Comparison of Maryland’s and Neighboring States’ Medicaid Fees to Medicare Fees

FY 2018 A Chart Book

March 1, 2018

Prepared for the Maryland Department of Health TABLE OF CONTENTS

Chapter 1. Overview of Maryland Physician Fees…..………………………………… 3 Maryland Medicaid Physician Fees Key Findings Chart Book Organization Data Source Chapter 2. Evaluation and Management Procedure Fees……………………………… 6 Chapter 3. Surgical Procedure Fee Data ……………………………………………… 8 Chapter 4. Medical Procedure Fee Data ……………………………………………… 23 List of Figures…………………………………………………………………………… 39

2 Chapter 1. Overview of Maryland Physician Fees

3 Chapter 1. Overview of Maryland Physician Fees

States Medicaid Physician Fees

This chart book compares the Medicaid reimbursement Virginia and Washington, DC have separate facility and rates of Maryland and its surrounding states with non-facility fees for some procedures, but they did not Maryland’s Medicare fee schedule for FY 2017. The report facility fees for some of the procedures that are surrounding states included in this study are Pennsylvania; included in this chart book. Therefore, this chart book only West Virginia; Virginia; Washington, DC; and Delaware. compares Medicaid non-facility fees of Virginia and Washington, DC with the corresponding Medicare non- Medicare physician fees include three components: facility fees for the Baltimore region. physician’s work, practice expense (e.g., costs of maintaining an office), and malpractice insurance expense. In the following charts, facility is abbreviated as FA and The practice expense component composes, on average, non-facility is abbreviated as NF. approximately 40% of the total physician fee. When physicians render services in facilities, such as hospitals and Key Findings long-term care facilities, they do not incur a practice expense. Therefore, facility fees are typically lower than In CY 2018, average Medicare fees in Maryland are non-facility fees. approximately 6% higher than Medicare fees in Delaware, 4% higher than Medicare fees in Pennsylvania, 5% higher Maryland and West Virginia have separate facility and non- than Medicare fees in Virginia, and 7% higher than Medicare facility fees. However, Delaware and Pennsylvania do not fees in West Virginia. On the other hand, average Medicare separate facility and non-facility fees; therefore, their fees fees in Maryland are approximately 5% lower than average are compared with Medicare non-facility fees. Hence, for Medicare fees in Washington, DC. Delaware and Pennsylvania, the percentages of Medicare fees reported underestimate the percentages of Medicare fees for procedures performed in facilities.

4 V

Chapter 1. Overview of Maryland Physician Fees continued

Chart Book Organization

The data in this chart book are presented in three sections: The charts compare Maryland and neighboring states’ Physician Fees for Evaluation and Management Medicaid fees for FY 2018 as a percentage of the corresponding Baltimore region Medicare reimbursement Procedures: This section includes data on the Medicaid rates. reimbursement rate for evaluation and management procedures as a percentage of the Medicare The charts show each state’s weighted average Medicaid reimbursement rates for Maryland. fees. Maryland Medicaid’s numbers of claims and encounters were used as the weights for fees. The average Physician Fees for Surgical Procedures: This section percentages of Medicare fees reported in this table includes data on the Medicaid reimbursement rate for correspond to the appropriate Medicare non-facility and surgical procedures as a percentage of the Medicare facility fees. More specifically, Medicaid non-facility fees are reimbursement rate for Maryland. compared with Medicare non-facility fees, and Medicaid Physician Fees for Medical Procedures: This section facility fees, reported for Maryland and West Virginia, are includes data on the Medicaid reimbursement rate for compared with Medicare facility fees. medical procedures as a percentage of the Medicare reimbursement rate for Maryland.

Data Sources

The information in this chart book was derived from the FY 2018 Medicaid Physician Fee Schedules for Maryland and its neighboring states. The data were collected from the Medicaid physician fee schedules of Delaware, Pennsylvania, Virginia, West Virginia, and Washington, DC.

