January 13, 2017
Preparing for Change
"I can't change the direction of the wind, but I can adjust my sails to always reach my destination." - Jimmy Dean
With the inauguration of President-elect Trump just a week away, tectonic changes to federal health care policy are no longer simply political talk, they are in the works. But what are the details? What form might change take, and what does it mean for hospitals? For Maryland? Here's a quick look at the political horizon:  
  • Before the new president takes his oath, Congress is expected to pass a budget resolution for the current federal fiscal year. The resolution is a non-binding "blueprint" that broadly allocates spending by category and guides congressional decisions. It is not a bill and thus does not get sent to the president for signature or veto.
  • The resolution is the precursor to a budget reconciliation bill (a maneuver that hasn't been used since 2010) that is expected to repeal parts of the Affordable Care Act and lay the groundwork for a potential replacement. This bill will contain the specific policies that four committees - House Energy and Commerce, House Ways and Means, Senate Finance, and Senate Health, Education, Labor and Pensions - will employ to meet the budget blueprint's spending guidelines. Lawmakers have set a mid-February target date for reconciliation approval.
  • Following the budget reconciliation approval, Congress plans to begin work on a fiscal 2018 budget bill, which is expected to include substantial reforms to Medicaid and possibly Medicare. Action on this legislation will likely come between March and September.
There will be other factors that affect how health care is paid for and delivered, including the incoming president's actions on President Obama's executive orders, and regulatory changes at the Centers for Medicare & Medicaid Services. Politics will play a significant role.
Ensuring that hospitals will be able to continue to serve their communities in this new and volatile environment is no small task, and MHA is working diligently with both state and federal representatives so that hospitals will be heard.
Yesterday, I spent much of the day discussing these changes with colleagues from the American Hospital Association (AHA) and the state hospital associations at a forum in Washington, D.C. One of the most discussed topics: potential changes to Medicaid and the impact on hospitals. Our guides in the discussion were Deborah Bachrach and Cindy Mann, partners in Manatt Health and among the nation's leading experts on Medicaid.
There are several possibilities for Medicaid reform that align with the perspective of Health & Human Services Secretary nominee Dr. Tom Price and CMS Administrator nominee Seema Verma, including: block grants, per capita funding caps, and reforms drawn from Healthy Indiana 2.0, which Verma helped create and implement.
To give you a sense of where she stands, in 2013 Verma testified at a congressional hearing on Medicaid reform from a state perspective: "The Medicaid program has not kept pace with the modern health care market," she said. "Its rigid, complex rules designed to protect enrollees have also created an intractable program that does not foster efficiency, quality or personal responsibility."
The guiding principles for Price and Verma will likely be greater flexibility and control at the state and local levels, with innovation driven by voluntary initiatives rather than federal mandates.
MHA is working closely with AHA (AHA's members-only transition resources are available here), as well as key members of Maryland's congressional delegation and Gov. Larry Hogan's administration to make the case that the work you've been doing under the All-Payer Model is in sync with this new philosophy - voluntary, generating accountability, and delivering incredible efficiency.
The details of reform have not yet begun to take shape, but when they come they will have an effect on the work you do every day. That's why it will be so important to be flexible - both in thought and action - to do what you have always done so well: help and heal your patients and communities.

General Assembly Convenes
Already more than 200 bills have been introduced in the 437th session of the Maryland General Assembly, which officially opened on Wednesday. On January 18, Governor Hogan is expected to introduce his operating and capital budget. Next Thursday, MHA will participate in a briefing on the All-Payer Model before the House Health & Government Operations Committee. MHA's government relations team will continue to closely monitor legislation and provide hearing dates and links to testimony through the weekly advocacy dashboard, the first of which will be sent in Update next Friday.
Scholarship Fund to Be Set Up for HSCRC Chairman's Grandchildren
Following the death of Health Services Cost Review Commission Chairman Nelson Sabatini's son in late 2016, Sabatini is helping establish a scholarship fund for his grandchildren; more details will be provided as they are available. A memorial service is being planned for February in Honolulu, and because the family has been overwhelmed with condolences and flowers, it has been suggested that additional condolences await the time of the service.
Care Alert Sprint Webinars Continue
A critical step to secure a full fiscal year update is to demonstrate to the Health Services Cost Review Commission that hospitals are making use of "care alerts." This can be done by uploading them to the Chesapeake Regional Information System for our Patients (CRISP). To help with this effort, CRISP and MHA have introduced a "Care Alert Sprint," a six-month initiative to meet this recommendation using existing hospital personnel and resources.
The initiative's second webinar, Workflow Strategies for Inpatient Readmission Reduction Teams, was earlier this week; slides and video from the webinar have been posted on the MHA website. The third webinar, Workflow Strategies for Emergency Departments, is January 18; participants can register on our website. The Care Alert Sprint is aimed at population health, readmissions reduction, and emergency department leads.
Contact:  Nicole Stallings
  Talking About Our Differences
Within the new political climate it is easy to identify our differences, yet the process that many people say is missing is that we are not discussing those differences in a manner befitting a civilized society.

Improve Patient Access Management
With increasingly changing 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.

Senate Passes Budget Resolution
The Senate voted 51-48 early Thursday to pass a fiscal year 2017 budget resolution, beginning the process to potentially repeal and replace parts of the Affordable Care Act. 

Tuesday, January 17
MHA Council on Financial Policy meeting
The Baltimore Sun, By Meredith Cohn, January 6
Capital Gazette, By Meredith Newman, January 7
The Baltimore Sun, By Erin Cox, January 9
Maryland Reporter, By Dan Menefee, January 10
Herald-Mail Media, By Tamela Baker, January 10
Herald-Mail Media, By CJ Lovelace, January 11