May 12, 2017
Listening, Questioning, and Learning
It was a packed room Wednesday, when hospital leaders gathered from across the state to hear from and provide face-to-face feedback to the state regulators who are negotiating with the Center for Medicare & Medicaid Innovation on the next phase of the All-Payer Model.
It was important that the state team - Health Secretary Dennis Schrader, Deputy Secretary for Public Health Services Dr. Howard Haft, Health Services Cost Review Commission Chairman Nelson Sabatini, HSCRC Commissioner John Colmers, and HSCRC Executive Director Donna Kinzer - hear your thoughts and ideas firsthand as we continue on a fast-paced negotiation timetable.
The goal of the state's team is to have a term sheet completed by June 1 and details worked out by the fall, and they have already had meetings with Health and Human Services Secretary Dr. Tom Price and CMS Administrator Seema Verma. The message from federal representatives: they are impressed with the strong results you've demonstrated so far, would like them to continue, and would like to move from the current 5-year contract to one covering 10 years.
Here is a quick recap of our key concerns expressed Wednesday:  
  • The need for clear rules in the use of a Medicare discount, which could be applied if total cost of care goals are not met
  • Delay in implementation of a hospital-specific total cost of care measure, including penalties and rewards, for two years until it can be developed and "shadow tested" before full implementation
  • A clearer approach to measuring improvement in statewide population health metrics over a longer time period
  • Elimination of Maryland's Hospital Acquired Conditions Program
  • A meaningful and achievable total cost of care savings amount
The robust discussion included tough questions from hospital leaders on topics like focus and bandwidth, the primary care model as just one means to achieve savings, addressing social determinants of health, the effect of the Medicaid tax on total cost of care, rural health, and more.
There are just two meetings left between state negotiators and representatives from the Center for Medicare & Medicaid Innovation before the term sheet for a new deal is supposed to be finalized, so our meeting was important in helping state negotiators understand how what they are deliberating will affect you and the people you care for.
My thanks to all who took the time, including those who drove for hours, to amplify hospitals' thoughts and concerns as this historic negotiation moves forward.
Hospitals and regulators share the goals of lower costs and better quality, and thanks to meetings like the one Wednesday, they are listening, questioning, and learning about what you need to realize that vision.

