Mid-Shore Health Future: The Risks of Repealing the ACA on the Shore with Jeananne Sciabarra


On Thursday, Jeananne Sciabarra, Executive Director of Consumer Health First spoke at the Democratic Club of Kent County about the implications of repealing the Patient Protection and Affordable Act (ACA), also known as “Obamacare.”

Founded in 2006 as the Maryland Women’s Coalition for Health Care Reform, the organization transitioned into CHF in 2016 with the same mission: to work collaboratively to promote health equity through access to comprehensive, high-quality and affordable health care for all Marylanders.

While the impact of repealing and replacing ACA with the currently proposed American Health Care Act (ACHA) would cause profound changes to healthcare nationwide, Sciabarra focused on what Marylanders, and specifically Congressional District, 1 would lose.

Talking about the rollback of Medicaid expansion, Sciabarra said that “the bottom line is that will push back the matching (between state and federal) to 50-50 which is going to make it extremely expensive for Maryland to continue that provision.” She added that on top of that, a block grant per capita system for each person enrolled in Medicaid would force the state to decide who doesn’t get services.

Also, in regard to hospitals, Sciabarra noted that Maryland has a unique rate-setting system that provides services at the same rate anywhere in the state and that during the expansion of Medicaid, uninsured costs went down $311 million between 2013-2015, and that with set amounts or “global budgets” hospitals were incentivized to participate in wellness programs to help people stay healthy and out of the hospital. A rollback of those kinds of programs would have a “catastrophic” effect on people not covered in the health exchange, especially older people.

The district’s uninsured rate has gone from 8.3% to 4.1% since the ACA was implemented. This 4.2 percentage point drop in the uninsured rate could be reversed if the ACA is entirely or partially repealed.

401,400 individuals in the district who now have health insurance that covers preventative services like cancer screenings and flu shots without any co-pays, coinsurance, or deductibles stand to lose this access if the Republican Congress eliminates ACA provisions requiring health insurers to cover essential preventative services without cost-sharing.

445,400 individuals in the district with employer-sponsored health insurance are at risk of losing important consumer protections like the prohibition on annual and lifetime limits, protection against unfair policy recession, and coverage of pre-existing health conditions if the ACA is entirely or partially repealed.

15,800 individuals in the district who have purchased high-quality marketplace coverage now stand to lose their coverage if the Republican Congress dismantles the Marketplaces.

11,800 individuals in the district who received financial assistance to purchase Marketplace coverage in 2016 are now at risk of coverage becoming unaffordable if the Republican Congress eliminates the premium tax credits.

8400 individuals in the district who are receiving cost-sharing reductions to lower out-of-pocket costs such as deductibles, co-pays, and coinsurance, are now at risk of healthcare becoming unaffordable is the Republican Congress eliminates cost-sharing reductions.

32,900 individuals in the district who are covered by the ACA’s Medicaid expansion now stand to lose coverage if the Republican Congress eliminates the Medicaid expansion.

This video is approximately nine minutes in length. For more information about Consumer Health First please go here. Sources: US Department of Health and Human Services, Urban Institute, Families USA, The Commonwealth Fund, National Women’s Law Center.

UM Shore Regional Health Publishes Community Benefits Report Online


The 2016 Community Health Improvement Report is now published and available for viewing on the UM Shore Regional Health website at http://umshoreregional.org/news-and-events/news/2017/um-shore-regional-2016-community-health-improvement-report.

The report, which describes highlights of the community health improvement programs and conducted by UM SRH, includes articles on four initiatives: the Ask the Expert series; the inauguration of Shore Behavioral Health’s Bridge Clinic; the Stepping On program offered by the Balance Center in partnership with Maintaining Active Citizens (MAC); and guided support programs (classes, screenings, support groups, etc.) that support better health management.

According to Ken Kozel, UM SRH president and CEO, “The value of our community benefits programs and services, including charity care, exceeds $32 million, but the value is stronger than money. It is building healthier communities and our steadfast commitment to helping our patients and their families enjoy their best health and quality of life.”

