February 17, 2017
Many Paths, One Destination
Allow me to offer a brief anecdote that conveys a bit of perspective during this time of uncertainty surrounding health care policy:
In the 1930s, serving on opposite sides during World War II, while working separately and knowing nothing of one another's plans, Hans von Ohain and Sir Frank Whittle each invented a working jet engine. Whittle used compressed air with a centrifugal flow perpendicular to the axis of rotation, while von Ohain compressed the air with an axial flow through the center of the engine. Opposite feats of engineering that relied on sound principles of physics to achieve the same outcome. Today, both von Ohain and Whittle are given equal credit for the jet engine - an invention that changed the world.
I share this story because the sense of anxiety around forthcoming federal health care policy changes - particularly changes to Medicaid - is palpable and, if executed poorly, the changes could be detrimental to Maryland's hospitals. But, as with the jet engine, we must remember that there is more than one pre-ordained path to achieve your mission of care.
New Health Secretary Dr. Tom Price has indicated his support for Medicaid block grants or per-capita caps to drive efficiency in health care delivery. Block grants would provide a fixed amount of federal funds to each state, shifting both enrollment and cost risks from the federal government to the states. Similarly, per-capita caps would shift the cost risks to the state, but the federal government would retain the enrollment risks.
Block grants and per-capita caps have long been a part of the Medicaid reform conversation. Our own Maryland All-Payer Model demonstration looks in many ways like a block grant, with a fixed amount of annual spending that each hospital may not exceed and a per capita limit on spending growth.
Block grants and per-capita caps force press a fair and valid question: What is an appropriate rate of growth in health care spending for Medicaid?
This is a question that Maryland's hospitals wrestled with several years ago, during the negotiations on the All-Payer Model. The conclusion at the time, and the evidence of the first three years has borne this out, was that there was indeed room in the health care system to both save money and improve quality. Your noteworthy performance on the demonstration's key metrics shows that it is possible.
There is now a shared belief that even more can be done by bringing incentives for primary care physicians and post-acute providers into alignment with those for hospitals, so that we all are providing value-based rather than volume-based care. Legislation to allow such alignment is pending before the General Assembly at the same time that we are working with state officials to negotiate with federal agencies an immediate extension of the state's All-Payer Model, which can further this alignment.
Depending on what form Medicaid policy takes, Maryland could be well-positioned to accommodate the changes, having already laid the foundation for high-quality, efficient care.
That said, we'll be watching federal activity closely. We'll make sure that if a per-capita cap or block grant system is in the mix, they are adequate to meet your needs. We'll oppose inadequate funding levels that either jeopardize the care you provide or those you care for. And we will gauge how any policy changes might interact with the All-Payer Model and fight efforts that would threaten it.
But until we know the details of any proposal, we need to avoid reflexive or emotional interpretations of vague concepts. And we need to remain confident that we may be able to invent a better solution. In this way we might take a cue from the inventors of the jet engine who proved, quite literally, that there is more than one way to get an idea off the ground.

At Work in Annapolis
This week MHA testified in support of a bill that would foster value-driven alignment across the health system, while protecting patients from efforts to weaken Maryland's strong self-referral law. Next week marks the halfway point in the 90-day session. MHA staff are preparing for the unofficial "hospital day" February 23 where members from across the state will come to Annapolis to testify on 10 different bills in three committees including:
Links to bills and our position papers are included in this week's Advocacy Dashboard.
Register Now for MPSC Patient Safety Conference
The Maryland Patient Safety Center's 2017 Maryland Patient Safety Conference is March 17 at the Hilton Baltimore. Online registration is available through March 3. The conference will feature nationally recognized speakers, including a keynote address by the pioneer of Just Culture, David Marx, and a closing keynote by Sue Sheridan and her son Cal, who will shed light on their journey with patient safety and the monumental impact one person can have on preventing systemic failures. Click here for details on the 2017 conference and to register.
MedStar's Mayer Wins Humanitarian Award
Dr. David Mayer, Vice President of Quality and Safety for MedStar Health, has been named a 2016 Humanitarian Award winner by the Patient Safety Movement Foundation. Every year the Patient Safety Movement Foundation identifies the most influential advocates in patient safety and honors them with the Humanitarian Award at the annual World Patient Safety, Science and Technology Summit. The award recognizes leaders who have made significant progress in eliminating preventable patient deaths. MedStar and Mayer recently worked with the U.S. Agency for Healthcare Research and Quality to develop and pilot a toolkit for their Communication and Optimal Resolution program. The program incorporates a suite of interventions that redesign traditional "deny and defend" responses to serious patient safety events.
AHA Offers Updates, Webinars on ACA
With so much activity surrounding potential repeal and replacement of the Affordable Care Act, the American Hospital Association is offering a dedicated web page to the topic. The page includes what's being said by political and thought leaders, potential processes for ACA change, regular webinars, slide decks, videos and more. If you are an AHA member, you can access all this information here.
AHA Offers Webinar on Rising Medication Costs
The American Hospital Association invites hospitals to participate in a webinar on Strategies to Address Rising Medication Costs. The March 16 webinar will feature a case study by the Ohio State University Wexner Medical Center which has developed a practical and sustainable model that includes opportunities for both short-term, immediate impact, and long-term strategic cost-containment efforts. The webinar is March 16 at 1 p.m. Eastern time. Click here to learn more and register.
MHEI Can Help You Be on Top of Your Game
In a recent article in Hospitals & Health Networks, health care strategist Jamie Orlikoff was cited as stating hospital leaders need to be "on the top of their game" in response to the changes in the current and pending health care environment.

PRIME Offers Capital and Construction Solutions
Prime, through its affiliation with MedAssets, would like to introduce you to MedAssets Capital and Construction Solutions, which deliver end-to-end capabilities to help you complete successful, on-time and on-budget construction or renovation projects.

AHA Report Explores 'Next Generation' of Community Health
A new  report from the AHA's Committee on Research explores what the next generation of community health may look like as hospitals and health systems redefine themselves to keep pace with the changing health care landscape.

Tuesday, February 21
MHA Council on Financial Policy

Wednesday, February 22
MHA Joint Quality - Finance Work Group meeting
MHA Operations Committee meeting

Friday, February 24
Carmela Coyle participates in the Healthcare Financial Management Association's
  Women in Leadership Program at MHA
The Baltimore Sun, By Meredith Cohn, February 13
The Baltimore Sun, By Andrea K. McDaniels, February 13
The Daily Record, By Staff, February 14
The Chestertown Spy, February 14
The Baltimore Sun, By Pamela Wood, February 15
The Baltimore Sun, By John Fritze, February 15