Bloomberg Businessweek
Maryland Will Limit Hospital Charges Statewide
Maryland just became the biggest petri dish in Americafs experiment to
contain health-care costs. The state will limit how much money hospitals take
in: Over the next five years, it will try to keep hospital charges from growing
faster than the average growth rate of Marylandfs economy, saving Medicare $330
million.
The state will also transform how hospitals get paid, from billing for each
service provided—an incentive for doctors to order more tests and treatments—to
getting paid for keeping people well. Thatfs an idea that Medicare, the federal
insurance program for the elderly, is testing across the country with groups of doctors and
hospitals. The Affordable Care Act nudges health-care providers to move away
from the fee-for-service system in an attempt to tamp down the national
medical bill, but itfs still how most health care is bought and sold in the
U.S.
gThe goals of this new system will be very challenging for hospitals,h said
Carmela Coyle, president of the Maryland Hospital Association, in a news
release (pdf). hThe
ideas included have never been tried nor tested before on this scale.h She
calls the change gthe right thing to do.h
Maryland is in a unique position to experiment. In other states, hospitals
negotiate prices with private insurers and agree to lower rates set by
Medicare—often below their costs. Maryland is the only state where a state commission sets hospital prices for all payers—that
is, private insurers and Medicare pay the same thing. Itfs similar to how state
utility commissions set the rates for electric companies. The arrangement, which
dates to the 1970s, requires a waiver from Medicare to pay Maryland hospitals
different rates than the rest of the country.
That agreement is being updated under the new deal. The state will get to
continue setting rates, but overall per-capita hospital spending canft grow more
than 3.58 percent per year, the average growth rate of the statefs economy over
the past decade. Hospitals agree to meet certain quality targets—reducing how
many Medicare patients are readmitted, for example. Theyfll also shift from
fee-for-service payments into a pay-for-performance system, the details of which
still need to be worked out.
gWefre really looking at being measured on how healthy the communities are
and not just how much we bring in,h says Jim Reiter, spokesman for the Maryland
Hospital Association.
The Obama administration is betting on the model to bring down costs. In a
news release, Medicare chief Marilyn Tavenner called it a gstep to ensure that
Marylandfs unique health-care delivery system can also be aligned with the goals
of lowering cost and improving health.h
If Maryland canft make it work—if hospitals fail to contain costs and donft
deliver the savings to Medicare—the state will have to go back to the same
Medicare rates that hospitals get in the rest of the country. But if the change
does succeed in reining in hospital costs and improving the health of
Marylanders, it likely wonft be the last state to try.