Mid-Atlantic Health Law TOPICS

1. In December, the Health Services Cost Review Commission (HSCRC) released its first comparison of the relative adjusted charges of hospitals' ambulatory surgery cases. Described as a "work in progress," the comparison uses a new Ambulatory Patient Groups system to adjust for case mix. HSCRC Staff noted that there is a wide disparity among hospitals regarding charges per ambulatory visit. Although this analysis does not list hospitals by name, the HSCRC will include hospital names in an updated analysis scheduled to be released in May.
2. The Maryland Health Care Commission (HCC) will implement recommendations set forth in the Certificate of Need (CON) Task Force's final report. Some recommendations are: (1) to increase the statutory capital expenditure review threshold from $1.25 to $10 million for HSCRC regulated hospitals; (2) to develop a streamlined, fast track CON review process for new hospital construction and renovation projects with no new beds/services and for which the hospital agrees not to file a partial rate application for capital; (3) to issue a staff report on CON applications within 90 days of docketing if there are no interested parties; (4) to revise the Determination of Non-Coverage requirements to deem the request approved if the Commission does not act within 60 days if a hospital takes the pledge not to raise rates; and (5) to expand the existing business office equipment exemption to include health information technology/medical information systems.
3. In January, the Governor named two new Commissioners to the HCC. Garrett A. Falcone, NHA is the Senior Administrator of Erickson Retirement Communities and Sheri D. Sensabaugh is the owner of ACT Personnel Service, Inc. in Western Maryland. This expands the HCC to 15 members as required by a 2005 statute.
4. In January, the HCC released its report "State Health Care Expenditures Experience from 2004." In 2004, Marylanders spent an average of $5,179 per person on health care compared to the national average of $5,374. The total health care spending in Maryland for 2004 was $28.8 billion compared to $26.9 billion in 2003. However, the 7% growth rate in 2004 was 2% lower than the 2003 growth rate, and shows a continued slow-down in health care spending first identified two years ago. The main components of Maryland's total health care expenditures are: inpatient services 24%, physician services 17%, other professional services 14%, prescription drugs 14%, and nursing home/ home health 12%. Private insurance spending per resident was less than the national average - $2,754 compared to $3,376 nationally. HMO enrollment as a percent of all insured was unchanged at 32%. Out-of-pocket spending (coinsurance, deductibles, co-payments and full direct payments) in 2004 grew at 6%, which was the same as the nation.
Lynn S. Slawson