As the Mid-Shore’s UM-Shore Regional Health starts to finalize reorganization plans this fall, including the future role of health care in Chestertown, Cambridge, and Easton, the Spy thought it would be interesting to understand more clearly the economic forces at play that required organizational reconstruction in the first place.
And on that question, we could find no better place to turn to than Maryland’s Health Services Cost Review Commission, or affectionately known as HSCRC. While the name might sound bureaucratic and even rather benign, the truth is that the HSCRC is at the heart of a revolutionary change taking place on the Eastern Shore and every other region in the state.
Why? It is because this tiny state agency, located next to a Burlington Coat Factory and a Panda Express near Baltimore, single-handedly decides the rates and global budgets for hospital services located at a hospital – for both inpatient and outpatient services. In other words, it doesn’t matter who pays your medical expenses, private health insurance, Medicare, or Medicaid, those charges only exist with the full approval of the HSCRC. It’s a big deal.
In fact, Maryland is the only state in the country that can control significant aspects of its health economy. And while it has been able to set health care costs since 1977, it was only in January of 2014 that the HSCRC instituted a new “All Payer” model that permanently terminated its pay for services model.
The end of pay for services has been replaced by a revenue model that encourages and economically rewards health systems that appropriate care options beyond inpatient care. At the same time, that same model pushes regional hospitals to increase community health programs that dramatically reduce the need for inpatient care with those with chronic illnesses.
Sitting on top of this revolution is Donna Kinzer, HSCRC’s executive director. A health policy consultant and analyst for several decades prior to joining HSCRC, her passion for redefining health care comes from a personal family tragedy. While caring for her terminally ill husband when she was 39 years old, Donna witnessed first hand how the old “hospital door to hospital door” model was grossly inadequate for both the patient and as a sustainable business model.
This video is approximately fourteen minutes in length