HSCRC Staff Recommend 3.12 Percent Increase in Global Budgets
Health Services Cost Review Commission staff this week offered their draft recommendation for the update to global budget revenues for fiscal year 2018 of 3.12 percent (2.75 percent on a per capita basis). This equates to about $500 million statewide for all hospitals. Non-global budget hospitals would receive a proposed increase of 2.18 percent. The recommendation was part of a busy commission agenda, reported in greater detail in this month's edition of Newsbreak .
David Brooks to Speak at MHA's Annual Membership Meeting 
MHA's Annual Membership Meeting will be held at the Four Seasons Hotel Baltimore on June 12 and 13 and is designed for senior leaders of Maryland's hospitals, from CEOs and trustees to chief medical officers, chief nursing officers and others. Invitations have been mailed. David Brooks, conservative columnist for The New York Times, PBS and NPR commentator, and bestselling author will speak at the general session on June 13. He will join us for a candid discussion about the Trump administration, its impact on the health care landscape and how the administration might evolve after a tumultuous beginning. If you need to book a room at the Four Seasons Hotel, the deadline to take advantage of the special MHA discounted rate is today! Click here to view the annual meeting brochure and click here to register.
Contact: Kathy Gotwalt
Hospitals Alerted About Carfentanil Overdose Treatment
The Department of Health and Mental Hygiene this week sent a letter to hospitals notifying them about several recent deaths in Anne Arundel and Frederick counties associated with carfentanil and providing specific treatment recommendations. Carfentanil is a synthetic opioid and is 10,000 times more potent that morphine and 100 times more potent than fentanyl. The recommendations include what providers should consider wearing (at a minimum: gloves, eye protection, and a face mask) when dealing with a carfentanil overdose patient and details on using naloxone on the patient and prescribing it to at risk-patients, their family and friends.
Armstrong Institute Offers Webinar on Opioid Epidemic
Opioid overdose deaths have nearly quadrupled since 1999 and health care facilities are now routinely prescribing naloxone to patients to reverse opioid overdoses. In July 2016, the Johns Hopkins Health System implemented a naloxone-prescribing policy across its academic and community hospitals, ambulatory settings and outpatient pharmacies. The Armstrong Institute for Patient Safety and Quality is offering a free webinar June 14 at 2 p.m. with two clinical pharmacy specialists who will draw on those experiences and discuss:  
  • Methods for identifying patients at high overdose risk
  • Recommendations for writing and filling of naloxone prescriptions
  • Challenges to developing and implementing naloxone prescribing across a health system
  • Strategies for incorporating overdose education and naloxone programs into different care settings 
Click here to register.
Moffit Appointed New Chair of MHCC
Governor Larry Hogan this week appointed Robert Emmet Moffit, PhD., as chairman of the Maryland Health Care Commission. Moffit, of Severna Park, succeeds Dr. Craig Tanio. He was initially appointed to the Commission in 2015. A press release from the Maryland Department of Health and Mental Hygiene states that the modernization of Maryland's certificate of need program will be one of Moffit's top priorities as chair, with additional focus on price transparency in health care.
Clinicians Informed of MIPS Status
The Centers for Medicare & Medicaid Services this week mailed letters to Medicare-enrolled clinician practices informing them of their Merit-based Incentive Payment System (MIPS) participation status. The letter informed clinicians if they, or the individuals in their group, are exempt from MIPS. The letter also requested that clinicians to review the information and determine whether they plan to participate as a group or if the clinicians within the group will participate individually. CMS also released a provider look-up tool, a web-based system that allows providers to verify their status. For a clinician to determine his or her status, all they need to do is to enter their national provider identifier into the entry field on the tool which can be found on the Quality Payment Program website at . Information will then be provided on whether or not the clinician should participate in MIPS this year and where to find resources. In addition, CMS provided a drop-in article organizations can share with their members.
Nominations Sought for Circle of Life Awards
Nominations are being accepted for the 2018 Circle of Life Awards, sponsored by the American Hospital Association, the Catholic Health Association, the National Hospice and Palliative Care Organization & National Hospice Foundation, and others. The Circle of Life Awards go to organizations with an innovative palliative and end-of-life care program. Up to three programs or organizations will receive the award in 2018. Click here to read about the criteria. The application can be downloaded from AHA's website. Hear past honorees talk about their innovations and the award's value at Questions can be emailed to
Bringing Best Practices To Maryland
In very simplistic terms, one of our jobs at MHEI is to bring best practices and relevant research evidence to your leadership team so that all of us can operate more effectively through better decision-making and actions. To that end, we have adjusted the cost and availability of our annual leadership conference so that all leaders, at all levels, in all Maryland hospitals can attend and receive this critical information.

Accelerate Collections by Capturing Missing Charges and Lost Revenue
Health care providers are facing common challenges - transitioning to ICD-10, managing the risk of new reimbursement models, improving net revenue, reducing days in accounts receivable, increasing efficiency, and managing complex contracts.

CDC Webinar May 23 on Resource Management During Infectious Disease Outbreaks
The Centers for Disease Control and Prevention will host a May 23 webinar for hospital epidemiologists on resource management and priority setting during infectious disease outbreaks. 

Monday, May 15
Carmela Coyle presents to Anne Arundel Medical Center for Nurses Week regarding Maryland's
  All-Payer Model

Tuesday, May 16
Carmela Coyle presents to the Greater Baltimore Committee Healthcare Committee regarding
  the legislative session and Maryland's waiver

WBAL-TV, By Lisa Robinson, May 5
WBAL-TV, By David Collins, May 5
Baltimore Business Journal, By Morgan Eichensehr, May 9
MPT, May 8, 2017
Baltimore Business Journal, By Morgan Eichensehr, May 9
The Baltimore Sun, By Michael Dresser, May 9
The Daily Record, By Tim Curtis, May 10
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