Mar

ylan

d H

ealth

Mod

el:

Less

ons f

or O

ther

Sta

tes

Oct

. 9, 2

019

‹#›

Age

nda

•D

escr

ibe

Mar

ylan

d H

ealth

Mod

el•

Resu

lts fr

om A

ll-Pa

yer M

odel

(201

4-20

18),

in w

hich

hos

pita

lgl

obal

bud

gets

wer

e th

e pr

imar

y in

nova

tion

•Pi

votin

g to

TCO

C M

odel

(201

9-20

26+)

, bui

ldin

g on

the

chas

sisof

hos

pita

l glo

bal b

udge

ts w

ith v

olun

tary

pay

men

t pro

gram

s•

Pitc

h: A

pply

ing

hosp

ital g

loba

l bud

gets

in o

ther

stat

es•

Why

oth

er st

ates

(hos

pita

ls an

d pa

yers

) mig

ht/sh

ould

be

inte

reste

d in

hos

pita

l glo

bal b

udge

ts, e

spec

ially

in ru

ral a

reas

•H

ow: T

ools/

optio

ns fo

r set

ting

glob

al b

udge

ts•

NO

TE: M

aryl

and

has a

lot o

f bel

ls an

d w

histl

es th

at a

re n

otes

sent

ial,

parti

cula

rly fo

r im

plem

entin

g gl

obal

bud

gets

in ru

ral

area

s

Ove

rvie

w o

fM

aryl

and

Hea

lth M

odel

‹#›

HSC

RC

: Who

We

Are

•H

ealth

Ser

vice

s Cos

t Rev

iew

Com

mis

sion

(HSC

RC

)re

spon

sibl

e fo

r reg

ulat

ing

the

qual

ity a

nd c

ost o

f hos

pita

lse

rvic

es to

ens

ure

all M

aryl

ande

rs h

ave

acce

ss to

hig

h qu

ality

heal

thca

re se

rvic

es

•7

Com

mis

sion

ers

•~4

0 st

aff

•H

elp

lead

the

Stat

e’s e

fforts

to tr

ansf

orm

the

deliv

ery

syst

eman

d ac

hiev

e po

pula

tion

heal

th im

prov

emen

t goa

ls u

nder

the

Mar

ylan

d m

odel

, inc

entiv

izin

g va

lue

not v

olum

e•

Und

er th

is M

odel

, bui

lt on

the

chas

sis o

f Mar

ylan

d’s u

niqu

eal

l-pay

er h

ospi

tal r

ate-

setti

ng sy

stem

, we

aim

to im

prov

ehe

alth

out

com

es, e

nhan

ce th

e qu

ality

of c

are,

and

ulti

mat

ely

redu

ce th

e to

tal c

ost o

f car

e fo

r Mar

ylan

ders

‹#›

Evol

utio

n of

the

Mar

ylan

d M

odel

•Si

nce

1977

, Mar

ylan

d ha

s had

an

all-p

ayer

hos

pita

l rat

e-se

tting

syste

m•

A gi

ven

acut

e ca

re h

ospi

tal’s

cha

rge

is th

e sa

me

rega

rdle

ss o

f pay

er•

Char

ges (

“pric

es”)

diff

er a

cros

s hos

pita

ls•

In 2

010,

ten

rura

l hos

pita

ls w

ere

plac

ed o

n To

tal P

atie

nt R

even

ue (T

PR) s

yste

ms

•TP

R w

as a

pilo

t for

wha

t bec

ame

Glo

bal B

udge

t Rev

enue

(GBR

) for

all

hosp

itals

in 2

014

•In

201

4, M

aryl

and

mov

ed to

the

All-

Paye

r Mod

el w

ith C

MM

I, fo

cuse

d on

con

trolli

ngho

spita

l cos

ts th

roug

h G

BR•

In 2

019,

Mar

ylan

d m

oved

to th

e To

tal C

ost o

f Car

e (T

COC)

Mod

el, f

ocus

ing

on(M

edic

are)

