Maryland Hospitals

A national group that directs organs to hospitals around the country decided yesterday to withdraw a policy that would have forced people scheduled for kidney transplants at Maryland hospitals to wait much longer.After hearing testimony that the policy would have punished the sick, the United Network for Organ Sharing agreed to a compromise that Maryland transplant advocates say treats the patients more fairly."I am very pleased that our patients will no longer be threatened and that we have a new plan that we can work with UNOS on," said Marion Borowiecki, chief executive officer of the Maryland Transplant Resource Center.

The University of Maryland Medical System said yesterday that it will become the parent company of Maryland General Health Systems in an "affiliation" that would preserve the two hospital systems as separate entities, while reducing their operating costs.No money will change hands, except for a contribution by UMMS for capital improvements at Maryland General, officials said at a news conference at Maryland General.Each system will retain its name and board of directors, but they will pool some medical resources and develop a joint referral system.

Faced with action by regulators that would cut hospital rates, the Maryland Hospital Association is proposing instead a one-year freeze on rates, Calvin M. Pierson, the association's president, said yesterday.Pierson said a proposal by the state Health Services Cost Review Commission to reduce the cost of an average hospital stay in Maryland by 6 percent over 2 1/2 years, was "totally unacceptable, in our view."Such deep cuts, he said, could mean "thousands of hospital employees laid off" (Maryland hospitals employ about 75,000, according to the association)

HEALTH CARE providers are under pressure to cut costs -- and then cut some more. From all directions, hospitals, nursing homes and physicians are feeling the fiscal squeeze, and worrying about their long-term ability to deliver quality care at a far lower price.In Maryland, the state's cost-control commission wants to lower hospital charges by 1 percent this year and more the next two years. This comes after stiff cuts in Medicare payments. More cuts will be needed through 2002 for Congress to stay within its budget caps.

IMAGINE the public hue and cry that would greet efforts to reduce education spending in Maryland to levels below the national average. Educating Maryland's children is a vital element of our state's quality of life. Usually measures that threaten our quality of life come under fire.Interestingly, some regulators, managed-care companies and politicians are backing a plan that endangers another key element of our quality of life -- hospitals. The state body that sets hospital rates has proposed requiring Maryland hospitals to reduce costs for a hospital stay to 3 percent below the national average over the next two years.

Maryland's hospital rates were not nearly as out-of-whack with the national average in 1998 as state regulators have assumed, the Association of Maryland Hospitals and Health Systems said yesterday.The association presented the new statistics to a state rate-setting board earlier this week in an effort to show that Maryland has gone too far in its efforts to rein in hospital charges.Instead of charging 6.1 percent more than the national average in 1998, as regulators have assumed when setting rates, Maryland hospitals were only 0.1 percent more expensive on average, the association said.

University of Maryland Medical System and Maryland General Health Systems announced yesterday that they are in talks that could lead to a "business affiliation."Maryland hospitals have been merging rapidly over the past few years, but they have also formed other kinds of alliances. UMMS and Maryland General, for example, have negotiated nonmerger deals to do Medicaid contracting.In yesterday's joint statement, they said they "are exploring a wide range of potential affiliations."The two set October as the target for deciding whether and how to join forces but said the deadline could be extended.

Profit margins at Maryland hospitals, at record levels the past two years, dropped sharply in the fiscal year that ended June 30, according to data from the Maryland Hospital Association.The decline was caused by tightened state controls on hospital rates, claim denials by insurers, cuts in Medicare reimbursements for some services and a drop in patient days, said Nancy Fiedler, senior vice president of the hospital association."The worry has to do with the fact that there doesn't seem to be any indication the downturn is going to change," Fiedler said.

The cost of an average hospital stay in Maryland jumped 3.4 percent last year -- nearly four times as much as the national rate of 0.9 percent -- according to a report yesterday to the state's hospital rate-setting commission.The Health Services Cost Review Commission responded by approving a formula designed to hold the increase in cost per case in the state to zero next year.Hospitals supported the formula change, but the Maryland Association of Health Maintenance Organizations called for cutting the per-case cost by 2.5 percent.

Last year, hospitals battled insurers over the state's formula for setting hospital rates, through task force meetings, hearings, a moratorium and a lawsuit. Finally, the Health Services Cost Review Commission crafted a compromise.Yesterday, the cycle started again.The staff of the commission, which sets Maryland hospital rates, proposed allowing hospitals an average rate increase of 1.7 percent to cover inflation over the next year.Hospitals said they could agree to that as a compromise, but felt that 2.5 percent is justified.

