December 2, 2016
Standing on Principles
In October, Health Services Cost Review Commission staff proffered a recommendation to retroactively adjust the commission's Quality Based Reimbursement Program, a proposal that would shift the statewide adjustment from a net positive $27 million to a net negative $10 million for the current fiscal year. The loss of already-budgeted real dollars is scary, but even more important is what we see as a dangerous precedent:  changing a payment policy after the start of a fiscal year.
That's a recipe for fiscal instability during a time of much volatility and uncertainty, and would occur under a prospective payment system designed to maintain predictability in budgeting for both hospitals and clinicians.
The genesis of the change was not a mistake but a lack of discussion about where within the range of maximum penalties and rewards hospital performance was expected to land. So, expectations were not set, and when the results came in, the change was sought as a result.
Ahead of the commission's December meeting, MHA will send our comment letter today outlining our concerns with this precedent, offering recommendations on how to proceed with policies that can keep hospital budgets whole for at least the current fiscal year, and other options that affect the following fiscal years.
To be frank, this will be an uphill battle. Commissioners and HSCRC staff are committed to adjusting the policy in a retroactive manner, but we'll continue to make the case ahead of the December meeting.
No matter what the outcome of the commission's vote, work to fight against bad policy is never done in vain. In hospitals' ceaseless endeavor to improve the health of all Marylanders, success lies not in winning every fight, but rather in bending the arc of health in the right direction over years and even decades. That's why principles matter, and why hospitals will always stand against threats to our patients and communities.

MHA Comments on Progression Plan
MHA this week submitted a letter to HSCRC Chairman Nelson Sabatini that provides feedback on a draft progression plan for the All-Payer Model. In addition to reiterating the principles for progression developed by the HSCRC's Advisory Council, the letter offers four critical concepts for consideration:  
  • That the core hospital model not be threatened as post-acute and primary care models are developed
  • That expanding access to dual eligibles will add to the total cost of care and therefore the calculation should be adjusted
  • That additional work is needed to address behavioral health needs
  • That the plan must recognize success cannot be achieved by resting the entirety of risk on hospitals alone 

Contact: Mike Robbins
New Medicare Reports Available
New Medicare Reports Available
CRISP has developed two types of total cost of care reports using the Centers for Medicare & Medicaid Services limited data set. The reports contain non-identifiable patient-level information. By using them, hospitals can help meet the intent of the recommendations that HSCRC stipulated to receive a full update factor for the second half of this fiscal year, including:
  • Monitoring the growth in Medicare's total cost of care and total hospital cost of care for its service area
  • Working with CRISP, HSCRC and MHA to obtain available information to support monitoring and implementation efforts
CRISP convened a November 10 webinar to demonstrate the reports and their utility. A recording can be viewed at
Contact: Nora Hoban
Community Benefits Top $1.6 Billion
The Health Services Cost Review Commission's most recent Community Benefits report showed that Maryland's hospitals increased their contributions to more than $1.6 billion, about 10 percent of total statewide hospital revenue. This is an increase over the previous year, notable because charity care dropped by $56 million, demonstrating an increase in hospitals' investment in community-based programs. MHA's Thursday press release on community benefits is included in today's Baltimore Sun.
GBMC Nurses to be Featured on WMAR
"The Art of Nursing," a 30-minute television special produced in collaboration with ABC 2-Baltimore (WMAR-TV), will offer a firsthand look at the life of nurses at Greater Baltimore Medical Center (GBMC) and Gilchrist Services. The special, premiering Wednesday, December 7, at 7 p.m., focuses on how GBMC HealthCare nurses care for patients in their greatest times of need. The stories in the special will provide viewers with an unexpected look into the lives of real GBMC patients, facing actual health and medical issues, and the lives of their nurses who make caring, comforting and providing kindness to their patients their life's work. Click here for a preview.
Fire Marshal Creates Data Collection Site
The Office of the State Fire Marshal is asking hospitals to use a new site to collect data related to burn injuries, fire fatalities, arson tips, smoke alarm/fire sprinkler activations, and fire safety inspection requests. The site aims to expedite the electronic collection of data and provide a secure and easy-to-use format to add data to spreadsheets within the system automatically. The Office of the State Fire Marshal asks that hospitals discontinue their current practice for sharing this information and begin using the new secure site. Click here to download a new burn injury reporting flyer. 
AHA Offers Guidance on Samsung Phones
The American Hospital Association, along with two of its personal membership groups (the American Society for Healthcare Engineering and the American Society for Healthcare Risk Management), is recommending that health care organizations review their current fire safety measures and conduct a risk assessment to determine appropriate next steps regarding the Samsung Galaxy Note 7, which has been recalled because it poses a fire hazard. Precautions could include possible restrictions on the phones, or special communications to patients, staff and visitors on hospital policies. See more in the AHA Advisory.
AHA Report Addresses Access in Vulnerable Communities
The American Hospital Association this week released a report from its Task Force on Ensuring Access in Vulnerable Communities. The report was the result of 15 months of work by a 29-member task force, and recommends nine emerging strategies for maintaining access to health care services.
HSCRC Webinars on All-Payer Model Continue
The sixth of seven webinars with HSCRC staff on the amendment to the All-Payer Model and on care redesign programs is Wednesday, December 7, followed by the final webinar 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 remaining webinars are:
  • Webinar 6: (9 a.m. Wednesday, December 7) - Care Redesign Program Monitoring
  • Webinar 7: (9 a.m. Friday, January 13) - Care Partner Agreements
During each webinar, participants can ask questions of HSCRC, the Center for Medicare & Medicaid Innovation, MHA, and CRISP. Click here to find the registration links for each webinar and the recordings of previous webinars.
The Impact of Culture
It is easy to ignore an organization's culture until a leader tries to implement a change and, at that time, recognizes that the culture is not flexible enough and the change cannot be implemented, or the culture is so strong that the old ways and methods soon return.

Reduce Lighting Energy Costs Up to 50 Percent
Lighting accounts for 30 to 60 percent of annual electric costs for many facilities, and many new advances in lighting technology can help your organization conserve energy and save money.

AHA shares public policy priorities with President-elect Trump
The AHA this week shared with President-elect Trump its public policy priorities for the new administration.

The Baltimore Sun, By Meredith Cohn, November 25
The Baltimore Sun, By Justin George, November 27
Baltimore Business Journal, By Morgan Eichensehr, November 28
Baltimore Business Journal, By Morgan Eichensehr, November 30
Modern Healthcare, By Harris Meyer, November 29
The Baltimore Sun, By Andrea K. McDaniels, December 1