5

Chapter 2. Evaluation and Management Procedure Fees

6 Figure 1. Evaluation and Management Weighted Average (%) of Medicare Fees

100% 93% 93% 92% 90% 84%

80% 70% 68% 70% 65% For evaluation and management

60% procedures, Maryland non-facility and facility fees ranked first (tied). 50% Delaware fees ranked second; 41%

Percentage Washington, DC fees ranked third; 40% Virginia non-facility fees ranked fourth; West Virginia facility fees 30% ranked fifth; West Virginia non- 20% facility fees ranked sixth; and Pennsylvania fees ranked seventh. 10%

0% MD NF MD FA DE DC VA NF WV FA WV NF PA State

7 Chapter 3. Surgical Procedure Fee Data

8 Figure 2. Integumentary and General Surgery Weighted Average (%) of Medicare Fees

100% 93% 90% 86%

80% 77% 76% 76%

70% 65% 62% For integumentary and general

60% surgery, Delaware fees ranked first, followed by Washington, DC. 50% Virginia non-facility fees ranked

Percentage third, Maryland non-facility and 40% facility fees (tied) ranked fourth, 29% West Virginia facility fees ranked 30% fifth, West Virginia non-facility fees 20% ranked sixth, and Pennsylvania fees ranked seventh. 10%

0% DE DC VA NF MD NF MD FA WV FA WV NF PA State

9 Figure 3. Musculoskeletal System Weighted Average (%) of Medicare Fees

100% 94% 88% 90% 86% 81% 80% 77%

70% 65% Delaware fees for musculoskeletal 63% system procedures were the 60% highest in the region. Maryland non-facility fees ranked second; 50% Maryland facility fees ranked third;

Percentage 39% Washington, DC fees ranked 40% fourth; Virginia non-facility fees 30% ranked fifth; West Virginia facility fees ranked sixth; West Virginia 20% non-facility fees ranked seventh; and Pennsylvania fees ranked 10% eighth.

0% DE MD NF MD FA DC VA NF WV FA WV NF PA State

10 Figure 4. Respiratory Weighted Average (%) of Medicare Fees

100%

90% 86% 85%

77% 80% 76% 75%

70% 67% 62% For respiratory procedures, 60% Washington, DC fees ranked first; Delaware fees ranked second; 50% Virginia non-facility fees ranked 41% Percentage 40% third; Maryland non-facility fees ranked fourth; Maryland facility 30% fees ranked fifth; West Virginia facility fees ranked sixth; West 20% Virginia non-facility fees ranked seventh; and Pennsylvania fees 10% ranked eighth.

0% DC DE VA NF MD NF MD FA WV FA WV NF PA State

11 Figure 5. Cardiovascular System Surgery Weighted Average (%) of Medicare Fees

100%

90% 86% 79% 80% 77% 73% 70% 68% For cardiovascular surgical 61% procedures, Washington, DC has

60% the highest fees. Maryland non- facility fees ranked second; Virginia 50% 45% non-facility fees ranked third;

Percentage Maryland facility fees ranked 40% 35% fourth; West Virginia facility fees ranked fifth; West Virginia non- 30% facility fees ranked sixth; Delaware 20% fees ranked seventh; and Pennsylvania fees ranked eighth. 10%

0% DC MD NF VA NF MD FA WV FA WV NF DE PA State

12 Figure 6. Hemic, Lymphatic, and Mediastinum Weighted Average (%) of Medicare Fees

100% 93%

90% 85%

80% 77% 73% 73% For selected hemic, lymphatic, 70% 66% 63% and mediastinum procedures, Delaware fees were the highest 60% in the region, followed by 50% Washington, DC fees (second), Virginia non-facility fees (third), Percentage 40% 36% Maryland non-facility and facility fees (tied for fourth), West Virginia 30% facility fees (fifth), West Virginia non-facility fees (sixth), and 20% Pennsylvania fees (seventh).

10%

0% DE DC VA NF MD NF MD FA WV FA WV NF PA State

13 Figure 7. Digestive System Weighted Average (%) of Medicare Fees

120%

106%

100%

86% 78% 80% 77% 77% For selected digestive system procedures, Delaware fees 67% ranked the highest, followed by 62% Washington, DC fees (sec0nd), 60% 52% Maryland non-facility fees (third),

Percentage Virginia facility fees and Maryland facility fees (tied for fourth), West 40% Virginia facility fees (fifth), West Virginia non-facility fees (sixth), and Pennsylvania fees (seventh). 20%

0% DE DC MD NF VA NF MD FA WV FA WV NF PA State

14 Figure 8. Urinary and Male Genital Weighted Average (%) of Medicare Fees

90% 83% 83% 77% 80% 75%

70% 67% 62% 60% For urinary and male genital 60% procedures, Maryland non-facility fees and Washington, DC fees 50% 43% were tied and ranked highest in the region. Virginia non-facility 40% Percentage fees ranked second; Maryland facility fees ranked third; West 30% Virginia facility fees ranked fourth; West Virginia non-facility fees 20% ranked fifth; Delaware fees ranked sixth; and Pennsylvania fees 10% ranked seventh.

