November 18, 2016
Setting aside the dubious wisdom of ingesting thousands of calories in one gathering (one estimate says 4,500 on average between snacking and dinner), Thanksgiving for me has always been a time for reflection, a time to gather with family and friends and remind one another to focus on the things we have, rather than the things we lack.
During this time of change and uncertainty in our nation and our state, that spirit is needed more than ever.
Take, for example, the massive transformation that Maryland's hospitals have undergone in the past three years. The path has been fraught with challenges, but along the way hospital leaders have cultivated healthier communities, and sown the seeds of a health care culture that is intensely focused on the person and not on the system. Your work, regardless of what happens in the political arena, will benefit the health of Marylanders for years.
That's something to be immensely thankful for.
You have worked with a broad range of collaborators in your communities to get the job done: doctors, skilled nursing facilities, legislators, regulators, community behavioral health providers, health consumer advocacy groups, patients, and more. Each approached the new health care landscape with their own goals, yet common ground was found, compromises agreed upon, and progress made. This collaborative spirit is also something to be thankful for.
And of course none of this could happen without the continued dedication of the women and men who make it happen on the front lines in your hospitals, including those who give up their time with family and friends so they can heal and give hope to those in need.
Their sacrifice embodies the very best ideals of the Thanksgiving story: that through hard times, we will take care of each other, selflessly and without expectation of reward.
So, thank you for your leadership, for facing challenges with the grit of the pioneers, and as always, for allowing us at your MHA to be your voice and your advocate. Our gratitude is as strong as our belief in what you do every do for so many Marylanders. 

