For Maryland's health spending plan, devil is in the details While some see Massachusetts as pushing boundaries by trying to establish health-spending ceilings, "Maryland has set hospital prices for more than 30 years" for insurance companies and Medicare alike, Joshua M. Sharfstein, state secretary of health and mental hygiene, said in an interview. There are tools to accomplish this in Maryland that do not exist in other states. The plan also discusses sweeping measures to coordinate treatment and reward caregivers for efficiency instead of performing procedures. "This is a really exciting proposal," said John McDonough, a Harvard University professor and former state legislator who helped design Massachusetts" health-care overhaul. It's nationally significant. The earliest the measure could take effect is January, but it is far from being adopted as written. Hospitals reacted coolly, and state legislators complained about how it was developed. The proposal is a "tectonic change" and "the single most important event that's affected Maryland hospitals in the last 40 years," Carmela Coyle, chief executive of the Maryland Hospital Association, said at a General Assembly hearing last week. The only thing that's certain at this point in the application is the [spending] cap. We don't know about the mechanisms that will actually get us there. Even the chief executive of Maryland's biggest private health insurer, who has reason to welcome measures to restrain hospital spending, said the plan is short on details and long on risks for hospitals. "It would be wonderful if [costs] could be slowed down," said Chet Burrell, chief executive of CareFirst Blue Cross Blue Shield. But then you have to turn to another question. And that is, what is the method by which they would decrease? How do you turn the system on a dime? That's where our concerns with the proposal are greatest. The plan leaves many of these details to Maryland's rate-setting Health Services Cost Review Commission. Two of the commission's seven members are hospital executives, including Chairman John Colmers, a vice president at Johns Hopkins Medicine in Baltimore. As a counterforce to industry skeptics, the proposal may have the backing of Obama administration officials who see Maryland's tradition of rate control as a promising model, said Joseph Antos, a health economist at the American Enterprise Institute who sat on the commission for several years. "People who favor rate-setting only have Maryland as the example," Antos said. The Obama administration believes that [such an approach] is an important strategy. I think this is the way they would want states to go in the future.