February 19, 2016
Getting Global Budget Updates Right
In less than four months, the recently reconfigured Health Services Cost Review Commission, along with its new chairman, Nelson Sabatini, will vote on a global budget update for hospitals for the coming fiscal year. Last year, as hospitals were ramping up population health management efforts in the earlier stages of the modernized Medicare waiver, HSCRC approved a 3.3 percent average per capita increase - the largest in more than six years. That delivered more than $500 million to help hospitals develop the capabilities they needed to meet the requirements of the waiver.
With hospitals successfully reducing avoidable utilization and hospital-acquired infections, and achieving more than $116 million in savings to Medicare to date, MHA has been laying the groundwork for what could be a more contentious debate about an appropriate global budget update for the coming fiscal year.
The update, which commissioners will vote on in June, will hinge on a series of factors, including:  
  • Hospital operating margins
  • The annual nature of updates (as opposed to a cumulative update)
  • The use of a Medicare payment differential
  • Medicare savings goals
  • Infrastructure funding
  • Inflation
  • CMS actuary spending forecasts 
MHA has been developing positions and supporting materials to address each of these issues, as well as others that may arise during the negotiations. And all of this is occurring simultaneously with efforts to determine the next steps in the long-term direction of the all-payer model (efforts are underway to deliver a proposal to CMS before President Obama's term expires and CMS leadership undergoes a large overhaul).
It's unclear what the HSCRC's "starting offer" for the update will be, but it's certainly clear that to maintain the early achievements hospitals have attained in the first half of the five-year all-payer experiment, hospitals will need to continue to invest in the transformation of care that their individual communities need. That's what your MHA, with guidance from the Council on Financial Policy and MHA's Executive Committee, will be fighting for as we engage with HSCRC commissioners and staff over the next several months.

At Work in Annapolis
With the bill introduction deadline for both the House and Senate now behind us, MHA has a clearer picture of the issues we will address during the remainder of the 2016 legislative session. MHA continues to participate in bill hearings, briefings and subcommittee meetings and advocate for our budget priorities as those discussions and decisions get underway. Read more in this week's Advocacy Dashboard.
MHA Position Papers Available
MHA's General Assembly Position Papers web page provides PDFs of MHA's submitted testimony and informational letters on various issues affecting Maryland's patients, hospitals, health systems and health policies. All of these materials are posted on the day of corresponding General Assembly briefings or hearings.
General Assembly Video Testimony Available
Video clips from the February 12 joint hearing of the House Health & Government Operations and Judiciary committees on the Birth Injury Fund are available on MHA's video testimony web page.
Faith Community Health Network Launches
MHA President & CEO Carmela Coyle joined dozens of Maryland's faith, hospital and health care leaders this week as they announced the formation of the Maryland Faith Community Health Network. This innovative program, based on one pioneered in Memphis in 2006, connects representatives at faith institutions and health care providers in hospitals. For the pilot, LifeBridge Health employees will be navigators and will match patients with community resources by working with members of particular congregations who can help make sure their congregants are doing well. You can learn more about the Maryland Faith Community Health Network at the Health Care for All website.

Faith and health care leaders gather to launch the Maryland Faith Community Health Network earlier this week. Photo courtesy Health Care for All.
Cardin Convenes Mental Health Event
Dozens of Maryland's health care leaders, including representatives from hospitals, Institutions for Mental Disease, and community-based providers, gathered last week at Sheppard Pratt Health System in Baltimore to discuss mental health care with U.S. Sen. Ben Cardin. The roundtable discussion, which Cardin convened, focused on challenges and opportunities to improve a deeply fragmented mental health care network whose problems are exacerbated by a lack of mental health professionals who can provide community-based treatment of illnesses, like addiction, that have long-term recovery periods. MHA President & CEO Carmela Coyle, along with several other hospital executives, shared their perspectives about hospitals' roles in improving mental health care statewide. To share your thoughts with Senator Cardin, contact his health policy advisor, Dr. Beth Vrabel, at beth_vrabel@cardin.senate.gov.
MedChi Sets Maternal Mortality Summit
MedChi, the Maryland State Medical Society, on March 12 will host its first Maternal Mortality Review Summit. Experts in obstetrics, addiction medicine and cardiology will educate attendees on the process of maternal mortality review in Maryland, relate the type and frequency of the various causes of maternal death, identify issues of addiction management in pregnancy, and more. This free event can provide educational credits. Click here for the registration flyer and more information.
When Organizational Change Runs Into Organizational Culture
We recognize the great change that is happening as we pursue the goals of the revised Medicare waiver and the tenets of population health. However, it's easy to get so caught up in the activity of change that we forget to take stock of our current foundation and plan for its future.

Improve Patient Access Management
With evolving reimbursement models and high-deductible health plans forcing patients to shoulder more payment liability, health systems must improve their registration and financial clearance to ensure up-front cash collections, reduce front-end denials and improve patient registration efficiencies to maintain patient satisfaction.

CDC: Adult ED Visits Largely Unchanged in First Year of ACA Coverage Provisions
Eighteen percent of adults under age 65 reported visiting a hospital emergency department at least once in 2014, about the same as in 2013, according to a report  released this week by the Centers for Disease Control and Prevention.

Wednesday, February 24
MHA Operations Committee meeting

Thursday, February 25
Prime Board meeting
NPR, By Jay Hancock, February 15
The Baltimore Sun, By Andrea K. McDaniels, February 15
PBS News Hour, By Jay Hancock, February 15
Maryland Reporter, By Alessia Grunberger, February 15
Your 4 State, By Mitti Hicks, February 16
The Baltimore Sun, By Jon Kelvey, February 17
The Baltimore Sun, By Meredith Cohn, February 17