October 14, 2016
From Vision to Action
If you want to go fast, go alone. If you want to go far, go together. - African proverb
For the first time on Tuesday, a statewide gathering of representatives from Maryland's hospitals and Maryland's community behavioral health providers began a serious dialogue about how to tackle a problem that has been plaguing our state for years and is growing: mental health and substance use disorders.
The challenge is well-known: from 2012 to 2015, drug- and alcohol-related intoxication deaths jumped 58 percent (deaths related to opioids alone have doubled since 2010). And those figures don't capture the hundreds of thousands of Marylanders who simply need specialized care for mental health or substance use disorders.
People needing help are flooding hospitals' emergency departments - in 2015, there were more than 107,000 such visits, up from 100,250 the prior year, and visits by behavioral health patients increased 11 percent between 2013 and 2015.
Community-based behavioral health providers also are overwhelmed. Gaps in payer coverage, limits to federal and state grant funding, and individuals with little to no ability to pay out of pocket mean that already scant resources are stretched dangerously thin. Add the significant challenges often seen in the behavioral health population - homelessness, criminal records, a lack of transportation, a lack of family support - and the challenge can seem daunting.
That's why it was so critically important to convene this week. With this meeting, the longstanding discussion about Maryland's behavioral health needs has begun to transform from words into action. After hearing several presentations on innovative partnerships between hospitals and community providers, attendees broke up into regional breakout sessions so they could have deeper conversations about the unique challenges they face and share ideas about how to overcome them.
Barriers were brought up; opportunities were discussed; and connections were made. Universally, the sense was that while this meeting had been a long time coming, its value was great and its impact could be long-lasting.
The meeting itself builds on the work of MHA's Behavioral Health Task Force, led by Howard County General Hospital President Steven Snelgrove. The task force last month released the Behavioral Health Environmental Scan, which examines Maryland's behavioral health needs, gaps in how those needs are met, and options to address those gaps. It will be another useful tool as the conversation on a solution begins in earnest.
Here's another first: MHA is working with community providers ahead of the 2017 General Assembly session on a joint legislative agenda to address our shared crisis. While both hospitals and community-based behavioral health providers care for the same patients, this is the first time they've come together to build a comprehensive solution. That in itself is telling, and the fact that momentum is now building for increased collaboration speaks even greater volumes.
That is perhaps the most powerful outcome of Tuesday's meeting: that the avenue of communication has been fully opened, and that meaningful conversation can continue as these dedicated organizations begin to work together to take solutions to Maryland's behavioral health crisis from vision to action.