Facing difficult economic times and the uncertainties of national health care reform, some Maryland hospitals are choosing to be swallowed up by larger medical systems, with an unusual string of mergers over the past 16 months and more likely on the way. "We're getting bombarded with it every day that our health care system has to change fundamentally - it's not sustainable as it is," said Steven Thompson, senior vice president of Johns Hopkins Medicine,...

A state regulatory panel approved on Wednesday a 1.77 percent increase in the amount Maryland hospitals can charge their patients - a compromise of sorts between the figure state cost review staff members recommended and what hospitals wanted. The 6-0 vote by Maryland's Health Services Cost Review Commission is expected to translate to higher costs for patients treated in Maryland hospitals, companies that pay for health care costs as part of workers' compensation and insurers. The increase takes effect July 1 and applies for one year to 47 hospitals, employing 88,000 people.

Maryland hospitals are sharing the pain as people who have lost jobs and health insurance in the economic downturn find it harder to pay medical bills. Some institutions have had to cut services, lay off employees and reduce subsidies paid to doctors and nurses to keep them on staff. Bon Secours Hospital, a venerable West Baltimore institution since 1881, has been especially hard hit. Most of the hospital's clients are poor and rely on Medicare and Medicaid to pay for health care. Many patients with chronic illnesses - such as diabetes, kidney disease and asthma - lack health insurance that would allow them to see a primary care physician for regular check-ups and preventive treatment.

Maryland hospitals say: We want our bailout! Not in so many words, but that's the upshot of last week's Chewbacca-like cry of anguish from the Maryland Hospital Association. "Economic Crisis Hits Maryland Hospitals," said the official statement, launched as the association seeks to push up prices for Marylanders needing hospital treatment. Terrible news, if true. Health and social care make up only about an eighth of the Maryland economy, but they have accounted for well over half of the state's job growth over the past five years.

Malpractice rollback a windfall for lawyers At a time when the nation's economy is slumping and the governor is proposing to mandate that Maryland hospitals and physicians provide more free care to lower-income families, it's ironic that the state House Judiciary Committee, led by trial lawyer Joseph F. Vallario Jr., is proposing legislation to roll back the reforms in the state's medical malpractice insurance policies enacted in 2004 ("Attack of the...

A state proposal to set income standards for charity care that Maryland hospitals provide - and are reimbursed for by the state - is welcome and overdue. A report on how Maryland hospitals provide treatment for indigent and uninsured patients found that collection policies on unpaid patient bills vary widely and are unclear. And that needs to change. A series in this newspaper last year detailed the lengths some hospitals will go to collect bills despite the state reimbursements. That included placing liens on the homes of people with few assets but for the house they live in. The practice left many patients at the mercy of collection agencies.

Thousands of Marylanders who are sued over unpaid bills show up in court without a lawyer. Many of them try to negotiate the legal system on their own and end up agreeing to settlements that may not be in their best interest. The system may help resolve small-claims cases faster, but it isn't always fair or just. Officials of the District Court of Maryland have rightly recognized that and are trying to do something about it. The problems surrounding these debt collection cases were documented by a University of Maryland study last fall and a Baltimore Sun investigative series that focused on hospitals' tactics to reclaim unpaid bills, including for treatment of poor people for which they were reimbursed by the state.

Hospitals often wind up with stacks of unpaid bills because of the lack of universal health insurance coverage in this country. And certainly, no one likes to receive a letter or call from a bill collector or go to court over a hospital charge. Yet hospitals can only survive if bills get paid. That was one of several key points missing from The Baltimore Sun's series "In Their Debt" (Dec. 21-23). At the same time, hospitals aren't anxious to litigate. Few disputes make it to court: less than 0.5 percent of all hospital bills.

Maryland's unique hospital rate-setting system was created to keep health care affordable and available to all Marylanders. Whether patients were insured or not and despite their income, the regulatory system built in incentives to keep rates low and encourage hospitals to operate efficiently. And the public took on the responsibility of helping offset the costs to avoid patient dumping and ensure a quality of care regardless of one's ability to pay. But today, some of the very people the system was designed to protect are being victimized by hospitals with aggressive collections policies and regulators who haven't held them accountable.

Delegate John A. Hurson wanted to make Maryland's system for setting hospital rates fairer to poor people. As chairman of the House health committee, he was in a powerful position to make those changes happen. But he couldn't get several proposals through his own panel. They were watered down or removed from bills after the rate-setting agency and the powerful trade group representing hospitals teamed up against them. Hurson's experience was a testament to how sacred rate regulation remains in Maryland, more than 30 years after it was created.