Re-sending to correct an error in a headline.
December 16, 2016
Repeal, Replace, and ...?
With November's election results, health care delivery over the next several years could look very different than the path laid out by the Affordable Care Act. President-elect Trump and incoming Health and Human Services Secretary Dr. Tom Price will push for repeal of the ACA, as well as major changes to Medicare and Medicaid, all of which will have a significant impact on how care may be paid for and provided.
At this point, it's still too early to know exactly how this might play out for hospitals generally, nor specifically for Maryland's All-Payer Model. There are many more questions than answers: With the authority for Maryland's model resting within the Center for Medicare & Medicaid Innovation, and Dr. Price's unfavorable view of that agency, can our model (and its $2 billion-plus annual gain for the state) be preserved? If Republicans intend to keep the popular parts of the ACA, how will those be funded if the unpopular parts are eliminated? What is the timeframe to find a replacement for the ACA, if indeed Congress repeals but delays the effective date of that action? Will Medicaid funding be converted into block grants? Will Medicare be transformed via premium support?
As the answers to these questions trickle in, Maryland's model is, in no uncertain terms, at significant risk. And that creates a series of subsequent unknowns for health care delivery in our state. At this point, the only thing we know is that change is coming, and while stability and predictability represent the ideal conditions for hospitals to thrive, the likely scenario is that policies, laws and regulations will be uncertain for some time.
As always, your MHA will play an important role in helping to navigate this murky landscape. As a member of the American Hospital Association's Board of Trustees, I am afforded a broad perspective of what's going on nationally, and have the opportunity to contribute to federal strategies that can have an impact locally. In addition, MHA is revamping its rolling work plan to account for several different scenarios, so that there's a strategy for every contingency. A brief overview of what we'll be tackling in the short term:
MHA will work closely with AHA to:
  • Maintain coverage for all
  • Delay the effective date of any coverage loss
  • "Escrow" any savings from coverage repeal to pay for later replacement program
  • Remove legal and regulatory barriers to care transformation 

MHA will:
  • Protect the All-Payer Model demonstration as best we can
  • Continue working with the HSCRC to develop the details of, and negotiate for, the progression plan for the All-Payer Model
  • Prepare for potential ACA repeal by analyzing Medicaid block grants and per capita caps within the context of the Maryland demonstration
  • Prepare for the possibility of losing Maryland's waiver and reverting to the national prospective payment system; develop what an "unwind" timeline might look like, including critical pathways (rate setting? no rate setting?) and critical decision points for the state, key stakeholders and hospital 

As we continue to learn more and plan for the future, it's certain that one thing won't change: your dedication to improving the lives of your patients and those who live in your communities. That never wavers, no matter what health care policies are in place.

