Mid-Atlantic Health Law TOPICS

1. In September, the Health Care Commission (HCC) approved the first two releases of information from the HCC's Medical Care Data Base. This data on patient services has been collected by the HCC from payors for several years, and is double encrypted to protect patient privacy. Brandeis University researchers and New York public health officials will use data to develop treatment protocols for alcohol and substance abuse disorders. The University of Maryland School of Medicine's Department of Epidemiology will also use data to study the prevalence of arthritis in each Maryland county.

2. In September, the Health Services Cost Review Commission (HSCRC) initiated a 3% reduction to Kent and Queen Anne's Hospital's charge per case (CPC) target because the hospital's CPC had increased inappropriately. In October, the HSCRC approved a temporary 1.3% rate increase for Memorial Hospital at Easton to cover its increased uncompensated care costs. This follows recent increases granted to the CPC targets, and to outpatient rates, for Holy Cross Hospital, St. Agnes Hospital and Sacred Heart Hospital. All three hospitals had submitted full rate applications, but they settled for interim increases that will be effective until the HSCRC completes its revision of the Inter-hospital Cost Comparison methodology, the measurement tool used during a detailed review of a hospital's costs.

3. In October, the HCC approved changes to the Comprehensive Standard Health Benefit Plan (CSHBP), the state regulated basic health insurance policy offered by businesses with up to 50 employees. To stay within the premium cap mandated by law, the HCC approved higher deductibles and co-payments starting July 1, 2001. Enrollees of the HMO version of the policy will pay an additional $10 to visit a physician, and there will be a $250 deductible on all hospitalizations. Deductibles will also increase for those covered by the indemnity and preferred-provider versions of the program. Also, the deductible on prescription coverage for all versions of the policy will increase from $150 to $250. Businesses offering the CSHBP can also choose to purchase insurance riders for their employees that will enhance the basic coverage. Last year, the CSHBP covered a half million Marylanders.

4. In October, the HCC directed its staff to draft regulations that update the State Health Plan Chapter on Cardiac Surgery. The update identifies a need for a new cardiac surgery program in the Washington D.C. suburbs. Also, instead of using the number of operating rooms dedicated to open heart surgery as a benchmark to quantify system capacity, the updated regulations will use numbers of cases. The regulations will state that the capacity of any program cannot be greater than the higher of 800 cases or 50% of the projected gross need for the planning region, and that the approval of a new cardiac surgery program should not result in any program falling below 350 cases per year. The regulations will also keep the minimum utilization standard for cardiac surgery at 200 cases per year. In addition, the HCC will maintain the current policy that merged asset hospital systems may not relocate any part of an existing cardiac surgery program to another hospital within its system without obtaining a Certificate of Need.

5. In October, the HSCRC approved two ground-breaking alternative rate applications that involve CareFirst. The agreements will reduce the historic case rates for the CareFirst HMO population at Mercy Medical Center and St. Joseph Medical Center (SJMC) by 5.30% and 11.97%, respectively. The Mercy agreement states that CareFirst will guarantee Mercy's current level of CareFirst HMO patients. At SJMC, CareFirst pledged to increase the hospital's admissions by directing its HMO enrollees to the hospital through a large Towson physician group. For both hospitals, CareFirst will eliminate all retrospective denials of care and will fund and implement a hospitalist program. The new rates are confined to the CareFirst HMO population, and will be in effect for 1 year starting October 1, 2000. If the hospitals achieve a positive performance, staff can extend the approval for an additional 2 years.