0% MD NF DC VA NF MD FA WV FA WV NF DE PA State

15 Figure 9. Gynecology and Obstetrics Weighted Average (%) of Medicare Fees

120% 109%

100% 95% 94% 91% 91% 86% 84% 81% 80% Pennsylvania fees for gynecology and obstetrics procedures ranked first in the region. West Virginia facility fees ranked second; West 60% Virginia non-facility fees ranked

Percentage third; Maryland non-facility and facility fees (tied) ranked fourth; 40% Delaware fees ranked fifth; Washington, DC fees ranked sixth; and Virginia non-facility fees 20% ranked seventh.

0% PA WV FA WV NF MD NF MD FA DE DC VA NF State

16 Figure 10. Endocrine System Weighted Average (%) of Medicare Fees

100% 94%

90% 84%

80% 78% 72% 72% 70% 67% 67% 62% For endocrine system procedures,

60% Delaware fees ranked the highest. Washington, DC fees ranked 50% second; Virginia non-facility fees

Percentage ranked third; Maryland’s non- 40% facility fees tied with its facility fees and ranked fourth; West 30% Virginia’s non-facility fees tied with 20% its facility fees and ranked fifth; and Pennsylvania fees ranked 10% sixth.

0% DE DC VA NF MD NF MD FA WV NF WV FA PA State

17 Figure 11. Neurosurgery Weighted Average (%) of Medicare Fees

120%

103% 100% 96% 95%

86% 85%

80% Maryland non-facility fees for 66% 62% neurosurgery procedures were the 60% highest in the region, followed— in ranking order—by Delaware Percentage 43% fees, Maryland facility fees, 40% Washington, DC fees, Virginia non- facility fees, West Virginia facility fees, West Virginia non-facility fees, and Pennsylvania fees. 20%

0% MD NF DE MD FA DC VA NF WV FA WV NF PA State

18 Figure 12. Eye Surgery Weighted Average (%) of Medicare Fees

100% 94%

90% 85% 85%

80% 78% 78% 78%

70% 64% 64% For eye surgery procedures, Delaware fees ranked first in the

60% region. Pennsylvania fees and 50% Washington, DC fees tied for second. Maryland non-facility fees, Percentage 40% Virginia non-facility fees, and Maryland facility fees tied for third. 30% West Virginia non-facility fees and West Virginia facility fees tied for 20% fourth.

10%

0% DE PA DC MD NF VA NF MD FA WV NF WV FA State

19 Figure 13. Ear Surgery Weighted Average (%) of Medicare Fees

90% 85% 83% 83% 80% 78%

70% 66% 64%

60% For ear surgery procedures, Washington, DC has the highest 49% 50% fees in the region. Maryland non- facility fees and Maryland facility 40% 40% fees (tied) ranked second, Virginia Percentage non-facility fees ranked third, West 30% Virginia facility fees ranked fourth, West Virginia non-facility fees 20% ranked fifth, Delaware fees ranked sixth, and Pennsylvania fees ranked seventh. 10%

0% DC MD NF MD FA VA NF WV FA WV NF DE PA State

20 Figure 14. Radiology Weighted Average (%) of Medicare Fees

100% 92% 90% 86% 79% 79% 79% 80% 72% 70% For radiology procedures, 60% 60% Delaware fees were highest in the

60% region. Following Delaware—in 50% ranking order—were Washington, DC fees; Maryland non-facility fees, Percentage 40% Virginia non-facility fees, and Maryland facility fees (tied); 30% Pennsylvania fees; and West Virginia non-facility and facility 20% fees (tied).

10%

0% DE DC MD NF VA NF MD FA PA WV NF WV FA State

21 Figure 15. Laboratory Weighted Average (%) of Medicare Fees

120%

105% 105% 101% 100%

86% 83% 79% 79% For each laboratory procedure, 80% Medicare had one fee, regardless

of place of service. West Virginia 64% facility and non-facility fees (tied) 60% were the highest in the region for the selected laboratory Percentage procedures, followed—in ranking 40% order—by Delaware fees; Virginia non-facility fees; Washington, DC fees; Maryland non-facility and 20% facility fees (tied); and Pennsylvania.