Senior Nation: The Science of Forgetfulness with Dr. Constantine Lyketsos


The celebrated poet Billy Collins wrote in one of his poems that his memory had retired “to the southern hemisphere of the brain, to a little fishing village where there are no phones.”  It is perhaps one of the most accurate descriptions of memory loss and the disorientation it causes in almost every human being of a certain age from time to time.

But what if the feeling of “no phones” was a more permanent condition?  That beyond the simple and temporary experience of forgetting where one left the car keys, one also could not remember what those car keys do. In that case, the condition is called dementia. And what has intrigued Johns Hopkins doctor Constantine Lyketsos is why those “phones,” the neurochemistry of the brain, are not working.

On March 8, the Talbot Hospice will be sponsoring a lecture by one of the leading experts in dementia and Alzheimer’s disease at Easton High School. Dr. Lyketsos, from the Hopkins department of psychiatry and behavioral sciences, will address these issues and the devastating effects of the illness, but also promising new treatments that give hope to patients and their families.

The Spy traveled to Baltimore to sit down with Lyketsos before the event for a primer on dementia and memory loss.

This video is approximately six minutes in length. For more information about the event please go here


MD Senate Finance Committee Approves Mandated Reimbursement Increases for Mental Health


Several hundred rallied in Annapolis Thursday in support of the Keep The Door Open Act, a bill that would increase funding for mental health and addiction treatment and tie the reimbursement rate for service providers to the Consumer Price Index.

A few hours later, the Senate Finance Committee voted to send the bill, SB 476, to the full Senate after 16 groups representing hospitals, service providers and nonprofits spoke in support of the bill.

Opposition from two cabinet officials at the hearing won a small concession from Finance Chair Thomas “Mac” Middleton, D-Charles, who added an amendment that would sunset the act in five years.

“Some of the testimony against the bill is very notable,” Middleton said.

Gov. Larry Hogan proposed a 2% increase in his fiscal 2018 budget. But supporters of the bill say a mandatory formula increasing payments based on the price index was needed to maintain a stable workforce and increase access to patients in their communities.

“This is really about keeping the door open for our constituents so they have access to mental health and substance abuse services in their community,” said the bill’s lead sponsor, Sen. Guy Guzzone, D-Howard County, at Thursday’s hearing. The bill currently has 33 co-sponsors in the Senate out of 47 members, including three Republicans. A similar bill passed the Senate and House last year but got hung up on differing amendments and was never enacted.

Guzzone said treatment should be available long before a patient ends up in the emergency room and easily accessible after release from the hospital. He said over a million Marylanders are in need of mental health and addiction treatment.

People in crisis

“We’ve been dealing with people in crisis, and having people end up in crisis in a hospital room is not the solution,” Guzzone said. “We need to [provide services] before they end up in the hospital.”

Under the bill, service providers would be reimbursed based on the Consumer Price Index averaged over the prior three years. Currently that average is 3.24% for the Baltimore-Washington region, according to the fiscal analysis.

General fund expenditures increase by nearly $179 million through fiscal 2022 and are matched by $170 million in federal Medicaid dollars over the same period.

Lori Doyle, public policy director for the Community Behavioral Health Association of Maryland, said inadequate funding would increase costs to the state in other areas and make it difficult to maintain a workforce.

Keeping people whole

“We’re going to continue to spend money on this population, It’s just a matter of where you want to spend it,” Doyle told the committee. “You can spend it in emergency departments, inpatient care and in our jails and prisons, or do you want to keep people whole and with their families?”

She said the federal reimbursement rate was paying just $10 to $12 an hour. “We used to hire college graduates but we can’t get them anymore,” she said.

She said 13 of Maryland’s 24 counties have a federally recognized shortfall in the mental health workforce and that “financial neglect” of service providers is evident in the rise of drug overdoses and suicides.

Brian Frazee of the Maryland Hospital Association said emergency room visits related to behavioral health have increased by 18% while all other visits have declined by 5%. He said Medicaid covered ER visits since 2013 have increased by nearly 30% at a cost of $47 million.

Administration says mandate inflexible

Marc Nicole, deputy secretary of Budget and Management, defended Hogan’s commitment to increase funding for service providers. He said the 2% increase when confronting a $544 million deficit demonstrated a clear commitment without the need for a mandate.

