Evaluation, Monitoring, Modification and Cancelation Provisions. A. Necessary Monitoring of TPR Operation and Performance Significant increases or decreases in the Hospital’s Market Share of patients (receiving regulated hospital services) in its Primary and Secondary Service Areas can have materially positive or negative impacts on the efficacy of this Agreement (the Hospital’s Primary and Secondary Service Areas are defined by ZIP code and presented in Appendix B to this Agreement). The HSCRC will monitor the Hospital’s market share overtime by analyzing and identifying and shifts in the Hospital’s patient volume from its base year Primary and Secondary service areas. Significant changes in the Hospital’s market share may be the basis for a renegotiation of the Hospital’s TPR constraint as 2 Update factor is inclusive of quality scaling for the Commission’s Quality-Based Reimbursement and Maryland Hospital Acquired Conditions described in subsection D below. Similarly, significant changes in the care delivery system in the Hospital’s Primary and Secondary Service Areas can also positively or negatively influence the appropriateness of the Hospital’s current TPR constraint. The Hospital thereby agrees to declare and describe any financial interest (or ownership) it has in non-hospital services provided within the Hospital’s Primary and Secondary Service Areas, as of the effective date of this Agreement, in Appendix C. The Hospital must also inform the HSCRC of any significant future acquisitions or divestitures of non-hospital health services.3 The HSCRC may request data on the utilization of these services historically and over time to ensure that compliance with the TPR Constraint is achieved by better utilization management of existing regulated services and not through a shifting of services from the regulated to the unregulated sectors. Hospital agrees to notify the HSCRC staff in advance or notify the HSCRC staff of any other significant changes to the care delivery system in its primary and secondary service area as a result of changes initiated by the Hospital, its affiliated providers or by other care groups not related to the hospital within 30 days of becoming aware of said developments. Staff will also monitor the Hospital’s performance on the HSCRC’s core Quality of care metrics (The Hospital’s overall ranking and year-to-year changes in Quality-Based Reimbursement, Maryland Hospital Acquired Conditions, Rates of Preventable Readmissions and a review of the Hospital’s risk- adjusted Mortality.) It is expec...
