in the United States" and noted its low rates of readmissions and surgical site infections. Cardin also discussed the federal government's role in helping hospitals keep people healthy. "It is my responsibility to make sure that you have a partner at the federal level that allows you to continue to do the great work that you're doing," Cardin said. "We need to work together to continue to ensure that our health care needs are met in what is a rapidly changing environment. We are fighting to give you the tools you need."
Pictured (l-r): Mark Boucot, GRMC president and CEO; US Senator Ben Cardin; Marjorie Fridkin, MD; Charles Walch, MD; Barbara Leighton, MD; Margaret Kaiser, MD; Dona Alvarez, MD; Marc Kirshner, DO; and Thomas Johnson, MD.
National Nurses Week Kicks Off May 6
The theme of this year's National Nurses Week is "Nursing: the Balance of Mind, Body and Spirit," a focus not only on how nurses promote the well-being of patients, but also on the mental and physical health of nurses, so they can better care for those in their charge. Celebrating National Nurses Week is one way organizations can show appreciation for the staff members who are the backbone of hospitals. The American Nurses Association has several resources to help celebrate nurses:  
For more information, visit this year's website.
AHA, National Urban League Partner on Equity and Diversity
The American Hospital Association and the National Urban League this week announced an alliance to advance health equity and diversity in health care leadership in communities across the U.S. Through the alliance, the organizations will collaborate on efforts to connect hospital CEOs with local Urban League leaders interested in opportunities to serve on governing boards at hospitals and health systems. Greater equity of care and more diversity in health care leadership is a top strategic priority for AHA, which has focused the field on its #123forEquity pledge campaign. All of Maryland's acute care hospitals have signed the pledge. 
Tomorrow is 'Take Back Day' for Prescription Drugs
National Prescription Drug Take Back Day is tomorrow and the Drug Enforcement Administration hopes the public will safely and responsibly dispose of unwanted or expired prescription drugs. Studies show that a majority of abused prescription drugs are old drugs that were obtained from family and friends or taken from a home medicine cabinet. In addition, Americans are now advised that flushing old medicines down the toilet or throwing them in the trash poses potential safety and health hazards. All sites are open from 10 a.m. to 2 p.m. tomorrow. Collection sites can be found on the DEA's Diversion Control Division website.
Leadership, Population Health, and our Communities
MHEI's Leadership Conference in the fall will begin with a lesson from retired four-star general Stan McChrystal.

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 Does Not Support Latest Version of ACA Repeal Legislation
The AHA cannot support the latest proposed amendment to the American Health Care Act, which would continue to jeopardize health coverage for many Americans, AHA President and CEO Rick Pollack said Thursday.

Tuesday, May 2
MHA Executive Committee meeting
The Baltimore Sun, By Pamela Wood, April 22
The Baltimore Sun, By Andrea K. McDaniels, April 24
The Baltimore Sun, By Meredith Cohn, April 25
My Eastern Shore MD, April 24
WCBC, April 25
Baltimore Business Journal, By Morgan Eichensehr, April 26
The Baltimore Sun, By Kevin Rector and Meredith Cohn, April 26