TCO

C th

roug

h sy

stem

-wid

e al

ignm

ent

‹#›

App

licat

ion

of h

ospi

tal g

loba

l bud

gets

in M

D: W

ill N

OT

be th

e sa

me

if ot

her s

tate

s ado

pt•

Defi

nite

ly si

nce

2014

, no

long

er fo

cus o

n se

tting

/scru

tiniz

ing

the

pric

e of

indi

vidu

al h

ospi

tal s

ervi

ces

•Th

is is

not t

he 1

970s

•Ra

ther

, we

set e

ach

hosp

ital’s

Glo

bal B

udge

t Rev

enue

(GBR

)fro

m a

ll pa

yers

•G

BR a

lso k

now

n as

Pop

ulat

ion-

Base

d Re

venu

e (P

BR) t

o re

flect

the

bloc

k/pe

r cap

ita n

atur

e of

the

appr

oach

•A

t any

giv

en h

ospi

tal,

char

ges a

re th

e sa

me

for a

ll pa

yers

•Pa

yers

still

pay

cla

ims o

n a

fee-

for-s

ervi

ce b

asis

•Bu

t hos

pita

ls ar

e gi

ven

flexi

bilit

y to

dia

l the

ir ch

arge

s in

orde

r to

hit

thei

r ann

ual G

BR. F

or e

xam

ple,

if v

olum

es fa

lls, p

rices

mus

t rise

!•

Hos

pita

l’s p

rice

incr

ease

s sin

ce 2

014

may

be

a go

od th

ing:

redu

cing

hosp

ital v

olum

e, m

ovin

g lo

w-v

alue

car

e ou

t of h

ospi

tals,

etc

.•

Key

exp

erie

nce

from

Mar

ylan

d’s u

niqu

e ap

proa

ch: I

t is n

ot (j

ust)

the

pric

es, s

tupi

d, b

ut th

e to

tal c

ost o

f car

e

‹#›

Wha

t cha

nges

in m

ove

to h

ospi

tal G

loba

l Bud

gets

?

•N

o lo

nger

cha

sing

vol

umes

on

pres

sure

d pr

ices

•In

cent

iviz

ing

and

enco

urag

ing

inve

stm

ent i

n:•

Bet

ter m

anag

ed in

tern

al c

osts

(foc

us o

n co

sts,

not r

even

ue)

•R

educ

ing

read

mis

sion

s•

Red

ucin

g ho

spita

l-acq

uire

d co

nditi

ons

•R

educ

ing

ambu

lato

ry-s

ensi

tive

cond

ition

s, or

Pre

vent

ion

Qua

lity

Indi

cato

rs (P

QIs

)•

Res

ults

•Im

prov

ed h

ealth

car

e qu

ality

, low

er c

osts

, bet

ter c

onsu

mer

expe

rienc

eB

ut m

ore

to b

e do

ne …

‹#›

Wha

t cha

lleng

es u

nder

Glo

bal B

udge

ts?

Wha

t is M

aryl

and

doin

g ab

out i

t?•

Acc

ess:

Ens

ure

no st

intin

g on

nec

essa

ry c

are

•R

eadm

issi

ons a

nd o

ther

qua

lity

mea

sure

s cap

ture

inad

equa

te h

ospi

tal

care

•H

SCR

C lo

oks i

nto

big

volu

me

drop

s/pr

ice

incr

ease

s•

Plen

ty o

f opp

ortu

nity

to re

duce

Pot

entia

lly A

void

able

Util

izat

ion

(PA

U) r

athe

r tha

n ne

cess

ary

care

•Sh

iftin

g vo

lum

es a

nd p

oten

tially

“do

uble

-pay

ing”

•Fr

om H

ospi

tal A

to H

ospi

tal B

, not

real

ly d

esira

ble

(Mar

ket S

hift)

•Le

ss o

f a c

once

rn in

rura

l are

as•

HSC

RC

gen

eral

ly ta

kes 5

0% o

f vol

umes

mov

ed o

ut o

f Hos

pita

l A, g

ives

50%

to H

ospi

tal B

but

onl

y up

to th

e am

ount

mov

ed o

ut o

f Hos

pita

l A•

HSC

RC

can

cus

tom

ize

base

d on

uni

que

circ

umst

ance

s (e.

g., h

ospi

tal s

hut d

own

serv

ice

but d

id n

ot in

form

HSC

RC

, as r

equi

red

in G

BR

con

tract

)

‹#›

Wha

t cha

lleng

es u

nder

Glo

bal B

udge

ts?