“These rate increases are mandated and quite costly,” Nicole said. He said the mandate would climb from $17 million in 2018 to $76 million by 2022. He said during that same period the fiscal deficit could reach $1.2 billion.

“We have shown our commitment on this,” Nicole said.

The administration should be allowed to make the funding decisions for service providers on an annual basis, he said.

Barbara Bazron, deputy director of behavioral health, echoed Nicole and said the compulsory rate increases in the bill create an “unsustainable fiscal impact” on the general fund that discriminates against other types of providers.

“The administration believes it is not fiscally prudent or socially responsible to mandate an expenditure that will likely balloon to $76 million,” she said. “By mandating that the administration dedicate Maryland’s scarce resources to only one type of provider [the bill] removes the flexibility for us to focus on all treatment providers.”

By Dan Menefee

1st District Health Care Town Hall Meetings to be Held Without Rep. Andy Harris


Constituents in Maryland’s 1st Congressional District are growing increasingly concerned about the potential repeal of the Affordable Care Act, and are looking to their elected officials to help address those concerns. Many calls, letters, and emails to Representative Andy Harris’s office have gone unanswered, or answered without addressing specific concerns. Constituent requests for Representative Harris to hold an in-person town hall meeting have not been successful.

Citizens for Health Care, a local grassroots organization, has heard these concerns and will host a series of citizens town hall meetings entitled “Patient Protection and the Affordable Care Act (ACA) Town Hall Meetings” intended to inform and educate constituents about the ACA and what it’s repeal could mean to them and their families and to consider methods to improve the ACA.

These town hall meetings will feature speakers from the professional healthcare community for an information session, as well as an open-panel question and answer session for public attendees. Representative Harris and other local elected officials have been invited to attend, in hopes of opening the lines of communication with their constituents and allowing for a discussion of what might come next. Hundreds of constituents have indicated they are interested in attending.

“At Citizens for Health Care, we understand that the subjects of health care and the ACA are not partisan issues: they are human issues,” said DeLane Lewis, one of the founders of Citizens for Health Care. “Congress is facing a dilemma at this moment, arguing whether to repeal or repair parts of the ACA. However, any decision they make will have a real, lasting impact on all U.S. citizens. It is our mission to keep the public informed and aware as to how these proposed changes could affect them.”

One of the major aims of the town hall meetings will be to answer the many questions that citizens currently have, including: What will be the impact on employer based plans? While all current and proposed plans, would continue to offer insurance for pre-existing conditions, under the ACA insurance companies are not allowed to charge higher premiums for pre-existing conditions. Will that be true under any new plan? In Maryland alone, almost 500,000 people are enrolled in health care coverage through the ACA. What will be the impact on the State of Maryland financially? On jobs?

Proposed plans that would eliminate current provisions of the ACA for federal financial assistance and Medicaid expansion are also of significant concern. According to research by the Urban Institute, eliminating individual and employer mandated, federal financial assistance and Medicaid expansion would increase the number of uninsured Americans by 22.5 million. The group estimates that an additional 7.3 million Americans would lose their insurance due to anear collapse of the non group insurance market.

Speakers at the citizens town hall plan to review and compare coverage options and statistics from pre-ACA, versus current options, as well as the various policy aspects of proposed changes or replacements. Health care professionals will also be available to discuss the implications for addiction treatment and mental health care in the community, as the ACA has greatly expanded coverage in both of these areas. Additionally, the financial costs of premiums and out-of-pocket expenses will be discussed to get a clear picture of the impact on the average healthcare consumer’s wallet.

