Mid-Atlantic Health Law TOPICS

1. In February, the Maryland Health Care Commission (HCC) released its "State Healthcare Expenditures Report" based on 2005 data. Total health care spending in Maryland was $30.2 billion, compared to $28.8 billion in 2004. Hospital inpatient/outpatient spending accounted for 41% of the $2.1 billion in new spending. In 2005, Marylanders spent an average of $1,846 per person for inpatient and outpatient hospital care, about 7% less than the national average. Total expenditures for practitioner services grew by 5%, compared to the national average of 7%. While nursing home expenditures grew by 4%, expenditures for home care grew by 8%. Maryland's payor administrative expenses and the net cost of insurance (private insurers' profits, capital expenditures, additions to surplus and assessments and taxes) increased by 12%, while the same expenses for the nation grew by 4%.

2. In March, the HCC approved regulations that create a new designation called a "participating entity" for Certificate of Need (CON) actions. A participating entity can be a third party payor, a health planning region or municipality located in the area of the proposed CON project. A participating entity may, at the discretion of the HCC, attend a CON project status conference, submit comments during a CON review, and address the Commission before the HCC's vote on a CON application. The new regulations do not give a participating entity a right to a judicial appeal of the HCC's decision.

3. In April, the Health Services Cost Review Commission (HSCRC) approved a 6.25% increase to inpatient hospital rates starting July 1, 2007, with an identical increase beginning July 1, 2008. It is expected that 5% of this increase will be driven by increases in prices, with another 1.25% being driven by increases in case mix. The Commission voted to set outpatient rates at an amount equal to current predictions of inflation plus .2%, meaning a likely increase of 3-4% on July 1, 2007, and again on July 1, 2008. The Commission announced that staff will do rate realignment between inpatient and outpatient rates each year for every hospital. Additionally, HSCRC staff will undertake a major, more thorough Financial Conditions Study of Maryland Hospitals in the next year.

4. In April, the HCC authorized Staff to develop regulations to allow hospitals to apply for waivers to perform elective percutaneous coronary intervention in hospitals without on-site cardiac surgery backup, as part of a clinical trial, known as C-PORT II. The HCC's Research Proposal Review Committee, with some reservations, deemed the design of the C-Port II research study to have scientific merit, and the HCC's executive director recommended that the HCC approve the study. C-Port II is a randomized clinical trial that compares the outcomes of elective angioplasty performed in hospitals with, and hospitals without, on site cardiac surgery services. The study is expected to last 2 years from the date of the first waiver.