September 23, 2016
Tackling the Behavioral Health Crisis
Maryland's behavioral health crisis did not happen overnight. It took nearly a decade, as the state shuttered many specialized facilities that treated mental health and substance use disorders, and as, at the same time, the effects of heroin and opioid misuse began to spread across the state and into our hospitals.
An estimated 1.5 million Marylanders suffer from mental health and/or substance abuse disorders, and help is not nearly as accessible as it should be. The result: these women, men and, too often, children, end up in a revolving door, where sporadic care, followed by a relapse, and then additional care, has become a poor substitute for a comprehensive care plan.
To better understand the crisis so that Maryland's hospitals might formulate the right strategies to overcome it, MHA's Executive Committee in June of last year approved the creation of MHA's Behavioral Health Task Force. Led by Howard County General Hospital President Steven Snelgrove, the task force is composed of hospital executives and clinical experts in mental health and substance use disorders.
Over the course of six meetings, the task force began to formulate a framework to capture the state of behavioral health needs and how hospitals might address them. The task force produced the Behavioral Health Environmental Scan, a report that looks at Maryland's behavioral health environment overall, at specific gaps in how people's needs are met, and at options to address those gaps. It is by no means the end of hospitals' work on this issue, nor a definitive roadmap to a resolution. But it is a valuable illustration of the current environment. A few notable data points:  
  • Emergency departments throughout Maryland are seeing an increase in behavioral health patients; in 2015 alone, there were more than 107,500 visits, up from 100,250 the prior year
  • While emergency department volume for non-behavioral services decreased between 2013 and 2015, behavioral health emergency department volume increased 11 percent during the same time period
  • Behavioral health patients are typically in the emergency department three hours longer than  non-behavioral patients 
These and other data in the scan suggest that meeting Maryland's behavioral health needs is a long-term proposition not just for hospitals, but for stakeholders across the state. The path to tackle this problem is one that will require an integrated behavioral health infrastructure, of which hospitals are just one piece. This infrastructure, which provides adequate physical and workforce capacity to meet individual needs, is the goal to which the state of Maryland must commit strength and resources. It's not just a matter of ED overcrowding; it's also the right thing to do for those who have for too long suffered in the shadows without the help they need. This is hospitals' great challenge going forward, and one for which the task force will continue to provide valuable information and guidance.
Just this week, MHA's Executive Committee approved a 2017 General Assembly advocacy agenda that specifically names behavioral health as a key advocacy issue. And MHA already has been working with community-based behavioral health providers and advocacy organizations on a joint legislative agenda for the 2017 session so that we can engage other stakeholders. Whatever solutions are generated by this work will have at their heart one of the task force's key conclusions: "any approach to addressing the behavioral health epidemic must consider the local needs of the population and the available supply of provider and community supports in that area."
I want to thank the members of the task force for their diligent work, and you for all you are doing to face a problem that by every indicator is getting worse. Once again, it is our field that is stepping up to the plate to create change. 

Full House at PQI Summit
More than 100 clinical leaders today attended MHA's summit on Prevention Quality Indicators (PQIs) and other types of Potentially Avoidable Utilization. PQIs are a set of conditions developed by the Agency for Healthcare Research and Quality for which good outpatient care can prevent the need for hospitalization or more serious complications. The summit featured leading experts on initiatives that have proven successful. Click here to see slides presented at today's summit.
State Coffers Falling Short
This week, the Maryland Board of Revenue Estimates reduced the state's revenue projections for fiscal year 2017 by $365 million and for fiscal year 2018 by $418 million, the largest such reduction since 2010. The reduced revenue projections are largely due to a decrease in individual income taxes and corporate income taxes. These revised projections make the prospects for additional spending or tax relief more difficult. In response to the revised revenue estimates, Governor Hogan's budget secretary said that the administration needs relief from the minimum spending requirements that the General Assembly has written into state law, while Democratic leaders say that the Governor is steering Maryland's economy in the wrong direction.
MHA Ramping Up Equity of Care Support
To further support Maryland's hospitals as they work to eliminate health care disparities via the national Equity of Care campaign, MHA is gathering from each hospital information on its lead person on the issue. Working with the Maryland Healthcare Education Institute, MHA expects to bring these leads together for in-person discussion groups, targeted training opportunities, and other health disparities resources. In addition, hospital CEOs earlier this week received updated data on readmissions, mortality, and a select group of in-hospital infections, stratified by race, ethnicity and language.
Contact: David Simon
Registration Still Open for Statewide Behavioral Health Meeting
MHA is partnering with several community behavioral health providers on a Behavioral Health Statewide Meeting October 11 at the BWI Marriott, and we are still accepting registrations. This meeting will convene hospital discharge planners, emergency department staff, community-based behavioral health providers, and local health departments to:  
  • highlight successful and effective partnerships between hospitals and community behavioral health providers
  • discuss issues and challenges to collaboration
  • share data and discuss actionable opportunities for strategic partnership
  • network and build foundation for strategic alignment 

