I just read a blog by Vinnie DeMarco, who runs the Maryland Citizen's Health Initiative, on the new Medicare Waiver in Maryland. It didn't take long into his blog for Vinnie to insult all Maryland hospitals. He describes life for hospitals under the new waiver that pretty much reflects what WMHS and nine other Maryland hospitals have been involved with over the last four plus years under Total Patient Revenue. But, then he goes onto describe how Maryland hospitals will try to game the system by encouraging costly patients to go to other hospitals and skimping on care by discharging patients to skilled nursing facilities.
All of our work over the last three years, which resulted in WMHS dramatically reducing readmissions, admissions, ED visits, observation stays and ultimately reducing cost of care, which resulted in WMHS paying money back to the State based on our achieved savings, seems to be for not. In addition, what Mr. DeMarco fails to realize is that we have truly bent the cost curve under value-based care delivery, that the Health Services Cost Review Commission has been monitoring the performance of all hospitals under the Total Patient Revenue payment methodology for the last three years and that they will begin to monitor all of the hospitals in Maryland as to their compliance with the waiver. The bottom line is that if we don't meet a lot of predetermined targets, Maryland hospitals will lose the waiver. All Maryland hospitals have agreed that is not an outcome that we want so, gaming the system isn't an option.
He complains of hospitals preparing to deliver too little care. Grant you, it is a delicate balance when you begin to provide care in the most appropriate setting which may be in an acute setting, but it also may be in a clinic, a physician's office, a skilled nursing facility or even in the patient's home. You can't accuse hospitals of driving up volume and the cost of care in one sentence and failing to deliver care to the patient in the next. After a great deal of hard work, TPR hospitals have figured out that balance as the remaining Maryland hospitals will in the near term.
In closing, I found Vinnie's last sentence interesting in that the Maryland Citizen's Health Initiative is going to work with every stakeholder possible, including providers, as we make this journey together. He certainly has a funny way of setting out on this self-described "collaborative" journey.