Tag Archives: maryland

Dallas, Baltimore children’s hospitals embrace high-tech features in behavioral health areas to promote calmness

Photo courtesy of Children’s Health

Children and teenagers presenting to emergency rooms with behavioral health crises sometimes wait hours to days for a bed in a psychiatric unit or facility. Children’s Medical Center in Dallas is trying to make that stay less stressful for patients and their families by incorporating technologies such as mood lighting, projected images of calming scenery and an interactive touchscreen allowing patients to draw, play music or games.

Also, this year, the University of Maryland Children’s Hospital in Baltimore opened a new inpatient psychiatry unit for patients ages 5-17 featuring nature themes, special lighting and patients’ choices of relaxing sounds. In both cases, clinicians aim to create more calming environments to help de-escalate behavioral and mental health crises.

The Dallas hospital opened three “Philips rooms” (named after Phillips, their health care technology partner) in their emergency department in June 2021. A fourth is scheduled to open in 2022.

The inspiration behind these rooms

Inspiration came partly from two memorable patient experiences, said Keri Kaiser, senior vice president and chief marketing and experience officer for Children’s Health, during a recent webinar hosted by Becker’s Healthcare. Kaiser was in the ED one day when she saw a young girl, who was extremely violent, being held in a bare room alone. She was in the custody of Child Protective Services and had no parents or guardians with her. Because of her aggression, staff limited their interaction while hoping to find a placement in a psychiatric facility. On another occasion, Kaiser’s friends told her that their daughter, who was being held in the ED, was physically safe but felt helpless being stuck in a bare room.

Shortly after, Kaiser and others with the health system were scheduled to visit Philips to see what technology advancements could be brought to the neonatal intensive care unit. The company has worked with hospitals to offer what it calls the “ambient experience” — a variety of room designs, dynamic lighting, image projection and calming sounds to make waiting areas, and procedure and recovery rooms more pleasant. As Kaiser viewed these options, she asked if they could also be used for behavioral and mental health patients in the ED.

Geneva Burnap, M.B.A., R.N., N.E.A.-B.C., a nurse, and senior director for emergency services at Children’s Health, said during the webinar that she initially got some pushback about creating these rooms, because behavioral health holds only made up 4.5% of their patients. But studying analytics, she and her colleagues found that some 20% of care hours were spent on these patients.

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Putting a human face on Maryland’s unique all-payer system

Sarah Gantz has been fascinated with Maryland’s Medicare waiver since the Baltimore Business Journal hired her to write about health care more than two and a half years ago. She describes the policy as “the lifeblood of Maryland’s $15 billion hospital industry.”

Photo: hea_medev via Flickr

Photo: hea_medev via Flickr

Maryland is the only state with an “all-payer” hospital system – a system in which every health plan and every payer pays about the same rate to a given hospital for a given procedure or treatment. That includes Medicare, under a waiver from the federal government.  A commission sets the costs and there’s a lot less cost-shifting in the system if everyone is playing by the same rules.

Despite its importance, Gantz says that most people write it off as a wonky hospital rule that doesn’t affect them. With help from the AHCJ Reporting Fellowship on Health Care Performance, Gantz set out to explain why the policy is worth taking the time to understand. In this piece for AHCJ, she tells our readers what she learned and how she turned wonky policy into stories about real people.

How health care price fixing works in Maryland

As part of her series in National Journal, Margot Sanger-Katz explains how four decades of health care price controls have held costs in Maryland from 25 percent above the national average in 1976 to 3 percent below average in 2009.

national journalIn addition to price, the state’s system has also had an impact on quality of care and on hospital access, because Maryland’s universal prices mean that inner-city hospitals won’t be lured out to more affluent suburbs as they have been in cities such as Detroit and St. Louis.

Maryland’s system is what health care economists call all-payer rate-setting. The cost-containment board looks at services and hospital needs and then selects a uniform menu of prices for all payers. In most states, prices for the same procedure vary. Some payers, usually the public ones such as Medicaid, get a steep discount, while others pay more to make up the difference. (The country’s most expensive CT scan of the head is $1,545, according to the international health-plan study.) In Maryland, Medicare, Medicaid, private insurers, and patients who pay cash all get the same bill for a CT scan. It means that bigger, more powerful hospitals can’t demand higher prices from insurers. It also means that hospitals that treat Medicaid patients don’t get bankrupted by skimpy reimbursement rates.

Sanger-Katz is writing this series as part of an AHCJ Media Fellowship on Health Performance, supported by the Commonwealth Fund.