Wha

t is M

aryl

and

doin

g ab

out i

t? P

. 2•

From

hos

pita

l to

non-

hosp

ital s

ettin

g, d

esira

ble

•H

SCR

C g

ener

ally

take

s 50%

of v

olum

es m

oved

out

of h

ospi

tal A

•In

nova

tions

(e.g

., hi

gh-c

ost d

rugs

)•

HSC

RC

has

car

ved

out c

erta

in d

rugs

from

glo

bal b

udge

t (i.e

., pa

yers

pay

on a

vol

ume

basi

s)•

New

cha

lleng

es fi

ve y

ears

in•

Exce

ss c

apac

ity: H

ospi

tals

to e

limin

ate

fixed

cos

ts?

Rep

urpo

seca

paci

ty?

Rem

ove

mon

ey fr

om G

BR

?•

Cap

ital f

undi

ng•

Vis

ion:

Wha

t sho

uld

be h

ospi

tals

’ rol

e m

ovin

g fo

rwar

d? W

hat m

ix o

fho

spita

l ser

vice

s ver

sus p

opul

atio

n an

d he

alth

man

agem

ent?

Wha

tsh

ould

glo

bal b

udge

ts b

e pa

ying

hos

pita

ls to

do,

and

how

do

we

mak

esu

re th

at is

hap

peni

ng?

‹#›

All-

Paye

r Mod

el P

erfo

rman

ce 2

014-

2018

:M

et o

r Exc

eede

d C

MS

Con

tract

Req

uire

men

tsPe

rfor

man

ce M

easu

res

Targ

ets

2018

Res

ults

Met

All-

Paye

r Hos

pita

l Rev

enue

Gro

wth

≤ 3.

58%

per c

apita

ann

ually

1.92

% a

vera

ge a

nnua

l gro

wth

per c

apita

sinc

e 20

13!

Med

icar

e Sa

ving

s in

Hos

pita

lEx

pend

iture

s

≥ $3

30M

cum

ulat

ive

(Low

er th

an n

atio

nal a

vera

gegr

owth

rate

from

201

3 ba

se y

ear)

$1.4

B c

umul

ativ

e(8

.74%

bel

ow n

atio

nal a

vera

gegr

owth

sinc

e 20

13)

!

Med

icar

e Sa

ving

s in

Tota

lC

ost o

f Car

e

Low

er th

an th

e na

tiona

lav

erag

e gr

owth

rate

for t

otal

cost

of c

are

from

201

3 ba

seye

ar

$869

M c

umul

ativ

e*(2

.74%

bel

ow n

atio

nal a

vera

gegr

owth

sinc

e 20

13)

!

All-

Paye

r Red

uctio

ns in

Hos

pita

l-Acq

uire

dC

ondi

tions

30%

redu

ctio

n ov

er 5

yea

rs53

%R

educ

tion

sinc

e 20

13!

Rea

dmis

sion

s Red

uctio

ns fo

rM

edic

are

≤ N

atio

nal a

vera

ge o

ver 5

year

sB

elow

nat

iona

l ave

rage

at t

heen

d of

the

four

th y

ear

!