There is no charge to attend, but you must RSVP here. Registration is limited to two people from each organization. If you have any questions, contact Sheena Siddiqui.
CANDOR Conference Offers Training on Conflict Resolution
The MedStar Institute for Quality & Safety and the Collaborative for Improvement and Accountability is convening an interactive training for leaders, Taking Action with CANDOR, on October 20 and 21 at the Omni Shoreham in Washington, D.C. Eight of MedStar Health's hospitals participated in a pilot program for CANDOR, short for "Communication and Optimal Resolution," and in the past four years, MedStar has lowered serious safety events by almost 60 percent. CANDOR was developed by the Agency for Healthcare Research and Quality to help break down the walls that tend to get built when an error occurs by encouraging full disclosure and an apology following an adverse event.
The small-group training ( attendees are eligible for continuing education credits), designed for board members, CEOs, COOs, CMOs, CNOs, and other patient safety leaders, will focus on the CANDOR toolkit, which contains videos, PowerPoint presentations and other documents explaining a variety of activities, including how to hold conversations with patients and families and how to implement disclosure programs across an institution.
MHA is an event partner and members of MHA are entitled to discounted rates (discount code is "NO HARM"). Click here for more information and here to register. 
Federal Court Denies Delay in Medicare Appeals Case
A DC federal court trial judge Sept. 19 denied the government's request to delay further proceedings in a case brought by the AHA and three hospital organizations to compel the Department of Health and Human Services to meet its congressionally mandated deadlines for reviewing Medicare claims denials. The government had requested a delay of the case until Sept. 30, 2017, arguing that such an extended delay was consistent with a February appellate court decision in the lawsuit. In February, the appeals court revived the lawsuit and sent the case back to the lower court, noting that the backlog of delays had gotten "worse, not better." The appellate court also instructed that "in all likelihood," the lower court should order the administration to comply with the appeals deadlines if HHS or Congress failed to make meaningful progress toward solving the problem within a reasonable period of time, pointing to the close of the next appropriations cycle as the deadline for resolution.
Quality Matters Website is Live
MHA's new website,, is now sharing the powerful and life-saving techniques Maryland's hospitals are using to make hospital care safer. The website is designed to help the public understand trends in hospital quality and safety, and provides hospitals themselves with an additional resource for best practices and novel ideas. It provides descriptions of the methods that successful hospitals and hospital units have used to drive down infection rates and readmissions, as well as other quality measures. To see the press release MHA issued yesterday, click here .
Contact: Jim Reiter
Overdose Deaths on the Rise
More than 900 Marylanders have died from illicit substance overdoses in the first half of 2016, according to recently released data from the Department of Health & Mental Hygiene. The 920 deaths from January to June is 319 more than during the same period last year; for all of 2015, there were 1,259 overdose deaths in Maryland. Heroin accounts for the most deaths in 2016, while deaths related to the painkiller fentanyl had the biggest spike. According to DHMH, clinical provider education and resources continue to be a focus of the department's addiction-prevention strategy, through Continuing Medical Education and the Prescription Drug Monitoring Program (PDMP). Providers will be required to register with the PDMP this fall to obtain a Controlled Dangerous Substance permit.
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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.

CMS Announces Average Medicare Advantage, Part D Premiums for 2017
The average Medicare Advantage premium will decrease by $1.19 to $31.40 next year, while the average monthly premium for a basic Medicare Part D prescription drug plan will increase by $1.44 to $34, according to Centers for Medicare & Medicaid Services premium and cost information released yesterday. 

Monday, September 26
Carmela Coyle Presents to the Consumer Health Foundation on population health and
  equity of care

Tuesday, September 27
MHA Statewide CEO/CFO meeting

Wednesday, September 28
MHA Joint Quality-Finance Work Group
The Baltimore Sun, By Andrea K. McDaniels, September 16
The Baltimore Sun, By Andrea K. McDaniels, September 19
Capital Gazette, By Ben Weathers, September 19
The Daily Record, By Daniel Leaderman, September 19
The Frederick News-Post, By Sylvia Carignan, September 20
The Baltimore Sun, By Michael Dresser, September 21