CMS approves Maryland waiver to encourage care coordination
Maryland hospitals have a new federal reprieve from kickback laws to team up with doctors and better coordinate patient care.
Under a new CMS waiver approval, Maryland hospitals and doctors can enter care-coordination partnerships and share savings stemming from more efficient treatment, according to Nicole Dempsey Stallings, vice president of policy at the Maryland Hospital Association.
Such partnerships could trigger federal anti-kickback laws, but the approved plan waives participants' liability starting July 1. Sixteen hospitals will participate in the Care Redesign Program, and more will be able to join next year.
"This model is recognition that initiatives affecting quality and cost need to include more than just hospital care," said Brian White, executive vice president at LifeBridge Health, a four-hospital not-for-profit provider based in Baltimore. "To affect true population health, we need mechanisms to allow outside partnerships."
Maryland's waiver will help the state maintain its Medicare cost-savings momentum.
Maryland is the only state that can set its own pay rate for hospitals, a policy that has been in place since the 1970s. All other states have theirs set by insurance companies or Medicare.
The arrangement has come with caveats. The state agreed in 2014 that it would have to cut total Medicare costs by $330 million over five years to keep its Maryland All-Payer Model. Maryland also had to reduce its hospital readmission rate and cut hospital-acquired infections and other preventable conditions.
If it failed to meet those conditions, Maryland's hospitals could have lost approximately $1 billion per year in Medicare payments. The state tends to reimburse care at a higher rate than the CMS.
The state's care redesign program will run through the end of 2018, when the current Maryland All-Payer Model contract ends. Maryland officials plan to submit a renewal proposal in the next year.
In addition to allowing hospitals and doctors to share in savings, the effort also makes it easier to access a patient's data from multiple providers to ensure that all providers responsible for that person's care are aware of all treatments being received.
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