A special state commission will recommend today that Maryland state agencies be given the ability to stop all expansion of Maryland hospitals, cap hospital revenues, strip hospitals of unneeded beds and services and even close them down.
The proposals, in a final report to be forwarded to Gov. Harry Hughes, would greatly strengthen the state's already formidable power to regulate the medical care community.
The commission concluded the changes are needed, Maryland House Speaker Benjamin L. Cardin said, "because we are paying for 2,/000 to 4,/000 excess hospital beds. It is uneconomical health care. We have to purge the system."
If endosed by the governor, the recommendations -- some of which are bitterly opposed by the Maryland Hospital Association -- will make up a major package of bills for the legislature when it convenes in January. General Assembly leaders predict that passage is far from certain, despite near-unanimous agreement that the state must act to constrain rising health care costs.
"The special interests will be opposing us," said Cardin, a member of the task force composed of legislators, physicians, state regulators and members of the business community.
The commission's recommendations would: impose an immediate moratorium on hospital expansions; encourage hospitals to voluntarily eliminate excess capacity through mergers and conversions to other uses; and give the state the authority to revoke licenses for beds and services if the industry fails to cooperate.
The task force has also recommended imposition of an overall revenue cap on the state's hospitals.
The task force's action comes in the wake of growing concern on the part of the Reagan administration and Congress, as well as private employers, about medical care costs, which have soared nationwide from $12.7 billion in 1950 to $322 billion in 1982.
Maryland has been relatively successful recently in curbing increases. In 1977, Maryland's hospital cost per day was 13 percent above the national average. By 1982, it was less than 0.5 percent above the national average.
Such performance is one reason Maryland hospital officials say they are opposed to further regulation. Adoption of the commission's recommendations would result in the closing of some hospitals, reduction in services at others and increased competition between hospitals and private physicians over the purchase of expensive equipment, said Richard Wade, spokesman for the Maryland Hospital Association.
"You'll see the closing of an institution or two in the next five years," Wade said, "undoubtedly in Baltimore."
The current drive to rein in health care costs in Maryland is designed to improve the state's chances of retaining the rate-setting system now in place for Medicare and Medicaid patients.
Since 1977, the federal government has allowed Maryland to set the rates doctors and hospitals can charge those patients, rather than force the state to accept rates set by the federal government.
Under the Maryland system, bad debts and the cost of charity cases are spread among all patients. This so-called all-payer system guarantees access to care to anyone and discourages hospitals from refusing service to those who cannot pay or who have no medical insurance.
Maryland has been able to hold on to its system because the rate of increase in the state's overall medical costs has been below the national average. However, Medicare changes adopted by Congress last year will make it increasingly difficult for Maryland to set its own Medicare rates unless it continues to make hospitals more efficient.
The task force proposals include:
* An immediate moratorium on all hospital and nursing home expansions until October 1985, to give state regulators breathing room to develop ways of coping with the projected excess of beds. The governor would also be given power to impose future moratoriums on new services.
* Measures to encourage hospitals to consolidate services and convert facilities to such uses as nursing homes and rehabilitation centers.
* Giving the secretary of health the power to decertify beds and services in cases where excess capacity is found and where voluntary steps fail. The secretary would have the power to remove a few beds or close an entire hospital.
* Giving the state authority to set an overall revenue cap for hospitals and reduce the rates of any whose costs are deemed too high.
* Regulating the purchase of expensive equipment by doctors, as is currently done with hospitals.
Officials of the Maryland Hospital Association, though they have worked with the commission and endorsed a number of its recommendations in principle, said they are opposed to the revenue cap and certain aspects of the moratorium and authority to revoke licenses.
The professional society representing the state's doctors is expected to oppose any regulation of the purchase of sophisticated and expensive equipment.
All of which promises an epic fight in Annapolis this winter. "It's going to be extremely tough," said Cardin. "It's not a popular thing to close a hospital."