The Maryland Waiver with the Centers for Medicare and Medicaid Innovation

It is a very complex topic, but readers of the blog know that the State of Maryland has an all-payer rate setting system. In Maryland, unlike in the other 49 states, hospital payments for services are determined by the Health Services Cost Review Commission (HSCRC), a quasi-governmental agency. In the rest of the country, hospitals negotiate payment rates with insurance companies and are told what the rates are by Medicare and Medicaid. Stand-alone hospitals, like GBMC, have little bargaining power in other states, so they are usually paid less than hospitals run by large companies. In Maryland, all payers, including Medicare and Medicaid, pay the same rate to the same hospital for the same service, and these rates are set by the HSCRC. In other states, Medicare usually pays below what private insurers pay and Medicaid significantly below what private insurers pay. GBMC gets paid less than many of the hospitals in our region for the same service, but we are protected by the all-payer rate setting system.

Recently, the Centers for Medicare and Medicaid Services (CMS) published an evaluation of the first two years of the Maryland Total Cost of Care Model. Since January 1, 2019, CMS has been holding Maryland accountable for reducing the total cost of care for Maryland Medicare beneficiaries, not just for hospital costs, while improving the quality of care and patient satisfaction. The evaluation points out that Maryland reduced total Medicare spending in 2019 (relative to national trends) by $365 million — $88 million more than the spending reduction achieved in 2018, which followed the previous waiver model. The report concluded that global budgets remain the biggest financial incentive in the Model. 

Maryland has also embarked on a new program to incentivize better primary care called the Maryland Primary Care Program (MDPCP). The report says that primary care practices in 2019 made gains in the targeted domains: access and continuity, care management, comprehensiveness and care coordination, patient and caregiver engagement, and planned care. Blog readers know that advanced primary care is a fundamental building block of the GBMC HealthCare System, so you won’t be surprised to know that we are among the leaders in MDPCP.

It will also come as no surprise that our GBMC Health Partners primary care providers were recently acknowledged by readers of The Sun as the best in the Best General Practitioner (primary care) category. It’s nice to see that members of the community now understand that we are different and validate our excellence as we move towards our vision of being a community-based system of care that can deliver to every patient, every time the care that we would want for our own loved ones. 

Readers of The Sun did not stop the accolades with primary care. They also found GBMC to be the Best Hospital in our region! Our Audiologists were also found to be the best!

And we had others recognized as runners-up in the following: 

• Best OB/GYN Practice

• Best Audiologist - Presbyterian Board of Governors Cochlear Implant Center of Excellence

• Best Pediatric Practice - GBMC Pediatric Group

I want to THANK the community for their support and all who voted for recognizing the hard work and dedication of our people.

Way to go!
I would also like to announce that Baltimore's Child Magazine recently unveiled its list of 2021 Readers’ Choice winners. GBMC was named: 

• Best Hospital - Hometown Heroes - COVID-19 Pandemic Response

• Best Place to Deliver Your Baby

• Best Pediatric Vision Care - Dr. Allison Jensen, Eye Center at GBMC

And runners-up in the following: 

• Best Pediatric Physician - Hometown Heroes - COVID-19 Pandemic Response, Dr. Theresa Nguyen - GBMC Pediatric Group

• Best Medical Matters

• Best ER for Kids

Congratulations to Drs. Jensen and Nguyen. I am very grateful for everyone who has made this recognition possible.

Congratulations!
It is no secret that those of us in the medical field never stop taking care of people even when we’re not at work. David Vitberg, MD, Director, Division of Medical and Surgical Critical Care Medicine, is a perfect example.  

Recently, Dr. Vitberg was awarded the Maryland Star of Life Award for his heroic efforts to save a man who was trapped under a waterfall in Rocks State Park. The award, presented by the Maryland Institute for Emergency Medical Services Systems (MIEMSS), combines the organization’s symbol, the Star of Life, with its shared vision, “the elimination of preventable death and disability from injury or sudden illness.”

Dr. Vitberg, along with first responders and other EMS physicians, played an instrumental role and worked for hours to free a man – nearly having to amputate his leg. Fortunately, the water rescue team was able pull him out just prior to the procedure. The man was treated on the scene and then transferred to a local hospital with his leg intact.

We are all incredibly honored to have Dr. Vitberg as a leader at GBMC and congratulate him for this award!