Maryland hospitals' care judged by state analytical tool

Starting next month, Maryland hospitals will lose part of their reimbursement if they can't reduce the incidence of 52 potentially preventable conditions. While the concept is far from unique these days, providers say the way officials plan to go about it could use a bit more polishing.

As part of the roll-up to the program launch, the state has been assessing complication rates for each hospital, using a software tool from 3M. Last month, the state told hospitals which cases would have lost money for the hospital under the new program. The state plans to use the data as a baseline to decide whether providers are cutting down on their reimbursement rates.

Providers, however, are a bit concerned about the process. They're telling the state that they haven't had time yet to find out whether the 3M tool drew accurate conclusions and whether the complications it targeted were actually preventable. The program is moving forward without resolving the remaining questions about the analytics, they say.

That being said, Maryland has been heavily involved in regulating its healthcare providers--a state agency sets hospital rates, for example--and I doubt officials will back off easily. The state's hospitals may just have to suck up the technical and operational costs and move on.

To learn more about this program:
- read this Modern Healthcare piece [1] (reg. req.)

Related Articles:
Study: Hospitals spent $30B on avoidable admissions in '06 [2]
CMS expands list of no-pay conditions [3]
NY Medicaid will stop paying for 'never events' [4]