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Health Picture of Health

New health care landscape

It was a year of significant changes in how health care is delivered in Maryland. Here are some highlights:

Rocky rollout for Obamacare

Years of effort preparing for the Affordable Care Act culminated with the opening of state and federal health insurance exchanges, including the Maryland Health Connection, on Oct. 1. But that wasn't the end of the story.

Major technical problems marred the rollout, hampering enrollment as the state aimed for a goal of signing up 150,000 Marylanders for health insurance by the end of March. Community groups working for the state took to street corners, pharmacies, churches and fairs to get the word out on new coverage available through the exchange and broadened Medicaid eligibility, but the website handling public queries and sign-ups was slow or nonfunctioning.

Behind the scenes, technical issues and disputes among contractors working on the state exchange's website set back the recruitment efforts, according to emails obtained by The Baltimore Sun in a public information act request.

Amid the problems, the exchange's executive director, Rebecca Pearce, resigned, and Gov. Martin O'Malley and Lt. Gov. Anthony G. Brown were put in the spotlight to answer for the problems. Brown, who is running for governor, was tasked with overseeing health reform efforts in the state.

Although some troubles remained, by mid-December users reported seeing improvements.

Maryland's troubles mirror those seen in other states and in the federal government's exchange.

Changes ahead for hospitals

Hospital leaders and state health care regulators spent much of the year ironing out a plan to bring major changes to the way the facilities are paid for care.

Hospitals would be guaranteed a certain amount of revenue for providing care each year under the new model, replacing a longstanding system in which hospitals are paid for each service performed. Growth in that revenue level would be limited to keep pace with growth in the state's economy.

The plan seeks to help drive down the overall costs of health care, encouraging hospitals to treat patients more efficiently. It comes in response to a steady rise in the state's cost per hospital case, a statistic that threatens a unique system in Maryland in which regulators set the rates all insurers, including the federal Medicare and Medicaid programs, pay to hospitals.

After months of fine-tuning and input from hospitals and insurers, state regulators submitted the plan to the federal Centers for Medicare and Medicaid Services in October. The agency's decision was expected by the end of the year, making the new model effective Jan. 1.

Justice extended for Henrietta Lacks

Henrietta Lacks, the Turners Station woman whose cells were collected 62 years ago by Johns Hopkins doctors, unknowingly helped countless patients when her genome was used in groundbreaking medical research. Now her family will have a say in advances yet to come.

The National Institutes of Health and members of Lacks' family reached an agreement in August requiring researchers to get permission to use what are known as HeLa cells.

The cells were taken from the 31-year-old after she died of cervical cancer in 1951, and were kept alive in a glass tube. Lacks' story became well-known outside the medical community when Rebecca Skloot's book, "The Immortal Life of Henrietta Lacks," was published in 2010.

A panel that includes two of Lacks' descendants who live in Baltimore now decides what research can use the cells.

Regulators crack down on cosmetic surgery, pharmacies, abortion clinics

Maryland health officials moved to more closely regulate cosmetic surgery centers and compounding pharmacies in response to tragedies. Meanwhile, new concerns arose over abortion clinics.

The state passed a law that forbids plastic surgeons from performing risky procedures like liposuction in facilities that aren't inspected by the government or accrediting bodies. The measure came in response to the death of a Lochearn woman who contracted an infection after undergoing liposuction.

In response to three deaths from meningitis in Maryland in 2012, regulators pressed for a state law that officials said could close a gap in the oversight of pharmacies responsible for mixing and preparing large batches of drugs. The law requires pharmacies that perform compounding to obtain a permit, and places stricter oversight on compounded drugs from outside the state. Congress also passed a law giving the Food and Drug Administration a broader role in regulating such specialty pharmacies. Across the country, 750 people were sickened and 64 people died after receiving injections of tainted steroids from a Massachusetts compounding pharmacy in 2012.

A chain of clinics that perform abortions faced crackdowns after a Baltimore patient died and state health regulators found problems. Four facilities of Associates in OB/GYN Care LLC were suspended in May, and three doctors' licenses were suspended in June. Two of the doctors' licenses were suspended as of Dec. 12, while the third was placed on probation, according to the state Board of Physicians. The licenses for the four facilities remained suspended as of mid-December.

Copyright © 2014, The Baltimore Sun
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