The town hall meetings will be held as follows:

Tuesday, February 21, 6:30 pm, Harford Community College, Darlington Hall, Room 202, Bel Air
Thursday, February 23, 6 pm, Queen Anne’s County Library, 200 Library Circle, Stevensville
Friday, February 24, 6 pm, Salvation Army, 429 N Lake Drive, Salisbury
Thursday, March 2, 6 pm, St Paul’s UCC, 17 Bond Street, Westminster

Current guest speakers scheduled to appear include:

– Sue Ehlenberger, Maryland Health Connection-Seedco
– Mark Romaninsky, Maryland Health Connection-Seedco
– Jeananne Sciabarra, Consumer Health First
– Scot Hurley, Ashley Addiction Treatment
– Katia Callan, MSW, LCSW-C, Insight Wellness of Maryland
– Dr. James Burdick, author of Talking About Single Payer: Health Care Equality for America
– Dr. Margaret Flowers, Healthcare is a Human Right
– Kaylie Potter, Door to Healthcare

About Citizens for Health Care: Citizens for Health Care, located in Bel Air, Md., is a grassroots organization dedicated to providing education and information regarding the Affordable Care Act and proposed changes to the bill. For more information, please visithttps://www.facebook.com/CitizensforHealthCare/


More Marylanders Enroll in Health Exchange as Repeal Looms

Enrollment in the Maryland Health Exchange thus far has been climbing at faster rates than in previous years, while President Donald Trump and the Republican-led Congress have taken their first steps to repeal the Affordable Care Act. 
As of Monday, more than 465,500 Marylanders had enrolled in the Maryland Health Connection since it opened on Nov. 1, surpassing the 457,862 who had enrolled by the same date last year. The enrollment period ends on Jan. 31
Delegate Clarence Lam, a Democrat representing Baltimore and Howard counties, and a physician, discusses the upcoming state budget and the impact a repeal of the Affordable Care Act

Delegate Clarence Lam, a Democrat representing Baltimore and Howard counties, and a physician, discusses the upcoming state budget and the impact a repeal of the Affordable Care Act

Of those 465,500, about 150,000 have enrolled in private health insurance and about 315,500 have enrolled in Medicaid. About 73,500 additional Marylanders have passively re-enrolled, meaning they will retain their same coverage if they do nothing to change their plans, according to data provided by Andrew Ratner, director of marketing and strategic initiatives at the Maryland Health Benefit Exchange. 

However, an executive order Trump signed on his first day in office could pave the way to gut the Affordable Care Act, signaling its repeal as one of his top priorities. The order gives federal agencies the power to eliminate or loosen some regulations created by the health care law.  
This followed a Jan. 12 measure by the U.S. Senate to begin dismantling the Affordable Care Act by passing a budget resolution that would make it easier to begin rolling back portions of the law. 
Health care advocates and state officials have been continuing to urge Marylanders to enroll in the exchange, touting the Affordable Care Act’s role in reducing the number of uninsured state residents by about 50 percent. Since the rollout of the health care law, the percentage of uninsured Marylanders has shrunk from 10.2 percent in 2013 to 6.6 percent in 2015, according to the U.S. Census. 
If the Affordable Care Act is repealed, the state could stand to lose up to $1.2 billion of federal funding for Medicaid and up to $200 million for other related services, according to David Romans, fiscal and policy analysis deputy director for the Maryland Department of Legislative Services.
The proposed 2018 state budget includes funding for 312,000 Marylanders who are enrolled under the Affordable Care Act Medicaid expansion, Romans said. Ninety-five percent of funding for Medicaid is provided by the federal government, but this number could be slashed in half if the health care law is repealed. 
To continue insuring the thousands of Marylanders who benefit from the Medicaid expansion, the state, which is already operating on a “lean budget,” would likely have to cut from other programs and services, Delegate Clarence Lam, D-Howard and Baltimore counties, told the University of Maryland’s Capital News Service. 
If the Affordable Care Act is repealed soon, the Maryland General Assembly may need to call a special session later in the year to address the budgetary concerns, Lam added. 
“There’s no place to get billions of dollars within the state of Maryland,” said Vincent DeMarco, president of Maryland Citizen’s Health Initiative. “We need to prevent the Affordable Care Act from being repealed and we’re going to work very hard to do that.” 
DeMarco has helped lead a recent health coverage enrollment initiative at a dozen faith organizations in Maryland over the inauguration weekend. He said he’s seen firsthand how the Affordable Care Act has saved the lives of the previously uninsured. 
“Any program that expands healthcare to 20 million plus Americans … is a huge success,” DeMarco said. “We’re going to protect it (and) we’re going to keep it there and build on it.”
About 18 million Americans would lose health insurance the first year after repealing the Affordable Care Act, according to a non-partisan report from the Congressional Budget Office. This number could double to 32 million by 2026, the office reported.
Moreover, premiums would increase by 20 percent to 25 percent in the first year, according to the same report. 
“It would be a significant step backwards to throw these people out of insurance and be concerned about how they pay their medical bills again,” Lam said. “That there are things that are afoot in Washington–maybe abstract or maybe things that we hear in the news–but at the end of the day there are real people being affected in our communities that will go without health insurance. We all pay for that.”
(Capital News Service correspondent Cara Newcomer contributed to this report.)