Hos

pita

l Rev

enue

to G

loba

lor

Pop

ulat

ion-

Bas

ed≥

80%

by

year

5A

ll M

aryl

and

hosp

itals

,w

ith 9

8% o

f rev

enue

und

erG

BR

!* $

273

mill

ion

in M

edic

are

TCOC

sav

ings

in 2

018

alon

e –

aka

Med

icar

e sa

ving

s ru

n ra

te(vs

. 201

3 bas

e)

‹#›

Mar

ylan

d M

odel

’s St

ory

of S

ucce

ss: M

edic

are

FFS

Savi

ngs v

s.N

atio

nal G

row

th fr

om 2

013

to 2

018

•Bi

gges

t sav

ings

(tha

t is,

Mar

ylan

d di

ffere

nce

from

nat

iona

lgr

owth

) fro

m h

ospi

tal s

pend

, inc

reas

ing

over

tim

e•

Prim

arily

from

vol

ume

decl

ines

, not

pric

e (a

lthou

gh ~

0.2%

rem

oved

annu

ally

from

hos

pita

l GBR

s for

pot

entia

lly a

void

able

util

izat

ion

(PA

U))

•H

ospi

tal O

utpa

tient

is la

rges

t sou

rce

of sa

ving

s•

Hos

pita

l Inp

atie

nt a

lso p

rodu

ced

savi

ngs

•D

issav

ings

: Inc

reas

e in

Par

t B n

on-h

ospi

tal.

For e

xam

ple:

•M

ovin

g ce

rtain

surg

erie

s fro

m in

patie

nt to

out

patie

nt/c

omm

unity

•M

ovin

g fro

m E

D to

com

mun

ity se

tting

s•

Ince

ntiv

izin

g m

ore

com

mun

ity c

are

and

follo

w-u

p to

avo

id re

adm

issio

ns•

Diss

avin

gs: I

ncre

ase

in h

ome

heal

th a

nd h

ospi

ce•

Savi

ngs o

verw

helm

diss

avin

gs•

All

indi

cate

succ

ess o

f the

Mod

el

‹#›

Cha

nges

from

All-

Paye

r Mod

el (2

014-

2018

) to

Tot

al C

ost o

f Car

e M

odel

Hos

pita

l foc

usSy

stem

-wid

e fo

cus

Hos

pita

l sav

ings

Tota

l cos

t of c

are

savi

ngs

Hos

pita

l qua

lity

met

rics

Hos

pita

l qua

lity and

popu

latio

n he

alth

met

rics

Acc

eler

atio

n of

pre

vent

ion/

chro

nic

care

man

agem

ent

Mar

ylan

d Pr

imar

y C

are

Prog

ram

(MD

PCP)

an

d ot

her c

are

trans

form

atio

n to

ols

Hos

pita

l alig

nmen

tPr

ovid

er a

lignm

ent v

ia

MA

CR

A-e

ligib

le p

rogr

ams

and

post

-acu

te p

rogr

ams

All-

Pay

er M

odel

Con

tract

Exp

ired

on D

ec. 3

1, 2

018

Tota

l Cos

t of C

are

Mod

elB

egan

Jan

.1, 2

019

‹#›

Tota

l Cos

t of C

are

(TCO

C) M

odel

Ove

rvie

w•

A 10

-yea

r agr

eem

ent (

2019

-202

8) b

etw

een

Mar

ylan

d an

d CM

S•

Five

yea

rs (2

019-

2023

) to

build

up

to c

ost s

avin

gs a

nd fi

ve y

ears

(202

4-20

28) t

o m

aint

ain

Med

icar

e co

st sa

ving

s and

qua

lity

impr

ovem

ents

•O

ppor

tuni

ty to

“ex

pand

” th

e m

odel

(tha

t is,

to m

ake

it pe

rman

ent)

base

don

how

we

perfo

rm o

ver t

he n

ext 3

-5 y

ears

•Li

mits

gro

wth

in to

tal c

ost o

f car

e pe

r cap

ita a

nd im

prov

es q

ualit

yan

d po

pula

tion

heal

th b

y:

•Co

ntin

uous

qua

lity

impr

ovem

ent i

n se

tting

hos

pita

l glo

bal b

udge

ts

•En

gagi

ng n

on-h

ospi

tal p

rovi

ders

in c

are

trans

form

atio

n an

d TC

OC

resp

onsib

ility

•Ta

rget

ing

spec

ific

popu

latio

n he

alth

goa

ls an

d in

terv

entio

ns

‹#›

TCO

C M

odel

Tar

gets

at a

Gla

nce

•Co

ntin

ue A

ll-Pa

yer t

otal

hos

pita

l per

cap

ita re

venu

e gr

owth

cei

ling

of 3

.58%

annu

al g

row

th

•M

edic

are

annu

al T

COC

savi

ngs o

f $30

0 m

illio

n by

end

of Y

ear 5

(202

3)•

Year

-ove

r-yea

r Med

icar

e TC

OC

Per C

apita

Gua

rdra

ils:

•M

aryl

and

Med

icar

e TC

OC

cann

ot e

xcee

d na

tiona

l gro

wth

for t

wo

cons

ecut

ive

year

s

•Ca

nnot

exc

eed

natio

nal g

row

th b

y m

ore

than

1%

in a

sing

le y

ear

•Su

stain

and

furth

er p

rogr

ess o

n pa

tient

and

pop

ulat

ion-

cent

ered

qua

lity

mea

sure

s

•A

ddre

ss p

opul

atio

n he

alth

. Sta

te to

focu

s on:

•D

iabe

tes

•Su

bsta

nce

Use

Diso

rder

•TB

D

‹#›

Dom

ains

of M

aryl

and’

s Sta

tew

ide

Inte

grat

ed H

ealth

Impr

ovem

ent S

trate

gy (n

on-fi

nanc

ial)

1. H

ospi

tal Q

ualit

y an

d P

ay-fo

r-P

erfo

rman

ce

2. C

are

Tran

sfor

mat

ion

Acr

oss

the

Sys

tem

3. T

otal

Pop

ulat

ion

Hea

lth

Shar

ed G

oals

and

Out

com

es

‹#›

Pote

ntia

l Exa

mpl

es o

f Sha

red

Mod

el G

oals

: Sta

te a

ndC

MM

I to

Agr

ee o

n Ta

rget

s

Hos

pita

l Qua

lity

& P

ay-fo

r-P

erfo

rman

ce

Car

e Tr

ansf

orm

atio

n A

cros

s th

e S

yste

mTo

tal P

opul

atio

n H

ealth

R

educ

e w

ithin

hos

pita

lre

adm

issio

n di

spar

ities

R

educ

e pe

r ca

pita

PA

U

Hos

pita

l

Stat

e/Lo

cal

Gov

’tC

omm

uniti

es

Hea

lthSe

ctor

Pitc

h to

Oth

er S

tate

s to

Cons

ider

Hos

pita

l Glo

bal B

udge

ts

‹#›

Paye

rs a

nd c

onsu

mer

s wan

t val

ue fo

r the

ir he

alth

care

dol

lar

Less

val

ue, m

ore

volu

me

Mor

e va

lue,

less

vol

ume

Sour

ce: H

CP-

LAN

Alte

rnat

ive

Paym

ent M

odel

(APM

) Fra

mew

ork

‹#›

Ince

ntiv

es o

f FFS

vs.

Glo

bal B

udge

ts: P

aid

for

volu

me

vs. v

alue

Less

val

ue, m

ore

volu

me

Mor

e va

lue,

less

vol

ume

•R

even

ue =

Pric

e *

Qua

ntity

•Pa

yers

figh

t pro

vide

rs o

ver

pric

es a

nd u

tiliz

atio

n(q

uant

ity)