CMS Releases Final Rule for New Medicare Physician Payment System
The Centers for Medicare & Medicaid Services this morning released its final rule implementing provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) related to the new two-track Medicare physician quality payment program: the Merit-based Incentive Payment System and alternative payment models. MHA staff are reviewing the information and will soon provide a brief summary of this rule, its interaction with our All-Payer Model, and any impact on your provider partners.
CDC Links Infections to Potentially Contaminated Heater-Cooler Devices
The Centers for Disease Control and Prevention is advising hospitals to alert patients who have had open-heart surgery involving a Sorin Stöckert 3T heater-cooler device that they might be at risk for developing a life-threatening infection from M. Chimaera. To assist hospitals in their outreach, CDC has developed the attached toolkit, which includes: a sample notification letter to patients, as well as a letter for patients to take to their health care providers; a letter for clinicians; and a questions-and-answers document. For more information, visit https://www.cdc.gov/HAI/outbreaks/heater-cooler.html. The web page also links to a Food and Drug Administration Safety Alert containing updated recommendations for preventing the spread of infection, and a short video for patients.
New Analysis Shows Skyrocketing Drug Prices
A new study commissioned by the American Hospital Association and the Federation of American Hospitals finds that inpatient hospital drug costs increased more than 38 percent per admission between 2013 and 2015. The report , released this week, is based on inpatient drug pricing data, as analyzed by the University of Chicago's NORC, an independent research institution. The analysis examines trends in inpatient drug spending and prices, and the impact these increases have on hospitals and their patients. Specifically, the NORC analysis found that:
  • The amount hospitals spent on inpatient drugs per admission rose by an average of 38.7 percent between 2013 and 2015.
  • Price increases appear to be random, inconsistent and unpredictable: large unit price increases occurred for both low- and high-volume drugs and for both branded and generic drugs. About half of the drugs evaluated had no generic competition.
  • For example, in 2013 the two GPOs spent roughly $2 million for calcitonin-salmon, a drug used to treat bone pain related to osteoporosis and other diseases. In 2015, they spent $55 million, mainly because the price per unit increased more than 3,000 percent.
  • Due to delays in refreshing the pharmaceutical price index, Medicare reimbursement cannot keep pace with rapidly increasing drug prices in the inpatient setting.
  • More than 90 percent of hospitals surveyed reported that changes in drug prices had a moderate to severe impact on their ability to manage hospital budgets. 
HFMA Hosts Webinar on Medicare Hospital Wage Index
The Healthcare Financial Management Association is hosting a webinar - "Understanding the Medicare Hospital Wage Index" - on Thursday, October 20, from noon to 1 p.m. Wage and benefit cost reporting by Maryland's acute care hospitals directly affects Medicare payments for all non-hospital providers in Maryland. The webinar, intended for CFOs and other hospital finance executives, will cover:
  • How Medicare uses the hospital wage index in its various national payment systems, including Maryland
  • The calculation of the wage index and national comparison
  • Basic data elements for preparation of the wage index worksheet on the Medicare Cost Report: Worksheet S-3 Part II
  • Key focus areas for an accurate wage index worksheet

The webinar is free, but you must register here.
HSCRC Offering Webinars on All-Payer Model Amendment and Care Redesign
HSCRC staff have scheduled seven webinars to provide hospitals with detailed information on the amendment to the All-Payer Model and on care redesign programs. 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)
Seven webinars are scheduled:
  • Webinar 1: (1 p.m. Friday, October 21) - Amendment Overview and Implementation Timeline of Care Redesign Programs
  • Webinar 2: (9 a.m. Tuesday, October 25) - Care Partner Approval Process
  • Webinar 3: (9 a.m. Wednesday, November 2) - CCIP Program Template and Implementation Protocol
  • Webinar 4: (9 a.m. Friday, November 18) - HCIP Program Template and Implementation Protocol
  • Webinar 5: (9 a.m. Wednesday, November 30) - Comprehensive Medicare Data Process and Use
  • 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 will have the opportunity to ask questions of HSCRC, the Center for Medicare & Medicaid Innovation, MHA, and CRISP. For those who cannot attend, webinar recordings will be posted on the HSCRC website. If you have any questions or comments, send an email to hscrc.care-redesign@maryland.gov.
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States Expect Slower Medicaid Enrollment, Spending Growth to Continue
Medicaid enrollment and spending growth slowed to 3.9 percent and 5.9 percent, respectively, in fiscal year 2016 due to slower enrollment related to the Affordable Care Act, according to the latest annual survey of state Medicaid directors by the Kaiser Commission on Medicaid and the Uninsured.


Tuesday, October 18

MHA Total Cost of Care Work Group meeting
MHA Council on Financial Policy meeting

Wednesday, October 19
Health Services Cost Review Commission meeting

Thursday, October 20
Carmela Coyle presents to the CCS Philanthropy Health Forum at MHA
MHA Council on Clinical and Quality Issues meeting
MHA Financial Technical Work Group meeting
The Baltimore Sun, By Andrea K. McDaniels, October 7
The Baltimore Sun, By Wendi Winters, October 6
The Baltimore Sun, By Amanda Yeager, October 10
Baltimore Business Journal, By Tina Reed, October 10
Your 4 State, October 12
Washington Post, By Associated Press, October 12
The Baltimore Sun, By David Anderson, October 13
The Baltimore Sun, By Fatimah Waseem, October 13