0% WV NF WV FA DE VA NF DC MD NF MD FA PA State

22 Chapter 4. Medical Procedure Fee Data

23 Figure 16. Psychiatry Weighted Average (%) of Medicare Fees

120%

100% 100% 100% 96%

83% 80% 80% For selected psychiatry 69% 69% procedures, Maryland’s non-facility and facility fees (tied) ranked first 60% in the region; Delaware fees ranked second; Washington, DC

Percentage fees ranked third; Virginia non- 38% facility fees ranked fourth; West 40% Virginia non-facility and facility fees (tied) ranked fifth; and Pennsylvania fees ranked last. 20%

0% MD NF MD FA DE DC VA NF WV NF WV FA PA State

24 Figure 17. Dialysis Weighted Average (%) of Medicare Fees

100% 95%

90% 84% 79% 80% 72% 72% 70% 67% 67% Delaware fees for dialysis 60% procedures were highest in the 50% region, followed—in ranking order—by Washington, DC fees; Percentage 40% Virginia non-facility fees; Maryland non-facility and facility fees (tied); 30% West Virginia non-facility and facility fees (tied); and 20% 16% Pennsylvania fees.

10%

0% DE DC VA NF MD NF MD FA WV NF WV FA PA State

25 Figure 18. Gastroenterology Weighted Average (%) of Medicare Fees

120%

100% 96% 93%

82% 80% 77% 77%

Delaware’s gastroenterology fees 60% 58% 58% were highest in the region, 60% followed—in ranking order—

Percentage by Washington, DC fees; Virginia non-facility fees; Maryland non- 40% facility and facility fees (tied); Pennsylvania fees; and West Virginia non-facility and facility fees 20% (tied).

0% DE DC VA NF MD NF MD FA PA WV NF WV FA State

26 Figure 19. Ophthalmology and Vision Care Weighted Average (%) of Medicare Fees

100% 94%

90% 85%

80% 78% 74% 73% 70% 66% 63% For the selected ophthalmology and vision care procedures, 60% Delaware fees ranked first in the region, followed by Washington, 50% DC, fees (second), Virginia non- Percentage 40% 37% facility fees (third), Maryland non- facility fees (fourth), Maryland 30% facility fees (fifth), West Virginia facility fees (sixth), West Virginia 20% non-facility fees (seventh), and Pennsylvania fees (eighth). 10%

0% DE DC VA NF MD NF MD FA WV FA WV NF PA State

27 Figure 20. ENT (Otorhinolaryngology) Weighted Average (%) of Medicare Fees

100% 92% 90% 87%

80% 77% 77% 77%

70% Delaware fees were the highest in the region for the selected 60% 59% 59%

60% otorhinolaryngology (ear, nose, and throat) procedures. 50% Washington, DC fees ranked second; Maryland non-facility fees, Percentage 40% Virginia non-facility fees, and Maryland facility fees ranked third 30% (tied); Pennsylvania fees ranked fourth; and West Virginia non- 20% facility and facility fees tied for 10% fifth.

0% DE DC MD NF VA NF MD FA PA WV NF WV FA State

28 Figure 21. Cardiovascular Medicine Procedures Weighted Average (%) of Medicare Fees

100% 92% 90% 86% 82% 82% 80% 77%

70% 66% 60% 60%

60% For the selected cardiovascular medicine procedures, Delaware 50% fees ranked first, followed by Washington, DC fees; Maryland Percentage 40% non-facility and facility fees (tied); Virginia non-facility fees; 30% Pennsylvania fees; and West Virginia non-facility and facility 20% fees (tied).

10%

0% DE DC MD NF MD FA VA NF PA WV NF WV FA State

29 Figure 22. Noninvasive Vascular Tests Weighted Average (%) of Medicare Fees

100% 90% 89% 90% 81% 81% 79% 80% 70% 70% 59% 59% For the selected noninvasive

60% vascular tests, Delaware fees 50% ranked first, followed—in ranking order—by Washington, DC fees; Percentage 40% Maryland non-facility and facility fees (tied); Virginia non-facility 30% fees; Pennsylvania fees; and West Virginia non-facility and facility 20% fees (tied).

