July 21, 2017
The Fight Isn't Over
Despite the failure this week of Senate Republicans to pass a bill that would have repealed the Affordable Care Act and replaced it with an alternative plan, millions of Americans remain at risk of losing their health care coverage.
There are several reasons.
First, U.S. Senate Majority Leader Mitch McConnell is calling for a vote on a bill that passed Congress in 2015. That bill repeals the ACA without a clear and immediate replacement, instead creating a two-year transition period during which Congress would presumably develop a new health care plan. McConnell is also examining other options to press the debate, despite uncertainty about the vote count. (It's important to remember that the Better Care Reconciliation Act failed in part because several senators believed it did not go far enough to cut coverage.)
If the 2015 repeal-only bill is approved, the unpredictability of the transition period and what would come after would destabilize ACA insurance marketplaces, hastening yet a second threat to health care coverage: President Trump's idea to make the Affordable Care Act unviable through regulatory and administrative actions.
In a series of tweets earlier this week, President Trump expressed disappointment in both Democrats and Republicans and promised a return to the health care effort after letting "ObamaCare fail." The administration has already considered several options, such as not paying cost-sharing subsidies to individuals, and cutting insurance subsidies that help offset losses incurred when providing coverage to people with pre-existing conditions.
And remember that the president's proposed budget calls for some $800 billion in cuts to Medicaid over the next decade. While Congress will undoubtedly put its own stamp on the budget and could alter that number, 75 million people nationally and 1.3 million Marylanders - 22 percent of the state's population - rely on Medicaid for health coverage.
Every one of these scenarios is troubling - not only for those who might lose coverage, but also for individuals and businesses that would have to pay higher insurance premiums to cover the cost of providing care to the uninsured. And for hospitals, which have been able to improve care delivery under the Affordable Care Act by focusing on quality and efficiency, these coverage losses would mean fewer resources to extend care into communities and partner with doctors and post-acute providers.
In Maryland, coverage losses present an additional threat: the potential loss of the state's 40-year-old All-Payer Model. The model encourages hospitals to direct patients to the right care, at the right time, in the right setting: doctor's offices, pharmacies, nursing homes and more. But without the coverage needed to help people access these services, more Marylanders would turn to hospital emergency departments - health care's highest-cost setting - for care. That's not what our model is about.
The American Hospital Association Board of Trustees is meeting next week to discuss next steps. While the bill's defeat is a victory, it is likely temporary. We will remain vigilant.

HSCRC Staff Update MHCC on All-Payer Model
At this week's Maryland Health Care Commission meeting, representatives from the Health Services Cost Review Commission updated commissioners on the All-Payer Model and the ongoing negotiations for the model's progression plan. Chris Peterson, HSCRC Director, Center for Clinical and Financial Information, told commissioners that the term sheet for a total cost of care All-Payer Model has been agreed to by the state and HSCRC. Commissioners asked staff about the value of the All-Payer Model to patients, the timing of a new contract with the Centers for Medicare & Medicaid Services, how to integrate doctors, specialists and others into the model, and plans for implementation.
Contact: Mike Robbins
AHRQ Antibiotics Program Seeks Hospitals
The Johns Hopkins Armstrong Institute for Patient Safety and Quality is seeking hospitals to join a national project to reduce inappropriate antibiotic use while preserving antibiotic effectiveness. The free 12-month program begins this December and is funded and guided by the Agency for Healthcare Research and Quality. Participants will receive antibiotic-use guidelines for several infectious diseases, expert coaching, online education, improvement tools, patient education materials and other resources to help run an effective antibiotic stewardship program. Three informational webinars to learn about project goals, interventions and expectations of participants are scheduled for July 25 at 1 p.m., August 15 at noon and August 29 at 1 p.m. Registration is required. Please click each date above to register. Visit the project website for additional information.
CDC Announces Funding for Opioid Epidemic
The Centers for Disease Control and Prevention this week will award 20 states and the District of Columbia a portion of $7.5 million to help track and prevent opioid-related overdoses, the agency has announced. The states are Alaska, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Nevada, New Jersey, North Carolina, Tennessee, Utah, Vermont, Virginia and Washington. CDC also will award eight states part of $4.8 million to enhance prescription drug monitoring programs and implement and evaluate strategies to improve opioid prescribing practices. Those states are: Arizona, Delaware, Illinois, Maryland, Massachusetts, Nevada, North Carolina and West Virginia.
Preparing the Next Generation to Lead
We are in the midst of a leadership crisis in health care. This may not sound too different from headlines of five or 10 years ago, except that the current crisis includes a group of leaders to whom we have not paid attention while the winds of health care policy changes have been blowing.

Improve Patient Access Management
With increasingly changing reimbursement models and high-deductible health plans forcing patients to shoulder more payment liability, health systems must improve their registration and financial clearance to ensure up-front cash collections, reduce front-end denials and improve patient registration efficiencies to maintain patient satisfaction.

Revised BCRA Released; Straight Repeal Scored
Senate leaders this week released a revised draft of the Better Care Reconciliation Act , legislation to repeal and replace the Affordable Care Act.

Thursday, July 27
MHA Joint Quality - Finance Work Group meeting

Thursday, July 27 to Saturday, July 29
Carmela Coyle attends the American Hospital Association's Leadership Summit and Board meeting
Baltimore Business Journal, By Joanna Sullivan, July 14
Baltimore Business Journal, By Tina Reed, July 14
The Baltimore Sun, By Kate Magill, July 17
The Baltimore Sun, By Meredith Cohn, July 17
Delmarva Now, By Jeremy Cox, July 17
The Baltimore Sun, By Meredith Cohn, July 18
Delmarva Now, By Deborah Gates, July 18
WBAL, By Tyler Waldman, July 19