September 14, 2018
Primary Care Program Prospects
August 31 was the deadline for physician practices to apply for the Maryland Primary Care Program . The tally of applicants for the first year - nearly 600 representing several thousand physicians - far exceeded projections. Ultimate participation may be smaller as CMMI wants to be sure each practice has enough patients on its panel to let the "law of large numbers" work.
The enthusiasm is encouraging and suggests that care transformation is of interest to more than just hospitals. That's important, given that hospitals' success under the Total Cost of Care Model, where we are the only at-risk actors, depends on big changes in the way non-hospital providers deliver care.
The primary care program has five core elements to drive change in physician practice: care management, access and continuity, planned care for health outcomes, beneficiary and caregiver experience, and comprehensiveness and coordination across the continuum of care.
These sound similar to a lot of the buzzwords that apply to the ways our hospitals are working to drive cost containment while preserving or improving the quality of care. And in fact, most of the Care Transformation Organizations that were selected to support the primary care practices are hospital affiliates.
So, yes, we do hope the primary care program succeeds.
But the program warrants close monitoring, as its potential return on investment is not assured. The care management costs associated with the program will be counted against the total cost of care beginning January 1, 2019, so savings must be accelerated elsewhere to offset the spending.
For some perspective, in year four of the current model (2017), non-hospital spending exceeded the national trend by $147 million. Hospital savings of $285 million more than offset this excess, but there is precious little room for hospitals to offset deficits on the non-hospital side of the ledger.
The primary care program is one of several tools being established to help doctors, post-acute care providers and others to act more like hospitals have been under global budgets - focusing on efficient, effective care. In this environment, where many strategies are being launched statewide, it's important that hospitals connect with care partners across the continuum to ensure the model's success.
We at your MHA will also engage with our counterparts in the private and public sectors to ease implementation, assess program performance, and press for improvements where warranted.

Bob Atlas
President and CEO

Total Cost of Care Growth on Track for 2018
Maryland Medicare Total Cost of Care growth is projected to come in between 0.2 and 0.4 percent below the national growth rate this calendar year, Katie Wunderlich, the new executive director of the Health Services Cost Review Commission, said at the HSCRC's meeting this month. HSCRC staff also presented a draft policy recommendation on the maximum amount of revenue at risk for its quality-based programs. Read more in this month's edition of Newsbreak .
MHA Comments on Inpatient Psychiatric Bed Capacity
An analysis of Maryland's inpatient psychiatric bed capacity must capture more than just inpatient psychiatric services, according to a letter MHA submitted this month to the Maryland Department of Health. The letter states that to fully measure Maryland's demand for treatment, other inpatient units and outpatient settings - where a significant portion of treatment now is conducted - must be considered.
Rx Time Restrictions Lifted Amid State of Emergency
Health carriers in Maryland are required to waive time restrictions on prescription medication refills until Gov. Larry Hogan lifts the State of Emergency he signed Monday in response to Hurricane Florence. During the State of Emergency, the Maryland Insurance Administration authorizes payment to pharmacies that fill prescriptions for at least a 30-day supply, regardless of how recently the medication was filled. The order also applies to the replacement of durable medical equipment or supplies, eyeglasses and dentures.
Form Available to Report Immigration Enforcement in Hospitals
The Maryland Office of the Attorney General, working with MHA, has finalized a form for hospitals to report cases where a federal Immigration and Customs Enforcement agent attempts to enforce immigration law on hospital grounds. Hospitals have been deemed "sensitive locations," where such enforcement activity is prohibited by law. The attorney general's office will be the repository for these reports. In September 2017, the attorney general issued guidance on this issue following a request from several state legislators to clarify the protections patients can expect while at a hospital.
Case Management Conference Offers Education, Networking Opportunities
The Maryland chapter of the American Case Management Association will hold its 16th Annual Case Management and Transitions of Care Conference on September 29. The event, at the Renaissance Baltimore Harborplace Hotel, will include professional education on case management practices, as well as opportunities to learn from and network with sponsors, exhibitors and fellow case managers. Register at .
ACHI Seeking Proposals for 2019 Conference
The Association for Community Health Improvement is seeking presenters to share their expertise, demonstrate actionable tools for population health, and engage conference participants in meaningful discussion at the National Conference in Chicago, March 19-21, 2019. Population health leaders come from multiple sectors and professions, but share a common goal: to advance well-being and health equity for individuals and communities. Visit for more information. Proposals are due by September 28. Contact with any questions.
Is "Mindfulness" a Lever for Success
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Looking for a Cutting Edge Provider for Blood and Associated Services?
For more than 60 years, Blood Bank of Delmarva (BBD) has provided blood and blood components to hospitals throughout the Delmarva region, helping avoid blood shortages and saving thousands of lives with assistance from more than 150,000 current donors.

Coalition Pushes Back on PhRMA's Claims About Drug Prices
A coalition of health care providers, insurers, seniors and others is pushing back on some of the latest claims by the Pharmaceutical Research and Manufacturers of America that incorrectly blame hospitals for the rising price of drugs.

Tuesday, September 18
MHA Council on Financial Policy meeting
MHA Medicare Performance Adjustment Work Group meeting
The Baltimore Sun , By David Anderson, September 7
The Daily Record , By Tim Curtis, September 7
The Daily Record , By Tim Curtis, September 10
Baltimore Business Journal , By Carley Milligan, September 10
Herald-Mail Media , By CJ Lovelace, September 12
The Baltimore Sun , By Cody Boteler, September 11
The Baltimore Sun , By Andrea K. McDaniels, September 12
The Baltimore Sun , By Yvonne Wenger, September 12