10%

0% DE DC MD NF MD FA VA NF PA WV NF WV FA State

30 Figure 23. Pulmonary Weighted Average (%) of Medicare Fees

100% 92% 90% 87%

80% 76% 73% 73% 70% Similar to last year’s report, for the 58% 58% selected pulmonary procedures, 60% Delaware fees ranked first in the 50% region, followed—in ranking order—by Washington, DC fees; Percentage 40% 34% Virginia non-facility fees; Maryland non-facility and facility fees (tied); 30% West Virginia non-facility and facility fees (tied); and 20% Pennsylvania fees.

10%

0% DE DC VA NF MD NF MD FA WV NF WV FA PA State

31 Figure 24. Allergy and Immunology Weighted Average (%) of Medicare Fees

100% 92% 88% 90% 87% 86%

80% 76%

70% For selected allergy and

60% 57% 57% immunology procedures, Delaware 53% fees ranked first; Washington, DC 50% fees ranked second; Maryland

Percentage facility fees ranked third; Maryland 40% non-facility fees ranked fourth; 30% Virginia non-facility fees ranked fifth; West Virginia non-facility and 20% facility fees ranked sixth (tied); and Pennsylvania fees ranked seventh. 10%

0% DE DC MD FA MD NF VA NF WV NF WV FA PA State

32 Figure 25. Neurology and Neuromuscular Weighted Average (%) of Medicare Fees

80% 76% 76% 73% 73%

70% 66%

60%

50% 48% 48% Delaware and Washington, DC fees tied and were the highest in the 40% region for neurology and 40% neuromuscular procedures,

Percentage followed—in ranking order—by 30% Maryland non-facility and facility fees (tied), Virginia non-facility 20% fees, West Virginia non-facility and facility fees (tied), and Pennsylvania fees. 10%

0% DE DC MD NF MD FA VA NF WV NF WV FA PA State

33 Figure 26. Central Nervous System (CNS) Assessment Tests Weighted Average (%) of Medicare Fees

100%

90% 86% 79% 79% 80% 77%

70% 61% 61% For the selected CNS assessment

60% procedures, Washington, DC fees 54% 52% ranked first; Maryland non-facility 50% and facility fees ranked second (tied); Virginia non-facility fees Percentage 40% ranked third; West Virginia non- facility and facility fees ranked 30% fourth (tied); Pennsylvania fees ranked fifth; and Delaware fees 20% ranked sixth. 10%

0% DC MD NF MD FA VA NF WV NF WV FA PA DE State

34 Figure 27. Chemotherapy Administration Weighted Average (%) of Medicare Fees

100% 90% 90% 87% 83% 83% 79% 80% 76%

70%

58% 58% For chemotherapy administration 60% procedures, Delaware fees ranked first, followed by Washington, DC 50% fees (second); Maryland non-

Percentage 40% facility and facility fees (tied for third); Pennsylvania fees (fourth); 30% Virginia non-facility fees (fifth); and West Virginia non-facility and 20% facility fees (tied for sixth).

10%

0% DE DC MD NF MD FA PA VA NF WV NF WV FA State

35 Figure 28. Special Dermatological Weighted Average (%) of Medicare Fees

100% 93% 90%

80% 76% 72% 72% 70% As an average percentage of 58% 58% 58% Medicare fees for the selected 60% dermatology procedures, Delaware had the highest fees. 50% Virginia non-facility fees ranked

Percentage 40% second; Maryland non-facility and facility fees (tied) ranked third; 30% 28% West Virginia non-facility fees, Washington, DC fees, and West 20% Virginia facility fees (tied) ranked fourth; and Pennsylvania fees 10% ranked fifth.