Haft Presents Primary Care Model
Dr. Howard Haft, deputy secretary for public health, on Monday came to MHA's Elkridge offices to present to hospital leaders an overview of the Department of Health & Mental Hygiene's Maryland Comprehensive Primary Care Model. Earlier this year, the Center for Medicare & Medicaid Innovation charged the state with the development of a primary care model, emphasizing its importance to care transformation. Hospital leaders will have an opportunity to provide feedback on the model once a draft concept paper is released. The DHMH model is based on additional Medicare Part B funding from the federal government, revenue that will be used to fund care management resources and infrastructure for primary care physicians. The model is designed to complement other state delivery system transformation activities and meet the requirements for an advanced alternative payment model under the Medicare Access and CHIP Reauthorization Act (MACRA). The model also aims to sustain the early gains of the state's All-Payer Model and support continued reduction in unnecessary utilization and improved patient outcomes through advanced primary care access and prevention. MHA will provide additional details as they become available.
Contact: Nicole Stallings
CareFirst Abandons Common Model
In a letter sent earlier this week to HSCRC Chairman Nelson Sabatini and copied to commissioners, CMS and DHMH, CareFirst President & CEO Chet Burrell says his organization will "surrender our hope of extending the Common Model to the Medicare program." At last week's HSCRC public meeting, CareFirst had urged commissioners to use hospital rates to extend the program to Medicare patients after the company had self-funded the program. Commissioners decided to push a final decision into December, a process Burrell writes "seems to us to lead to an extended time for review and negotiation with an uncertain outcome." Burrell writes that the program will be terminated by year's end.
Surgeon General Releases Report on Drug and Alcohol Addiction
Surgeon General Dr. Vivek Murthy this week released Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs and Health, an exhaustive and thorough look at the substance abuse problem in our country. You can access the study at this link. Click here to view an interview with the Surgeon General.
Behavioral Health Advisory Council Needs Help with Survey
The Maryland Behavioral Health Advisory Council is asking hospitals to complete a survey that will help the council develop a strategic plan to ensure that clinical crisis walk-in services and mobile crisis teams are available statewide. The questions have been designed to generate feedback on the availability of clinical crisis walk-in services and mobile crisis teams, and to help identify priorities that will guide decision-making as the council works to expand these services. The deadline for submission is December 2.
HSCRC Webinars Continue; Letter of Intent Due Today
The fifth of seven webinars with HSCRC staff to provide hospitals with detailed information on the amendment to the All-Payer Model and on care redesign programs is Wednesday, November 30; the schedule for the remain webinars is below. The amendment, approved earlier this month:
  • Gives hospitals and their care partners access to comprehensive Medicare data across the care continuum that supports care coordination and a focus on controlling total cost of care
  • Creates the next steps toward total cost of care and delivery system transformation
Under the amendment, the first two care redesign programs are:
  • the Complex and Chronic Care Improvement Program (CCIP)
  • the Hospital Care Improvement Program (HCIP)
The remaining webinars are:
  • Webinar 5: (9 a.m. Wednesday, November 30) - Comprehensive Medicare Data Process and Use
  • Webinar 6: (9 a.m. Wednesday, December 7) - Care Redesign Program Monitoring
  • Webinar 7: (9 a.m. Friday, January 13) - Care Partner Agreements
During each webinar, participants can ask questions of HSCRC, the Center for Medicare & Medicaid Innovation, MHA, and CRISP. Click here to find the registration links for each webinar and the recordings of previous webinars.
For many hospitals, attending these webinars will culminate with the signing of a letter of intent - a nonbinding agreement submitted to the HSCRC that indicates interest in participating in one or both of the care redesign programs (Hospital Care Improvement Program and Complex and Chronic Care Improvement Program; details at the top of this page). Please note that the deadline to submit the letter of intent is today, November 18. Click here for the letter of intent template. In addition, should you submit a letter of intent to the HSCRC, please copy Pat Ross at MHA so we can tabulate the field's participation in the care redesign programs. If you have any questions, contact Nicole Stallings.
CMS Announces Medicare Premiums, Deductibles
The Centers for Medicare & Medicaid Services announced last week that the Part A deductible for inpatient hospital services will increase by $28 in calendar year 2017, to $1,316. The Part A daily coinsurance amounts will be $329 for days 61-90 of hospitalization in a benefit period; $658 for lifetime reserve days; and $164.50 for days 21-100 of extended care services in a skilled nursing facility in a benefit period. The monthly Part A premium, paid by beneficiaries who have fewer than 40 quarters of Medicare-covered employment and certain people with disabilities, will increase by $2 in calendar year 2017, to $413. Most people with Medicare Part B will not see an increase in their monthly premium in calendar year 2017 due to a statutory "hold harmless" provision. For about 30 percent of beneficiaries, the standard Part B premium will increase by about $12 to $134, CMS said.
FBI Shares Important Cybersecurity Intelligence
Awareness and active evaluation of new and emerging threats and vulnerabilities is critical for hospitals to effectively prepare and manage cybersecurity risks. To keep hospitals informed of significant threats and vulnerabilities that may affect the health care sector, the American Hospital Association is working with the Federal Bureau of Investigation (FBI) and other federal agencies to share important cybersecurity intelligence. The AHA, on behalf of the FBI, has shared the document "APT Targets US Public and Private Sector Entities with New Exploits" with its members. Note: You must be logged into the AHA members-only cybersecurity webpage to review this document. In addition, because of the sensitive nature of the information contained in this document, please share it only with colleagues who have a valid need to know, including your chief information security officer, chief information officer, chief technology officer, legal counsel and others who are critical to your cybersecurity efforts. No portion of this document should be released to the media, posted to public-facing websites, or transmitted over non-secure, external communications channels or otherwise made publicly available. For additional AHA resources on cybersecurity, visit Questions should be directed to AHA Assistant General Counsel Lawrence Hughes at or (202) 626-2346, or AHA Vice President of Policy Chantal Worzala at or (202) 626-2313.
AHA Encourages Hospitals to "Unite Against the Flu"
The American Hospital Association has released its second packet for the United Against the Flu campaign, with several resources available to help hospitals get the word out to patients and communities about how to prepare for flu season. The United Against the Flu web page, , serves as a home base for the campaign and features infographics, helpful resources like the CDC's flu shot finder tool, and promotional messaging.
Other quick ways to get involved:
  • Provide a link to the AHA's Flu Vaccine landing page
  • Share a story about what quality care means to your community and why vaccination is such a crucial component of healthy communities
  • Follow AHA on Facebook and Twitter
  • Use the hashtag #UnitedAgainstFlu in your social posts
  • Post provided content from AHA on social media within 48 hours of receiving it via email
Change and Culture
While leading change is often fraught with difficulty, leading change in an organization where the culture is deeply entrenched is both difficult and frustrating.

Prime Presents Revenue Opportunity
The Mainsail Group helps clients find new and significant means of revenue and cost containment. They help hospitals form strategic partnerships with consumer brands in a manner that is supportive of a health system's mission of care.

CMS Issues APIs to Help Physicians Implement MACRA Quality Payment Program
The Centers for Medicare & Medicaid Services this week released application program interfaces to help clinicians implement the Quality Payment Program mandated by the Medicare Access and CHIP Reauthorization Act of 2015.

Wednesday, November 30
Total Cost of Care Work Group meeting
Carmela Coyle presents with Joe DeMattos, president of Health Facilities
  Association of Maryland, to members of the Center Club on "Healthcare Connections"

MHA's offices will be closed Thursday, November 24 and Friday, November 25 for the
Thanksgiving holiday; there will be no MHA Update newsletter on November 25.
Update will return Friday, December 2.
NBC Washington, By Tracee Wilkins, November 11
Baltimore Business Journal, By Morgan Eichensehr, November 11
Capital-Gazette, By Amanda Yeager, November 14
The Baltimore Sun, By Andrea K. McDaniels, November 14
Capital Gazette, By Amanda Yeager, November 16
Herald-Mail Media, By Dan Dearth, November 16
The Baltimore Sun, By Scott Dance, November 16