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Media
Contacts: |
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For Immediate
Release |
Office of Communications
David Paulson
Karen Black
Office: 410-767-6490
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BALTIMORE,
MD (June 10, 2009) – The
Maryland Health Services Cost Review
Commission (HSCRC) has voted to
approve a new payment-related
methodology that will provide
hospitals with strong financial
incentives to reduce the frequency
of hospital-based complications.
This initiative, effective July 1,
is expected to dramatically improve
the quality and efficiency of
patient care in the State’s 47 acute
care hospitals.
Maryland is the
only state in the nation to have the
authority to establish hospital
payment levels applicable to all
payers (both private insurance
companies and public insurers such
as Medicare and Medicaid). Given
this unique system, Maryland
hospitals are exempt from the
payment decreases for Hospital
Acquired Conditions (HACs)
implemented by the Centers for
Medicare and Medicaid Services (CMS)
beginning October 1, 2008. This
exemption enabled the HSCRC to build
upon the basic concept of the
federal approach and craft a payment
methodology that is much broader
than the CMS initiative, more
appropriate for all patients, and
consistent with the State’s unique
risk-adjusted payment structure.
The methodology, which commences
July 1, 2009, will link payments to
hospital performance on a proposed
set of 52 Maryland Hospital Acquired
Conditions (MHACs) across all-payers
and patients in the State. MHACs
were derived from a list of 64
Potentially Preventable
Complications (PPCs). PPCs are
complications that are unlikely to
be a consequence of the
natural progression of an underlying
illness. PPCs are not present when the
patient is first admitted and, thus, are
associated with the care during the
hospitalization. Examples of these 52
categories of preventable complications
include Urinary Tract Infection,
Septicemia (infection in the blood), and
iatrogenic Pneumothrax (collapsed
lung). During fiscal year 2008, these
hospital-based preventable complications
were present in approximately 55,000 of
the State’s total 800,000 inpatient
cases and represented $522 million in
potentially preventable hospital
payments.
The proposed MHAC
methodology will provide a system of
payment incentives based on a hospital’s
actual number of complications versus a
statewide target rate for each of the
proposed 52 MHAC categories. Under this
approach, hospitals will face strong
financial incentives to reduce
complication rates. They will also be
armed with a sophisticated data analysis
tool that will enable them to
systematically help achieve this
collective goal of reducing
complications.
The report
entitled, “Final Staff Recommendations
Regarding HSCRC Payment Policy for
Highly Preventable Hospital Acquired
Conditions,” was approved by the
Commission at its June 3 meeting is
available at the following URL:
http://www.hscrc.state.md.us/init_qbr_MHAC.cfm
This initiative
also provides a template for the HSCRC
to work collaboratively with the
hospital and payer industries to develop
a system of payment incentives to reduce
Potentially Preventable Readmissions (PPRs),
which it expects to implement in 2010.
A methodology to reduce preventable
readmissions is consistent with health
reform recommendations from the White
House, Congress, and the Medicare
Prospective Payment Commission (Medpac).
According to the
Commission’s Executive Director Robert
Murray: “Maryland has long been a leader
in the United States in the areas of
hospital cost containment, access to
care, equity in payment, financial
stability and accountability. With the
implementation of its MHAC and
re-admission based methodologies,
Maryland will distinguish itself as the
leader in the nation in the area of
clinical care quality as well.”
For further
information about the Commission’s MHAC
initiative and other quality-based
payment activities contact Robert Murray
or Diane Feeney, Commission staff.
(410) 764-2605
BMurray@HSCRC.State.MD.US
Note: PPRs and PPCs
are a product of 3M’s Health Information
Systems, Inc.
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