The Maryland Hospital Association keeps a busy calendar during the legislative session in Annapolis. Carmela Coyle, the association’s president and CEO, said this year the organization would offer recommendations on more than 100 bills.
And this year she’s also had to pay attention to efforts to repeal and replace the Affordable Care Act led by congressional Republicans and President Donald Trump.
In Maryland, that includes protecting the unique way the state funds its hospitals, using global budgets instead of a fee-for-service system.
In an interview with The Daily Record last month, Coyle talked about the association’s legislative priorities, how to look after the state’s health care interests during the Affordable Care Act repeal talks and other issues affecting hospitals.
This year in Annapolis, the association’s focuses include a Medicaid tax reduction, liability reform and mental health care.
The following interview has been edited for length and clarity.
The Daily Record: How’s it going in Annapolis with your legislative priorities?
We’ll engage in probably well over 100 bills. But our three major priorities are: one, the spend down in the Medicaid tax. This was a tax that was put in place in 2009. It was intended to try to back-fill a hole in the state Medicaid budget, and it was intended to be temporary. It has never gone away. In fact it has ballooned from about $19 million in its first year to nearly $300 million. The good news is, last year the governor and the legislature agreed to put it on a spend-down plan. We were going to reduce it by $25 million a year. Not an extraordinarily rapid pace, but progress nonetheless. In the governor’s budget this year it was put on hold, given some of the financial issues the state is facing. We are working with the legislature right now and we hope to have that spend down reinstated for the current fiscal year and obviously continue to see that happen. …
Our second big issue is on the liability front and there are two bills that are the center of our efforts.
The first is there’s an effort on the part of trial lawyers to increase the cap on non-economic damages. They’re seeking to triple that cap in the case of wrongful death. We already provide unlimited compensation for economic losses — anything anyone might need, anything the family might need. The current cap is more than three-quarters of a million dollars. Our sense is that it is one of the higher caps among capped states and that now is not the time. …
And the second piece on liability is something that we’ve been talking about for years: the notion of creating a no-fault birth injury fund. A fund exists in the state of Virginia. Another fund exists in the state of Florida. It’s a way, first and foremost, to get families the compensation that they need timely. It doesn’t require people to have to go through the litigation system, which can take four-plus years to get compensation out of that system. It’s also a way to keep liability costs lower because it is a more administrative process as opposed to an adversarial legal process. This would apply to somewhere the actuaries have estimated between five and seven cases a year. …
Our third legislative push, and this is where we are really in the lead, is the behavioral health issue — mental health and substance abuse issues. We’ve got a crisis in Maryland, we’ve got a crisis nationwide. We are working on a couple of pieces. We are very proud of the fact this year that we have come together with the community-based health providers. Last year there were 110, I think, behavioral health bills. And we said we need to really come together and help the legislature understand what our handful of health priorities are.
How are you dealing with the repeal of the Affordable Care Act at the federal level?
We are working very closely with our national counterpart, the American Hospital Association. I have the pleasure at the moment of serving on their board of trustees. I have the advantage at the moment of a front-row seat. I think it’s a 21-member board. That pulls Maryland, I like to think we’re at the right place at the right time. …
The most important message is we’ve all got to maintain coverage expansions that were achieved under the Affordable Care Act. We’ve got to make certain that if there is a repeal of the Affordable Care Act that there is a simultaneous replacement. By simultaneous we don’t necessarily mean in the same piece of legislation, but at the same time. …
From my perspective for Maryland’s hospitals, we need three things in order to continue to be successful: broad-based continuous coverage, a high-functioning insurance market, and these value-based payment options like we have here in Maryland.
There are issues with staffing of specialized nurses at hospitals. Is this a broad problem?
We have shortages in particular in certain kinds of specialties. Intensive care unit nurses, critical care unit nurses, in particular, are in very, very short supply. I know they’ve got concerns in the state psychiatric hospitals. That is a very tough job, high levels of burnout as in the ICU and CCU. Most of our hospitals are having to resort to temporary staffing agencies more than they previously did. We have shortages perhaps of the most highly trained and/or seasoned nurses.
It’s not about getting nurses right out of school, it’s about those dealing with the most serious and acute situations. It is a challenge. It is something that we are dealing with. It can result in some backup in the emergency department because if we are not able to staff the telemetry beds we are finding people are waiting longer in the emergency department longer than anyone would like before we can move them up to these special floors.
Maryland jumped out to get involved in the national drive to reduce disparities in care. Where are you with that? Has there been any progress made?
This is going to be a long-term effort. It’s not something that’s going to change overnight. I am particularly proud of Maryland. We are the only state that has 100 percent of our hospitals signed on to participate. That’s the easy part of our question. The hard part is actually, we’re talking about changing the culture and behavior within organizations, large organizations. We’re the largest private-sector employer in the state. … So we have been doing some listening. What do you need? What are your challenges? How can we be helpful to you? And we are encouraging them to learn from one another. …
This has a lot of personal import for me. I am Colombian. As Carmela Sofia Peña, this is an issue that means a lot to me personally. This is something that I will be personally involved and engaged in. And it’s just an appreciation perhaps, more than some others, about the cultural differences that we have the privilege to treat.
Some hospitals outside Maryland are trying to identify ‘frequent fliers’ in order to lower costs. Our hospitals are doing that?
We are doing it … broader and deeper than anyplace else.
We are pedal to the metal here in Maryland, we really are. We talk about the data analytic capability, we’ve got some of our systems, I’ll use MedStar as an example, they are going and doing predictive analytics. This is some cool stuff. They can actually go in and using predictive data analytics, understand, not only who your friendly faces are, but who they are going to be. This is the whole (Wayne) Gretzky (quote), ‘you have to skate to where the puck is going.’ They can actually predict who is at greatest risk and the patients we need to be focused on now because they are about to be the high risk patients.
President & CEO, Maryland Hospital Association, 2008 – present
Board member, American Hospital Association
Board member, Maryland Healthcare Education Institute
Board member, Maryland Patient Safety Center
Board member: Living Legacy Foundation of Maryland
20-year career with the American Hospital Association (achieving Senior VP, Policy; national media spokesperson), 1988-2008
Analyst, Congressional Budget Office, 1982-1988
University of Michigan, Ann Arbor, MI
Fellow, Pew Charitable Trust
Course work and exams completed toward Doctorate in Public Health, October 1992
Carleton College, Northfield, MN
B.A., Economics and Spanish Literature, June 1982