Commissioners Take Final Action on QBR Program for 2017
The Health Services Cost Review Commission this week voted to approve the staff revised recommendation on the Quality-Based Reimbursement (QBR) program for fiscal year 2017, and proposed draft changes to the program for fiscal years 2018 and 2019. Commissioners also received an update from the Chesapeake Regional Information System for our Patients (CRISP) on hospital activities underway that meet the terms of the enhanced global budget update effective January 1, 2017. More details are in this month's edition of Newsbreak. At the end of the meeting, commissioners and others publicly thanked Deputy Director Steve Ports for his many years of service. This was his last public commission meeting.
Health Equity Conference Calls for Action on Inequities
Representatives from more than 140 Maryland organizations attended the 13 th Annual Health Equity Conference in Baltimore on Tuesday. The conference, organized by the Department of Health & Mental Hygiene's Office of Minority Health and Health Disparities, aimed to inform attendees about the root causes of health disparities and provide ideas for how to address them. Topics included: combating institutional racism, how public policy affects health equity, how health care delivery is changing in Maryland, and more. Additional information is available here ; organizers expect to have presentations from the daylong conference available within the next couple of weeks.
Contact: David Simon
2017 Legislative Advocacy Materials Available
The Maryland General Assembly reconvenes January 11 and MHA has developed a bank of materials to help hospitals advocate for the field's three top legislative priorities:  
  • Address Maryland's behavioral health crisis
  • Uphold the agreement to reduce the Medicaid tax
  • Establish a no-fault birth injury fund and reject efforts to increase the state's cap on non-economic damages
Our advocacy efforts will expand beyond those three, and our issue papers and infographics address other key issues as well. Included at the link to our website are:  
  • MHA's 2017 Legislative Agenda
  • A pocket-sized Top Ten Facts to Know About Maryland's Hospitals
  • Single-page issues papers on key topics
  • At-a-glance infographics
  • The latest hospital quality reports
Contact: Jane Krienke
MHA Submits Multiple Comment Letters
Over the past couple of weeks, MHA has submitted four comment letters on proposals relevant to hospitals:  
These letters represent one element of ongoing conversations about these topics. We will keep hospital leaders apprised of new information as it becomes available.
HSCRC Submits Report on Hospital and Community Behavioral Health Providers Partnerships
The 2016 Joint Chairmen's Report from the Maryland General Assembly called on the Health Services Cost Review Commission to report on the status of hospital partnerships with community behavioral health providers. That report was sent to the legislature this week. The report, available for download here, provides an overview of the partnerships that have been formed between hospitals and community-based organizations to reduce potentially avoidable utilization and also details funds dedicated to support this work from transformation grants and other HSCRC financial incentives.
Contact: Brian Frazee
Medicare Posts New Observation Notice Form
The Centers for Medicare & Medicaid Services has posted a final version of the Medicare Outpatient Observation Notice. The notice is a standard notice that all hospitals must provide beginning March 8, 2017, to all Medicare beneficiaries (including those who have Medicare Advantage or Medicare as a secondary payer) who receive outpatient observation services lasting more than 24 hours. The form, which must be accompanied with verbal notification, was created to meet the written notice requirement of the federal Notice of Observation Treatment and Implication for Care Eligibility Act, informs patients that they are an "outpatient receiving observation services, not an inpatient," and explains the associated implications for cost-sharing and eligibility for coverage of skilled nursing facility services. (The file with the form is available here.) The Department of Health & Mental Hygiene has indicated that it will soon issue regulations to reconcile Maryland's regulations regarding observation notice with federal requirements around the form. Regulations from DHMH will be published in a future version of the Maryland Register, and subject to comment.
Contact: Justin Ziombra
Survey: Physicians Split on Price as HHS Secretary
Physicians appear split on President-elect Donald Trump's nomination of Dr. Tom Price as for Secretary of Health and Human Services. According to an online survey of 1,094 physicians conducted by Merritt Hawkins, a physician search firm, 46 percent of physicians feel generally positive about Price, 42 percent feel generally negative, and 12 percent are neutral. Forty-six percent indicated he would improve practice conditions, while 34 percent said he would worsen them, with 20 percent neutral. On access to care, 47 percent said Price will detract from patients' ability to obtain quality care, and 42 percent said he would improve access. According to Merritt Hawkins, those numbers suggest uncertainty about how patients will obtain health insurance if Obamacare is repealed.
Mark Your Calendar for Final HSCRC Webinar on All-Payer Model Jan 13
The final in a series of seven webinars with HSCRC staff on the amendment to the All-Payer Model and on care redesign programs is Friday, January 13. 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)
Again, the final webinar is:
  • Webinar 7: (9 a.m. Friday, January 13) - Care Partner Agreements
During the webinar, participants can ask questions of HSCRC, the Center for Medicare & Medicaid Innovation, MHA, and CRISP. Click here to find the registration link for the final webinar and the recordings of previous webinars.
Empowering Health Care Managers in the New Year
Health care management requires long hours and hard work ¾ often done behind the scenes. But as we know, this is just as important as the work done directly in patient rooms.

Prime's Value to Member Hospitals
Prime is the shared service/group purchasing subsidiary of the Maryland Hospital Association. Its goal is to help our member hospitals reduce the cost of care.

AHRQ: Opioid-Related ED Visits, Inpatient Stays Up Sharply Over Decade
Hospital emergency department visits and inpatient stays related to opioids increased 99% and 64% between 2005 and 2014, according to a new report from the Agency for Healthcare Research and Quality.

Tuesday, December 20
MHA Council on Financial Policy (conference call)
The Baltimore Sun, By Michael Dresser, December 10
Ellicott City Patch, By Jamie Wilkins, December 9
Baltimore Business Journal, By Morgan Eichensehr, December 13
The Daily Record, By Adam Bednar, December 12
Baltimore Business Journal, By Morgan Eichensehr, December 13
The Baltimore Sun, By Eduarda A. Encina, December 13
Baltimore Business Journal, By Morgan Eichensehr, December 14
Baltimore Business Journal, By Morgan Eichensehr, December 15