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Carmela Coyle

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Progress report on Maryland’s healthcare-transformation program


Tidal marshes on the Chesapeake Bay, Maryland’s most notable natural feature.

Here’s a  update from  Carmela Coyle,  president and CEO of the Maryland Hospital Association, on Maryland’s nationally watched five-year partnership with the Center for Medicare & Medicaid Innovation to see the effectiveness/outcomes from shifting hospitals’ focus toward preventive, community-based care from  acute emergency care, surgeries and inpatient stays. The goal are to control cost growth  and to help people get and stay healthy, before they need a hospital visit.

Ms. Coyle writes:

 “This {program} was a 180-degree turn from the traditional hospital business model and from the way things are done just about everywhere else in the country. No longer would hospitals be paid based on how many patients they treated or services they provided, but rather on making sure that people receive the right care, at the right time, in the right setting.”

Last month the experiment reached its midpoint. Ms. Coyle listed some outcomes so far:

  • “Readmissions rates are decreasing faster than the national rate
  • “Hospital-acquired conditions are down by more than one third
  • “Avoidable hospital visits are down more than 17 percent

“Much of this has been accomplished through innovative, non-traditional hospital activities like the Maryland Faith Health Network, a pilot program that connects hospitals with churches, synagogues, temples and other faith organizations to improve their congregants’ well-being and ability to navigate the system. Other examples:

  • “A free program that connects people who have complex health issues with a health navigator–a registered nurse or licensed social worker who provides one-on-one guidance and care coordination.
  • “Care A Van,” a large RV that transports a social worker and medical staff, who provide free health screenings, help with Medicaid applications, immunizations and more for uninsured children and their families with no regular source of medical care.
  • “Wholesome Wave, which provides a “prescription” for healthy foods for underinsured and uninsured diabetic patients. Vendors at local farmers markets accept these ‘prescriptions’ and provide healthy food at a reduced cost.”

“For the most part, these programs and others like them were conceived and implemented by hospital staff and leaders. While the initiatives have generated strong results, consumers have been largely unaware of these seismic changes, or what they mean for navigating the rapidly changing world of healthcare.’

“Enter a new statewide public engagement campaign, launched in late June, to connect healthcare consumers to this transformation through their local hospitals. The campaign, ‘A Breath of Fresh Care,’ features several health- engagement tools for Marylanders who would like to know more about how healthcare is changing and about how they can partner with healthcare providers to take a more active role in staying healthy before they need care, being empowered during care and remaining healthy after care.”

To read all of her comments, please hit this link.

Md. hospitals launch patient-engagement campaign


The Baltimore Sun reports on how hospitals in Maryland, as in many other places, are changing  how they deliver care, “focusing more on coordinating services and preventing complications.” And they’re launching a campaign to explain the new approach to the public.

“Called ‘A Breath of Fresh Care,’ the campaign’s goal is to get patients to engage in their care by directing them to hospital wellness and chronic-disease management initiatives, as well as information on interacting with providers or even the process of registering a complaint,” the paper reports.

So the Maryland Hospital Association has set up a Web site called with links to individual hospitals’ Web sites. And public-education forums will start in the fall.

“Healthcare in Maryland, is evolving by leaps and bounds; gone are the days when consumers sat on the sidelines, detached from their care,” said Carmela Coyle, association president and CEO. “Healthcare in the 21st Century is about patients; hospitals and other providers are looking to their patients and communities like never before as partners in health. Simply put, to enable Marylanders to lead long, healthy lives, we need their help.”

To read The Sun’s story, please hit this link.

Facing the challenge to tax-exempt status


Carmela Coyle, president and CEO of the Maryland Hospital Association, says that moves by municipal, county, state and federal governments to challenge the tax-exempt status of not-for-profit hospitals are a call to arms.

She notes  in a Hospital Impact piece that the Affordable Care Act imposed additional requirements that hospitals must meet to keep their tax-exempt status:

  • Conduct a community health needs assessment at least once every three years
  • Adopt a written financial assistance and emergency medical care policy conforming to statutory criteria
  • Do not charge patients eligible for financial assistance more than “amounts generally billed” to insured patients
  • Do not begin “extraordinary collection actions” before making “reasonable efforts” to determine if a patient is eligible for financial assistance

Ms. Coyle writes: “While the individual efforts of various states and the requirements in the ACA are more than enough for hospitals to address, there’s something bigger happening. These recent movements appear to be the culmination of a significant and worrisome erosion of the trusted relationships hospitals have enjoyed for so many decades with their communities.”

“There remain many battles to be fought over the tax-exempt nature of hospitals, but fixing the root of this issue won’t take place in a courtroom or legislative hearing room. It will take place in each of the communities that hospitals are privileged to serve. In 2006, the American Hospital Association (AHA) released the 28-page Trust Counts Now report, which called for hospitals to ‘reaffirm their rightful place as valued and vital community resources that merit broad public support.”’

“With hospitals’ very nature under assault due to increased governmental budget pressures, that call is as relevant now as it was a decade ago. A Web site from AHA, Community Connections, offers resources to help with that effort, but it is at the hospital level, where nurses, doctors, trustees and others, will need to begin to rebuild and reaffirm the relationships with their communities, so that hospitals once again are perceived not as a drain on county coffers, but as the invaluable resources they are.”


Maryland successes in partnerships


“Here in Maryland, operating under a unique agreement with the Centers for Medicare & Medicaid Services, hospitals have made great strides in the quality of care by fostering new and innovative partnerships. In the first year under this agreement, hospitals have:

  • “Reduced the readmissions rate by 0.80 percent, faster than the nation as a whole.
  • “Reduced the cost of potentially avoidable utilization by nearly 7 percent.
  • “Reduced admissions from the emergency department by nearly 4 percent./

“This success was only possible because of collaboration among primary care physicians, long-term care facilities, home health operators and others. There is much experimentation around healthcare partnerships, but amid the uncertainty that comes with any new venture is a very inspiring idea–that different organizations, no matter where they sit along the care continuum, are committed to caring for the whole spectrum of their patients’ needs.”



More hospitals reject job applicants who smoke



Sigmund Freud, M.D., died of oral cancer caused by cigar smoking.

Carmela Coyle,  president and CEO of the Maryland Hospital Association, writes in Hospital Impact about some hospitals in that state that have banned the hiring of tobacco users. As she notes, some other providers in the nation, such as Cleveland Clinic, Baylor Health System and WellSpan, have done the same thing.
They’re on to something, she writes:  “From a public relations perspective, it’s tough to preach smoking cessation to patients and the community when hospital employees, who, in this new world of community partnerships, serve in many ways as hospital representatives, are smokers themselves. More importantly, however, is that the mindset of hospital executives and trustees is changing, as hospitals shift from fee-for-service payment models to those built on a foundation of population-health management. This new zeitgeist is one of abiding responsibility, for every single life in a hospital’s care. Its employees are no exception.”

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