Recovery: Hogan Announces new Measures to Address Opioid Addiction

Gov. Larry Hogan and Lt. Gov. Boyd Rutherford announced Tuesday they are rolling out new legislation that would counter Maryland’s growing opioid addiction crisis.
The Prescriber Limits Act would prevent doctors from prescribing more than seven days worth of opioid painkillers during a patient’s first visit or consultation. The law exempts patients going through cancer treatment and those diagnosed with a terminal illness. 
The Distribution of Opioids Resulting in Death Act would introduce a new felony charge carrying up to 30 years in prison for people convicted of illegally selling opioids or opioid analogues that result in the death of a user. Rutherford said the law would carry protections for people who were selling to support their addiction.
And the Overdose Prevention Act authorizes the collection of and review of non-fatal overdose data and would make it easier for people to fill prescriptions for naloxone, a drug that can counteract the effects of an opioid overdose. 
Hogan and Rutherford, whom the governor has directed to focus on opioid addiction, announced the legislation in a press conference at Anne Arundel Medical Center on Tuesday
Rutherford also announced that the governor would sign an executive order that will create an Opioid Operations Command Center — a “virtual” task force charged with organizing training and funding for local anti-addiction teams as well as collecting data on opioid use and abuse. 
Hogan said that he did not fully appreciate the scope of the opioid epidemic until he began crisscrossing Maryland during the early phases of his gubernatorial campaign. He said he asked people in different parts of the state what their community’s biggest problem was and that, regardless of whether they were from a rural, urban, wealthy, or poor community, “the answer was always the same: heroin.”
Both Hogan and Rutherford appeared optimistic but acknowledged that the problem of opioid addiction is worsening in Maryland. Anne Arundel County Executive Steve Schuh said that, at the start of his tenure a couple years ago, there was one overdose per day and one death per week from opioid abuse in his county. He said those figures have risen to two overdoses per day and two and a half deaths per week.
At the press conference, State’s Attorney Wes Adams, R-Anne Arundel, spoke about the recent death of his brother-in-law, who he said died of an opioid overdose.
Adams said his brother-in-law became addicted to opioids after being prescribed them following a surgery about eight years ago. He said he moved in and out of rehab centers and periodically became clean, only to relapse later. 
Adams lamented the obstacles from the medical and insurance industries that he and his family faced as they tried to keep his brother-in-law in treatment. 
He also expressed consternation over recently being prescribed a substantial supply of Oxycontin, an opioid pain-killer, following a medical procedure, despite telling his doctor that he was only experiencing moderate pain. 
He said angrily that the only major side-effect his pharmacist warned him of was constipation, despite the well-documented risk of addiction that use of the drug carries. 

Maryland Lawmakers, Residents Worried after Obamacare Repeal Report


First, Diana Muller’s vision starts to blur. Next, she loses feeling along her left side. Then comes the debilitating pain.

The 39-year-old Silver Spring resident suffers from seizure migraines, some of which last more than four days. But after President Barack Obama signed the Affordable Care Act, worrying about how she would pay for health insurance was no longer a headache.

That changed after the election.

Now Muller, along with many of Maryland’s Democratic lawmakers, has plenty to worry about.

President-elect Donald Trump said throughout his campaign and in the months since his election that he would make repealing Obamacare a priority, although no clear replacement plan has been set forth.

The potential impact of such an action was revealed Tuesday, when the nonpartisan Congressional Budget Office released a report saying that 18 million people would lose their health insurance within a year if Congress repealed certain major provisions of the law.

