Skip Ribbon Commands
Skip to main content
Navigate Up
Sign In

Speeches and Testimony : Briefing before Joint Committee on Health Care Delivery and Financing

 

Briefing before Joint Committee on Health Care Delivery and Financing

May 29, 2013

Maryland’s Proposal to Modernize All-Payer Rate Setting: Enhancing Patient Experience, Controlling Costs, and Improving Health
Joint Committee on Health Care Delivery and Financing Briefing

May 29, 2013

John M. Colmers Chairman Health Services Cost Review Commission
Joshua M. Sharfstein, M.D.
Secretary

Maryland Department of Health and Mental Hygiene

Background

  • Since the late 1970s, the independent Health Services Cost Review Commission sets inpatient and outpatient hospital rates for all public and private payers.
  • In the last 35 years, Maryland’s hospital finance system has:
       Eliminated cost-shifting among payers
       Provided for the sharing of public goods (e.g., uncompensated care and medical education) among all payers
       Allowed usage of creative incentives to improve quality and outcomes


Maryland’s Current Rate Setting System Has Important Limitations

  • The Medicare Waiver in the Social Security Act at 1814(b) provides Maryland authority to set payment rates for Medicare.
  • CMS evaluates Maryland’s success under 1814(b) on a per discharge basis.
  • Waiver test rules focus on inpatient services only
  • Reflect a time when cost per discharge and average length of stay were the only measures for efficiency
  • The current system’s focus on inpatient per-case costs does not provide incentives aligned to population health and comprehensive coordinated care across different settings.

   Please Click Here for the additional presentation