Bob Atlas, president and CEO of the Maryland Hospital Association, wrote that Maryland hospitals are “doing it right” and should serve as a model to other states for high-quality, cost-effective hospital care [“Opinion: What Sets Maryland Hospitals Apart,” Jan. 9, 2020]. Perhaps he has forgotten the recent high-profile scandals of self-dealing by University of Maryland Medical System board members, and the dumping of a vulnerable patient at a bus stop in Baltimore wearing only a hospital gown on a frigid January night.
What sets Maryland hospitals apart is clearly a need for patient-centric care.
Let’s look at some hard data on the performance of Maryland hospitals relative to other states.
Maryland hospitals rank 46th in the USA in patient satisfaction, as measured by the Centers for Medicare and Medicaid Services. CMS surveys patients about critical aspects of their hospital experience. Metrics include communication with nurses and doctors, responsiveness of hospital staff, pain management, care transition, cleanliness and quietness of the hospital environment, discharge information and overall rating of the hospital. Maryland has remained at or near the bottom of 50 states since the patient satisfaction results were first published in 2015.
Maryland hospitals rank only 38th in patient safety, based on analyses conducted by the Leapfrog Group in fall 2019. The Leapfrog Hospital Safety Grade uses national performance measures from CMS, the Leapfrog Hospital Survey and other sources. Metrics for the Hospital Safety Grade include medical errors, hospital acquired infections (including the deadly C.diff infection), hospital-caused accidents and injuries. The Leapfrog Group notes that most hospital errors can be prevented. Maryland hospitals need to work harder to protect their patients from errors, injuries, accidents and infections that can result in disability or death.
Maryland hospitals rank 50th in emergency room wait times. Based on data from the CMS, ProPublica published ER wait times by state — both the average time a patient spends in the ER before being sent home and the average time a patient spends in the ER before admission. In both categories, Maryland ranked worst (longest average wait time) of 50 states. Maryland hospitals can do better; for example, additional staffing could be provided during peak ER periods such as flu season.
Despite these low rankings in key indices of hospital health care, Mr. Atlas stated that Maryland is a model health care system that aims to control costs and improve quality on a large scale. If this is indeed the aspiration of the MHA, Maryland hospitals need to become more patient-centric and transparent on costs.
Here are several ways to start:
All Maryland hospitals need to actively implement the 2019 Hospital Patient’s Bill of Rights which passed the Maryland General Assembly unanimously and was signed into law by Gov. Larry Hogan. The new law requires that each hospital patient — whether admitted, out-patient or in ER — be provided a copy of the Hospital Patient’s Bill of Rights in a manner they understand. The law, which went into effect Oct. 1, requires that all 24 legal rights of hospital patients are also posted in conspicuous places throughout the hospital. Annual training of all medical personnel in patient rights is required. Similar laws have been passed in 27 other states.
Despite the clear mandates of the law, some Maryland hospitals are slow in its implementation. Some hospital websites fail to accurately communicate the rights clearly stated in the law; rights are deleted, incomplete or changed in meaning. The MHA should work proactively to ensure that all hospital members are compliant.
Patient advocates should be available at every hospital to support vulnerable patients, especially those who arrive alone. Pairing vulnerable patients with trained advocates could help prevent patient dumping by hospitals, and ensure each patient is treated with dignity and respect in a safe environment.
Patient advocacy groups should be represented on the board of directors for each hospital. Advocates, particularly those who represent vulnerable groups such as people with disabilities and seniors, should be voting members of all Maryland hospital boards. Such an approach will help to ensure that the hospital serves the best interests of its patients.
Surprise billing of hospital patients by non-preferred providers must be curtailed. A provision in a 2010 Maryland law titled “Assignment of Benefits and Reimbursement of Non-Preferred Providers” requires that patients be informed when they may be charged for non-covered services. The law is poorly implemented, however, and surprise hospital billing continues to be a problem in Maryland.
Finally, it is time to stop mythologizing the stature of Maryland hospitals and to acknowledge the problems.
Maryland hospital leaders need to work constructively with patient advocacy groups and elected officials to improve the quality of care in Maryland hospitals, which falls far below the national average in key measures. There’s a lot of work to do, so let’s get started.
— ANNA PALMISANO
The writer is with Marylanders for Patient Rights. The Marylanders for Patient Rights Coalition includes 25 advocacy groups: AARP MD, Alzheimer’s Association of MD, AAUW, American Council of the Blind-MD, The Arc Maryland, CASA, Citizens for Patient Safety, Compassion and Choices, Consumer Health First, Disability Rights MD, Maryland Alliance for the Poor, Maryland Coalition of Families, Maryland Coalition on Mental Health and Aging, Maryland Developmental Disabilities Council, Maryland Protection and Advocacy for Individuals with Mental Illness Advisory Council, Maryland Retired School Personnel Association, Mental Health Association of Maryland, NAACP–MSC, NARAL Pro-Choice MD, National Association of Social Workers – MD, Patient Safety America, Support for Families of Nursing Home Residents, Surgical Fire, Unitarian Universalist Legislative Ministry of Maryland and United Seniors of Maryland.