Over the next decade, the report said, repealing the health care law without a plan to replace it could translate into an increase of 32 million uninsured Americans, while individual non-group insurance premiums could double.

“I’m really, really scared,” Muller said. “If the Affordable Care Act goes away, then so does my health insurance.”

The budget office’s report analyzed a proposed 2015 measure to repeal the bill, which was ultimately vetoed by Obama.

Sen. Orrin Hatch, R-Utah, criticized the report’s conclusions, saying it represented a “one-sided hypothetical scenario.”

“Today’s report shows only part of the equation – a repeal of Obamacare without any transitional policies or reforms to address costs and empower patients,” said Hatch, chairman of the Senate Finance Committee. “Republicans support repealing Obamacare and implementing step by step reforms so that Americans have access to affordable health care.”

But Maryland Democrats have used the findings to fuel their fight against repealing the Affordable Care Act.

House Democratic Whip Steny Hoyer called the report a “damning indictment of Congressional Republicans’ irresponsible and dangerous repeal proposal.”

“This report ought to alarm all Americans who care deeply about the future of health care in our country and of our economy, no matter their political affiliation,” Hoyer said in a statement.

Maryland Democratic Sen. Ben Cardin tweeted that “numbers don’t lie,” adding that repealing the legislation without a plan to replace it “would be financially devastating and morally irresponsible.”

“It’s not just about 400K MDers who will lose coverage if #ACA repealed w/o replacement. We all will have higher premiums and less coverage,” Cardin tweeted.

Hours after the budget office released its report, five members of the Maryland congressional delegation spoke about the importance of Obamacare at a town hall meeting in Clinton, Maryland.

In Maryland, the uninsured rate has fallen 42 percent since 2010 and 278,000 people in the state have gained coverage, according to U.S. Department of Health and Human Services data.

Muller already is thinking about the ways in which the legislation’s repeal would change her life. Before Obama’s landmark healthcare law, she said, she paid a $500 premium every month and needed financial help from her parents to make it work. Her seizure migraines have made it difficult to find work.

Muller’s current insurance plan makes it possible to visit a neurologist and pain management doctor, and covers her trips to the emergency room and urgent care.

Last week, the Republican-controlled Congress voted to pass a budget resolution that signaled the first step toward repealing the law. Some GOP lawmakers have said they’ll announce their replacement plans in coming days, as House and Senate committees are preparing to write legislation rolling back large portions of the law.

Trump told The Washington Post last weekend that he was almost done with a plan to provide “insurance for everybody,” but The Post noted that he did not provide details or a timeline.

Confirmation hearings began Wednesday for Rep. Tom Price, Trump’s pick to head the Department of Health and Human Services. In this position, the Georgia Republican would play an integral role in shaping the administration’s policy on health care.

Price has introduced his own legislation to repeal and replace Obamacare four times.

As Muller awaits Trump’s inauguration, the uncertainty has her worried and the recent CBO report didn’t help.

“This is something that’s extremely important to a lot of people, including me,” she said. “People don’t realize how they’re going to be affected – and I think it will affect more than 18 million people.”


Mid-Shore News: Rural Health WorkGroup Focuses on Health Delivery Transformation


Tasked with studying the healthcare needs for the five counties of the Mid-Shore and offering policy templates to the State, Rural Health Care Delivery Group held their third of seven workshops at Washington College on Monday.

The 32-member committee co-chaired by Deborah Mizeur and Dr. Joseph Ciotola, and attended by health care officials, county and state elected officials and business owners, the workshop sought to clarify the goals and possible implementation of an across-the-board transformation of health care delivery of the mid-Eastern Shore as national health care trends change from total dependence on hospitals a sole provider for health needs.

The work group’s focus is “to examine challenges to health care delivery, including limited availability of health care providers and services; special needs of vulnerable populations; transportation barriers, and the economic impact of closing, partly closing or converting health care facilities and also to identify how the benefits of telehealth and the Maryland all-payer model contract might help in restructuring the delivery of rural health care services. Finally, the study is to develop policy options that address the health care needs of residents and improve the health care delivery system in the five counties.”