0% DE VA NF MD NF MD FA WV NF DC WV FA PA State

36 Figure 29. Physical Medicine and Rehabilitation Weighted Average (%) of Medicare Fees

100% 90% 90% 85%

80% 77% 77% 76%

70% 64% 64% Delaware fees ranked the highest

60% for physical medicine and rehabilitation procedures, 50% 46% followed—in ranking order— by Washington, DC fees; Maryland Percentage 40% non-facility and facility fees (tied); Virginia non-facility fees; West 30% Virginia non-facility and facility fees (tied); and Pennsylvania fees. 20%

10%

0% DE DC MD NF MD FA VA NF WV NF WV FA PA State

37 Figure 30. Osteopathy, Chiropractic, and Other Medicine Weighted Average (%) of Medicare Fees

160%

137% 140%

120% For the selected osteopathy, 100% 92% chiropractic, and other medicine

84% procedures, Pennsylvania fees 79% were highest, followed—in 80% 73% 72% ranking order—by Delaware fees; Percentage 62% 62% Washington, DC fees; Maryland 60% non-facility fees; Virginia non- facility fees; Maryland facility fees; 40% and West Virginia non-facility and facility fees (tied). 20%

0% PA DE DC MD NF VA NF MD FA WV NF WV FA State

38 LIST OF FIGURES

Chapter 2. Evaluation and Management Procedure Fees

Figure 1. Evaluation and Management Weighted Average (%) of Medicare Fees …… 7 Chapter 3. Surgical Procedure Fee Data Figure 2. Integumentary and General Surgery Weighted Average (%) of Medicare Fees …………………………………………………………………………………… 9 Figure 3. Musculoskeletal System Weighted Average (%) of Medicare Fees ……….. 10 Figure 4. Respiratory Weighted Average (%) of Medicare Fees ……………………… 11 Figure 5. Cardiovascular System Surgery Weighted Average (%) of Medicare Fees …………………………………………………………………………………… 12 Figure 6. Hemic, Lymphatic, and Mediastinum Weighted Average (%) of Medicare Fees……………………………………………………………………………………. 13 Figure 7. Digestive System Weighted Average (%) of Medicare Fees ………………... 14 Figure 8. Urinary and Male Genital Weighted Average (%) of Medicare Fees ……….. 15 Figure 9. Gynecology and Obstetrics Weighted Average (%) of Medicare Fees …….. 16 Figure 10. Endocrine System Weighted Average (%) of Medicare Fees ……………… 17 Figure 11. Neurosurgery Weighted Average (%) of Medicare Fees …………………... 18 Figure 12. Eye Surgery Weighted Average (%) of Medicare Fees …………………….. 19 Figure 13. Ear Surgery Weighted Average (%) of Medicare Fees …………………….. 20 Figure 14. Radiology Weighted Average (%) of Medicare Fees ………………………. 21 Figure 15. Laboratory Weighted Average (%) of Medicare Fees ……………………... 22

39 LIST OF FIGURES continued

Chapter 4. Medical Procedure Fee Data

Figure 16. Psychiatry Weighted Average (%) of Medicare Fees ………………………. 24 Figure 17. Dialysis Weighted Average (%) of Medicare Fees ………………………….. 25 Figure 18. Gastroenterology Weighted Average (%) of Medicare Fees ………………. 26 Figure 19. Ophthalmology and Vision Care Weighted Average (%) of Medicare Fees ………………………………………………………………………... 27 Figure 20. ENT (Otorhinolaryngology) Weighted Average (%) of Medicare Fees …… 28 Figure 21. Cardiovascular Medicine Procedures Weighted Average (%) of Medicare Fees ……………………………………………………………………... 29 Figure 22. Noninvasive Vascular Tests Weighted Average (%) of Medicare Fees ……. 30 Figure 23. Pulmonary Weighted Average (%) of Medicare Fees ……………………… 31 Figure 24. Allergy and Immunology Weighted Average (%) of Medicare Fees ……… 32 Figure 25. Neurology and Neuromuscular Weighted Average (%) of Medicare Fees …………………………………………………………………………………… 33 Figure 26. Central Nervous System (CNS) Assessment Tests Weighted Average (%) of Medicare Fees …………………………………………………………………….. 34 Figure 27. Chemotherapy Administration Weighted Average (%) of Medicare Fees …………………………………………………………………………………… 35 Figure 28. Special Dermatological Weighted Average (%) of Medicare Fees ……….. 36 Figure 29. Physical Medicine and Rehabilitation Weighted Average (%) of Medicare Fees …………………………………………………………………….. 37 Figure 30. Osteopathy, Chiropractic, and Other Medicine Weighted Average (%) of Medicare Fees …………………………………………………………………….. 38

40 University o University of Maryland, Baltimore County University of Maryland, Baltimore County Sondheim Hall, 3rd Floor 1000 Hilltop Circle Baltimore, MD 21250 410-455-6854 www.hilltopinstitute.org