•M

edic

are

PPS

does

not

pay

for e

very

indi

vidu

alse

rvic

e/ite

m, b

ut h

ospi

tals

are

still

ince

ntiv

ized

to b

ring

inm

ore

volu

me

– th

at is

, mor

eca

ses

•C

AH

s und

er v

olum

e in

cent

ive

•R

even

ue =

Bas

e ye

ar re

venu

e +

trend

± v

alue

-bas

ed a

djus

tmen

ts

•H

ospi

tals

no

long

er in

cent

iviz

edto

brin

g in

(mar

gina

l) ca

ses;

inst

ead,

turn

thei

r atte

ntio

n to

keep

ing

peop

le w

ell,

avoi

d(r

e)ad

mis

sion

s•

Con

sum

ers s

houl

d be

nefit

mos

t•

Paye

rs/p

rovi

ders

shou

ld h

ave

less

hagg

ling

•18

0-de

gree

cha

nge

‹#›

Wha

t pro

blem

do

Glo

bal B

udge

ts a

ddre

ss, p

artic

ular

ly in

rura

lar

eas?

Exam

ples

:•

Hos

pita

ls w

ith fi

nanc

ial h

ards

hip

beca

use

decl

inin

g FF

Svo

lum

e•

Mul

tiple

driv

ers:

dec

linin

g nu

mbe

r of c

ases

, dec

linin

g de

man

d fo

rho

spita

l-bas

ed se

rvic

es, d

eclin

ing

popu

latio

n•

Hos

pita

l pre

ssur

ed to

pro

vide

car

e th

at m

ay b

e of

mar

gina

l ben

efit

•Tr

ying

to ru

n up

the

Dow

n es

cala

tor

•Pa

yers

pre

ssur

ed to

pay

hig

her a

nd h

ighe

r pric

es (“

cost

shift

ing”

) on

thos

e de

clin

ing

volu

mes

•R

aise

s que

stio

ns a

bout

wha

t pay

ers a

re p

ayin

g fo

r

‹#›

Con

sider

atio

ns fo

r Oth

er S

tate

s. Es

tabl

ishi

ng H

ospi

tal G

loba

l Bud

gets

: Sta

rtup

•Ex

plai

n w

hy•

Arti

cula

te M

odel

goa

ls a

nd p

rinci

ples

: Sho

uld

be w

in-w

in-w

in•

Esta

blis

h po

licie

s con

sist

ent w

ith th

ose

goal

s and

prin

cipl

es•

Wha

t hos

pita

ls a

re su

ppos

ed to

do?

•H

ow a

re h

ospi

tals

ince

ntiv

ized

to d

o th

at?

•M

axim

ize

paye

r par

ticip

atio

n•

In M

aryl

and,

HSC

RC

has

had

aut

horit

y to

set h

ospi

tal r

ates

for a

ll pa

yers

sinc

e th

e 19

70s

•Si

nce

2014

, Med

icar

e pa

rtici

pate

s via

CM

MI

•St

ates

hav

e au

thor

ity to

“se

t” h

ospi

tal r

ates

on

ERIS

A p

lans

bas

ed o

n Su

prem

eC

ourt

deci

sion

Blu

es v

. Tra

vele

rs•

In v

olun

tary

con

text

, hav

e to

arti

cula

te v

alue

pro

posi

tion:

Wha

t’s in

it fo

rth

em?

•Pr

edic

tabl

e gr

owth

•In

put i

nto

wha

t hos

pita

ls sh

ould

be

doin

g, e

nsur

ing

appr

opria

te a

cces

s to

need

edse

rvic

es a

t the

righ

t pla

ce, w

ith th

e rig

ht tr

end

and

adju

stm

ents

‹#›

Con

sider

atio

ns fo

r Oth

er S

tate

s. Es

tabl

ishi

ng H

ospi

tal G

loba

l Bud

gets

: Set

ting

the

Num

ber

•W

ho se

ts/n

egot

iate

s the

glo

bal b

udge

t?•

Com

mis

sion

/gro

up w

ith re

pres

enta

tion

from

pay

ers,

prov

ider

s, et

c.•

Pick

reve

nue

Bas

e Ye

ar (2

013

in M

aryl

and

for i

mpl

emen

tatio

nbe

ginn

ing

in 2

014)

•W

hat i

s exc

lude

d (tr

ansp

lant

s? o

ut-o

f-st

ate?