Rural Health Care Delivery Workgroup. Co-chairs Joseph Ciotola and Deborah Mizeur at center.

Rural Health Care Delivery Workgroup. Co-chairs Joseph Ciotola and Deborah Mizeur at center.

Addressing the complexity of designing a transformative rural healthcare model for the mid-shore, Deborah Mizeur said that much of the first two meetings were used to orient all committee members to the healthcare landscape. “We have a wide spectrum of membership, from physicians to businessmen and we all need to be on the same page to move forward. I’m energized and encouraged by the progress we’ve made.”

The session began with an overview of Maryland’s progression plan for an All-Payer Model given by Katie Wunderlich, Gov. Hogan’s deputy legislative officer for health care issues. Using slides, Wunderlich walked the group through key strategies, components, and a timeline to frame further work group discussions on how best to create policy platforms to be submitted to the State next October.

One slide, “Rural Health Nationally” stood out as a profound indicator of the need for a systemic change in rural health care delivery. It showed that in urban settings:

  • morbidity rates in females decreased by 10% and in rural areas morbidity rates increased by 40% along with a fivefold increase in opioid and heroin overdoses, doubling of suicides and tripling of deaths due to cirrhosis of the liver, linked to alcohol abuse.
  • At the same time, nationally, “rural hospitals have faced declining margins of 5% annually since 2011, due to shrinking inpatient demand.
  • Nationally, 68 rural hospitals have closed over the last 5 years, and an additional 670 are vulnerable to closure in 2016, up from 280 in 2015.
  • Many Americans living in rural communities rely on their hospital as one of their few sources of health care.

With a declining use of hospitals nationwide due to migration from inpatient care to outpatient care—from hospital-centric to population-centric— the focus is on a continuum of care keeping patients healthy through preventive and primary care services, and out of acute care facilities whenever possible. Refined medical procedures have shortened inpatient stays while outpatient procedure have kept patients out of the hospital altogether.

Wunderlich offered key points to sustaining rural health care with an emphasis on building on the success of the current rate-setting Total Patient Revenue (TPR)—the mechanism replacing Fee-For-Service incentives—and creating a geographic value-based model incentive “to address local accountability for population health and Medicare total cost of care.”

“This is basically putting in rewards for providers, for hospitals, for when they are able to improve their methods,” Wunderlich said.

Wunderlich added that a critical component to addressing rural health care is the transformation of primary care to support care management, care coordination, connections to behavioral health, social services and other resources.

In its fourth year of a five-year plan transforming the state’s health care system, 2017 will include continuing infrastructure development and increased support of high need patients with a 2018 focus on primary care home models, incentive harmonization and developing and organizing geographic and regional efforts.

Deputy secretary for public health at the Department of Health and Mental Hygiene Howard Haft discussed community-based “patient centers” working in tandem with the primary care model as part of the overall transformation needed to meet the needs of the rural population.

“We’re really going to have to transform what we do in primary care, Haft said. “There are insufficient numbers of doctors in the state and certainly a disproportionate number of doctors in rural communities who have to provide more and more care in small intervals. So we must shift from how many people we can see to delivering the best care for every person you can see.”

Patient Centers offer interdisciplinary teams of doctors and specialists who coordinate diagnostics and treatment while taking the stress off overloaded primary physicians. Patient centers would alleviate some of the problems in recruiting new physicians, according to Haft. Many primary physicians are seeing between 35 and 40 patients day. Along with the fact that attracting a physician to a rural area and a lower income model is difficult, Haft sees patient centers as the strengthening of relationships between patient and physician by using coordinated care efforts rather than episodic care visits. This model encourages teamwork between a patient —and his or her willingness to work toward person health goals—physician and other support staff.

The video starts with some of Health Services Cost Review Principal Deputy Director Katie Wunderlich’s overview of the progression plan and is followed by. Dr. Howard Haft, Deputy Secretary for Public Health, DHMH.

The next meeting will be held in March in Annapolis.The Rural Health Care Delivery Plane will be submitted to the State General Assembly in October.

This video is approximately 13 minutes in length  To see slides of each of the presentations, go here. Scroll to the January 9 meeting section.