Mid-Atlantic Health Law TOPICS

The Governor has appointed Lynn Etheridge, a health care consultant, and Dr. Allen Jensen, an ophthalmologist, to the Maryland Health Care Commission (HCC). The new members replace Commissioners Ruth Spector and Dr. Catherine Smoot-Haselnus. Also, Larry L. Grosser has been appointed to the Health Services Cost Review Commission (HSCRC), replacing Commissioner James Lowthers. 2. In October, the HCC approved a Certificate of Need (CON) application for the redesign, expansion and renovation of Greater Baltimore Medical Center. GBMC's improvements include expansion of the emergency department, a pediatric inpatient unit, four mixed-use (inpatient and outpatient) operating rooms, with supporting post anesthesia care unit, and a 12-bed critical care unit. GBMC neither asked the HSCRC for a rate increase to fund its project, nor requested an increase to its current inventory of 323 licensed acute care beds. 3. In October, the HCC voted to recommend to the General Assembly that the HCC's regulatory oversight of acute inpatient medical/surgical and pediatric services be maintained through the CON program. In addition, the HCC will recommend that the threshold for capital expenditures for CON review be increased to $2,500,000 from $1,250,000 for acute care hospitals. 4. In September, the Maryland Department of Health and Mental Hygiene proposed regulations that address pharmacies' and pharmacists' responsibilities when prescription medications are sent to patients via the United States Postal Service, common carrier or delivery system. The regulations prohibit a pharmacy from knowingly delivering prescriptions to a "depot." A depot is defined as a location where filled prescriptions are stored before delivery to the intended patient or the intended patient's authorized agent. The regulations also set forth how pharmacies and pharmacists must document the patient's authorization for delivery of the medication. 5. In October, the HSCRC notified all Maryland hospitals that the HSCRC will perform a detailed analysis of each hospital's charging practices. The HSCRC has noticed some shifts of revenue from inpatient to outpatient charges by as many as 18 hospitals. The Association of Maryland Hospitals and Health Systems contends that a large part of the increases in outpatient charges comes from an increase in volumes. The HSCRC believes that the shifts may be the result of the unbundling of outpatient procedure based pricing, or the misallocation of fixed overhead to medical/ surgical supplies and drugs. The HSCRC requires that the allocation of overhead be spread uniformly across inpatient and outpatient centers. If the HSCRC finds irregularities in its review of outpatient charges, it could revise a hospital's charge per case, or impose other penalties. 6. In November, the HSCRC unveiled a draft of its Outpatient Payment System for hospital ambulatory surgery, emergency departments and outpatient clinics. The HSCRC's goal is to structure a new system that has an established revenue per encounter that is adjusted by all-payor (not Medicare) weights. The new outpatient rates will be hospital specific, and the HSCRC hopes that the new system will be up and running by July 1, 2002.