)•

Set a

nnua

l Upd

ate

Fact

or a

nd h

ospi

tal-s

peci

fic a

djus

tmen

ts•

Pric

e in

flatio

n•

Volu

me

adju

stm

ent (

dem

ogra

phic

s)•

Qua

lity

adju

stm

ents

•H

airc

ut fo

r Pot

entia

lly A

void

able

Util

izat

ion

(PA

U)

•Fl

exib

ility

/pro

cess

for a

d-ho

c tw

eaks

?•

In M

aryl

and,

ther

e is

bot

h a

form

al C

omm

issi

oner

pro

cess

, as w

ell a

s ale

ss fo

rmal

staf

f pro

cess

. HSC

RC

staf

f hav

e fle

xibi

lity

to a

djus

t GB

Rs,

but

can

crea

te “

stra

y ca

t pro

blem

”

‹#›

Com

pone

nts o

f Mar

ylan

d’s G

BR U

pdat

e Fa

ctor

Infla

tion

Volu

me

Qua

lity

and

PAU

Oth

er A

djus

tmen

ts

* N

ote

that

onc

e th

e to

tal u

pdat

e is

dete

rmin

ed, a

num

ber o

f tes

ts ar

epe

rform

ed to

ens

ure

the

upda

te w

ill n

otbr

each

TCO

C M

odel

gua

rdra

ils a

ndm

aint

ain

Mar

ylan

d’s g

row

th b

elow

natio

nal M

edic

are

Man

y of

thes

ead

justm

ents

will

var

y by

hosp

ital.

The

pur

pose

of

this

tabl

e is

to p

rovi

de a

state

wid

e ov

ervi

ew.

‹#›

Fina

l rec

ap: H

ospi

tal g

loba

l bud

gets

don

’t ha

ve to

mirr

orM

aryl

and’

s app

roac

h•

Mar

ylan

d•

Hos

pita

l rev

enue

still

com

es th

roug

h a

FFS

syst

em –

with

hos

pita

ls a

ble

to c

hang

epr

ices

to h

it G

loba

l Bud

get a

mou

nt•

HSC

RC

has

a lo

t of d

ata

sour

ces (

deta

iled

mon

thly

hos

pita

l cas

e m

ix a

nd fi

nanc

ial

data

) and

ana

lytic

cap

acity

to c

aptu

re M

arke

t Shi

fts, e

tc.

•H

SCR

C is

a 7

-mem

ber c

omm

issi

on e

mpo

wer

ed b

y st

ate

stat

ute

and

reco

gniz

ed b

yth

e fe

dera

l gov

ernm

ent (

CM

MI c

ontra

ct) t

o se

t hos

pita

l rat

es fo

r all

paye

rs•

How

to a

pply

to o

ther

stat

es?

•Si

mpl

est a

ppro

ach

is to

take

ann

ual h

ospi

tal r

even

ue b

y pa

yer f

or b

ase

year

,in

crea

se b

y X

%, a

nd p

ayer

s cut

che

cks t

o ho

spita

l•

CM

MI i

s the

pat

hway

to g

et M

edic

are

incl

uded

. How

muc

h “s

avin

gs”

wou

ld C

MS

wan

t in

orde

r for

Med

icar

e to

par

ticip

ate?

Any

?•

Mar

ylan

d tw

eaks

may

not

be

nece

ssar

y. F

or e

xam

ple,

Mar

ket S

hift

may

be

irrel

evan

t if f

ocus

ed in

rura

l are

as w

here

no

othe

r hos

pita

l to

shift

to•

Who

dec

ides

ann

ual r

ate

upda

te?

Wha

t adj

ustm

ents

? H

ow m

uch

data

nec

essa

ry?

‹#›

Than

ks!

Chr

is L

. Pet

erso

nPr

inci

pal D

eput

y D

irect

orM

aryl

and

Hea

lth S

ervi

ces C

ost R

evie

w C

omm

issi

on (H

SCR

C)

chris

.pet

erso

n@m

aryl

and.

gov