July 27, 2018
Spotlight on Rising Drug Prices
As Maryland's hospitals begin in earnest their preparations to rein in health care costs ahead of the inception of the Total Cost of Care Model, there's one factor that has long escaped any meaningful constraints: drug prices.
How bad are things? Approximately 6 percent of hospital spending on care is attributed to pharmaceuticals. And while overall hospital spending growth in Maryland has been held to barely more than 2 percent annually over the past four-and-a-half years, drug costs are climbing far more quickly. A year ago, the group purchasing organization Vizient projected hospitals' costs of pharmaceuticals would grow by almost 8 percent in the coming year.
A few weeks ago, I met (unofficially) with an old friend who holds a senior position with PhRMA in Washington, D.C. I expressed our concern. She argued that hospitals deserve blame for marking up drug prices as much as 400 percent. I explained how that isn't so in Maryland and suggested PhRMA needs to rethink that argument when it comes to our state.
Because Maryland's hospitals operate under fixed global budgets, and are tasked with reducing growth in health care costs in all settings, they have scant wiggle room to absorb costs that are spiraling out of control. Success under the Total Cost of Care Model demands that every facet of health care cost growth be suppressed.
The out-of-control growth has led the American Hospital Association to enter the national fray, joining the Campaign for Sustainable Rx Pricing. There are also state-level efforts, including Maryland's passage of a law in 2017 that would have curbed sharp increases in the price of generic medicines. That law was ruled unconstitutional by the 4 th Circuit Court of Appeals in April and on Tuesday the court declined to rehear the case. Nevertheless, the issue will return in the coming General Assembly session.
Maryland's hospitals are arming themselves with many new tools to hold costs in check: care redesign initiatives, bundled payments, primary care coordination incentives, and more. Control of input prices, drugs among them, is crucial to the success of those measures. We must continue to push back on the pharmaceutical industry and seek appropriate regulatory relief.
No matter what form that takes, the goal is to strengthen access to affordable treatments and cures for patients. 

Bob Atlas
President and CEO

Hospitals Asked to Participate in Behavioral Health Study
In a letter to CEOs, MHA President & CEO Bob Atlas this week asked for help to collect data on behavioral health patients who are ready to be discharged but essentially have nowhere to go due to limited space in non-hospital facilities. Data collected will be used to educate legislators on the types of services that are lacking in communities for behavioral health patients.
While the focus of the study is on inpatient behavioral health units, there is opportunity for other medical units, serving a high volume of behavioral health patients or with excessive behavioral health patient boarding, to participate. Please share this recording of an informational webinar with relevant hospital staff.
This is a 90-day effort and MHA hopes all hospitals will participate. Details can be found in this Letter of Commitment , which should be signed by CEOs by August 3 to participate. Contact Erin Dorrien with questions.
August HSCRC Meeting Cancelled
The August 8 Health Service Cost Review Commission public meeting has been canceled. The next commission meeting is scheduled for September 12.
CRISP Developing Family Reunification Service
The Chesapeake Regional Information System for our Patients (CRISP), Maryland's designated health information exchange, is developing a new service that will help family members reunite with loved ones who have been hospitalized following a large-scale incident with multiple casualties. The family reunification service is modeled on a similar service in Washington, D.C., and will provide access to select hospital employees to query CRISP's database to identify patients. The service will help streamline reunification efforts statewide. Testing is expected to begin in the coming months, with a full rollout after that.
Contact: David Simon
Nearly $80 Million for Crime Victim Services Available
The Hogan Administration this week announced that the Governor's Office of Crime Control & Prevention will provide nearly $80 million in funding from the Victims of Crime Assistance Grant program to Maryland counties and programs serving victims of crime. Applications for funding are being accepted through August 16. Hospitals that provide direct services to victims, such as crisis counseling, forensic examinations, or other wraparound services are eligible to apply. Funds are allocated over a two-year period. More information about the program and the Notice of Funding Availability may be found here or by contacting Kim Herndon, Director of Victims of Crime Assistance Initiatives and Program Manager at 410-697-9312 or kimberly.herndon@maryland.gov .
Report: Intoxication Deaths Continue to Rise
The Maryland Department of Health this week released data on unintentional drug and alcohol-related intoxication deaths for 2017 and the first quarter of 2018. Both reports can be found here . The total deaths in 2017 from drug and alcohol-related intoxication were 2,282, 2,009 of which were opioid-related. Fentanyl-related deaths rose from 1,119 in 2016 to 1,594 in 2017, and cocaine-related deaths also rose (from 464 in 2016 to 691 in 2017).
FDA Alerts Providers to Cesium Chloride Risks
The Food and Drug Administration this week alerted health care providers to safety risks associated with cesium chloride, a mineral salt sometimes taken by cancer patients who seek alternative treatments. Reported adverse events included QT prolongation (a dangerous abnormality that can impair the heart's ability to maintain a normal rhythm), low potassium, seizures, potentially lethal arrhythmias, fainting, cardiac arrest and death. The FDA intends to move cesium chloride to the category of substances that present significant safety risks in compounding.
Keeping Your Best Staff From Leaving
It's no secret that the reason good staff leave an organization is ..."because they can!" Other organizations don't recruit average employees and they certainly don't entertain applications from staff who are not performing well.

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AHA Joins Aligning for Health Initiative
The American Hospital Association has joined Aligning for Health , a coalition advocating for federal and state solutions to address the social determinants of health. 

The Baltimore Sun , By Erika Butler, July 23
Maryland Reporter , By Len Lazarick, July 22
The Baltimore Sun , By Andrea K. McDaniels, July 23
The Star Democrat , By Kayla Rivas, July 23
The Baltimore Sun , By Jonathan M. Pitts, July 25
Edgewater Patch , By News Desk, July 25
The Baltimore Sun , By Pamela Wood, July 25