August 24, 2018
The Differential Makes a Difference
It's just 20 weeks until the launch of Maryland's new hospital payment model. The Health Services Cost Review Commission is considering an important proposal that will help to get the model off on the right foot. The proposal is meant to adjust for the growing bad debt hospitals are seeing from commercially insured patients, the effect of which has been to shift costs onto Medicare and Medicaid.
MHA supported the proposal, to increase the public-payer differential by 1.7 percentage points to 7.7 percent, in a June 20 letter to the commission. Several hospitals also submitted letters of support. More hospitals need to make their voices heard.
HSCRC staff's rationale for this recommendation is spot-on: "Over the past few years, uncompensated care for commercially insured individuals has been increasing as a result of commercial plan design changes that increase the level of patient deductibles and co-pays."
An added benefit of the proposed adjustment is that it would support not only success under the model, but also the state's broader efforts to ensure that all stakeholders are contributing to meet the model's goals.
Coincidentally, the change could help offset the costs of the Maryland Primary Care Program - a last-minute addition made by the federal government just before the contract was signed - by as much as $40 million. That would help to reduce Medicare expenditures and give hospitals more leeway to continue to invest in initiatives to improve the health of their communities.
The topic has gotten some media attention in recent weeks, with an article in The Daily Record and some chatter at last week's Maryland Association of Counties conference. MHA is closely monitoring the progress of the recommendation and will remain vigilant as it makes its way through the approval process with commissioners.
Hospital and health system leaders can help ensure that commissioners approve the proposal. Let it be known that you truly are seeing the growth in uncompensated care from patients who have private insurance but cannot pay their high cost-sharing obligations. Put the word out about the importance of having a system in which there is a proper balance of contributions from all payers.

Bob Atlas
President and CEO

1332 Waiver Approval Boosts Access to Coverage
Earlier this week, Gov. Larry Hogan announced that the Centers for Medicare & Medicaid Services has approved Maryland's 1332 State Innovation Waiver to create a state reinsurance program. The program is designed to help stabilize Maryland's individual health insurance market and prevent large rate hikes. In early August, MHA submitted a comment letter to CMS in support of the application, noting that the waiver would ensure more Marylanders receive preventive services and care in the most appropriate settings. "This will reduce avoidable hospital utilization and lower the cost of care across the continuum," the letter states. "Affordable, stable coverage also improves access to substance use disorder and mental health services, particularly important given Maryland's unrelenting opioid crisis."
MHA Meets with Key Legislators at MACO
The Maryland Association of Counties' annual summer conference in Ocean City drew nearly 2,000 local, state, and federal government officials. MHA's Government Affairs team took part in several learning sessions and engaged with elected officials throughout the event. The team met with Governor Hogan and expressed appreciation for his help in finalizing the Maryland Model contract. The team also met with leadership on key legislative committees, discussing several topics affecting the hospital field such as medical liability, the Medicaid hospital assessment ("sick" tax), and the state's opioid crisis.
Governor Larry Hogan with MHA Government Affairs staff (from left to right) Nicole Stallings, Jennifer Witten, and Neal Karkhanis.
Webinars Offered on Episode Care Improvement Program
The Center for Medicare & Medicaid Innovation last month approved a new Care Redesign Program track for Maryland's hospitals to participate in a voluntary program similar to the federal Bundled Payments for Care Improvement Advanced program. The Episode Care Improvement Program (ECIP) joins the existing care redesign programs - Hospital Care Improvement Program and Complex and Chronic Care Improvement - and will launch in January 2019.
To facilitate hospitals' participation, CRISP is making available several resources, including Excel-based tools, reference documents, and webinars. Participating hospitals' implementation protocols for the ECIP must be submitted to CRISP by October 31, 2018.
The first of two core webinars to train hospital staff on how to use CRISP's tools was this week and the second, Completing Implementation Protocols and Selection Workbook, is September 5 at 9:30 a.m. Click here to register. Attendees will learn how to calculate target payments, how specific quality adjustors impact payments, and will be shown examples of how savings can be shared with care partners. They will also receive guidance on how to complete the implementation protocols.
Supplemental webinars will provide additional details and further opportunities for questions. Click the hyperlinks to register.  
  1. Supplemental Webinar A: Deep Dive into Technical Methodology, Target Prices & Quality Reporting - August 29, 9:30-11 a.m.
  2. Supplemental Webinar B: HCIP-ECIP Connection - September 27, 9:30-10:30 a.m.
  3. Supplemental Webinar C: Office Hours
    1. September 20,9:30-10:30 a.m.
    2. October 10,9:30-10:30 a.m.
    3. October 29,9:30-10:30 a.m.
  All webinars will be recorded and posted on MHA's website.
Contact: Nicole Stallings
Deadline Approaching for MDPCP Applications
The application deadline for practices to apply for the Maryland Primary Care Program (MDPCP) is August 31. A primary objective of the MDPCP is to enable clinicians to spend more time meeting the needs of their patients, rather than focusing on a higher volume of visits. Primary care physicians, physician assistants, nurse practitioners, and clinical nurse specialists are all eligible. Several tools and resources are available on the MDPCP website, including a Practice Application Portal , the Request for Applications (RFA) , Frequently Asked Questions (FAQs) , CTO Comparison Tool , and mini-webinar series .
Efficiency & Effectiveness of Management
There is a way to improve patient satisfaction, clinical quality, and employee engagement, as well as achieve cost reductions, with a set of leadership actions where each action works on all of those issues at the same time - the ultimate in efficient use of time.

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.

AHA Supports Amendment to Address 'Out-of-Control Cost' of Prescription Drugs
The AHA has expressed support for and urged all senators to support an amendment to the Labor, Health and Human Services and Education appropriations bill that would help address the out-of-control cost of prescription drugs.

The Baltimore Sun , By Michael Dresser, August 21
Patch , By Elizabeth Janney, August 21
The Baltimore Sun , By Erika Butler, August 21
The Daily Record , By Bryan P. Sears, August 21
Baltimore Business Journal , By Morgan Eichensehr, August 21
The Daily Record , By Tim Curtis, August 23