Monday Report July 28

IN THIS ISSUE

Governor Signs Fiscal Year 2009 Medicaid Budget
Michigan Hospitals Take Top National Quality Awards
Senate Subcommittee Reviews Quality Assessment Assurance Programs
Occupational Mix Survey Due Sept. 1
BCBSM Unveils Transparency Initiative
Vote in the Upcoming Primary Election Tuesday, Aug. 5
Proposed Policy Mandates Pregnant Women Enroll into Medicaid HMOs
Governor's Veto Prompts CON Commission to Revise Standard
Governor Signs Booster Seat Bill into Law
Announcement of Recovery Audit Contractor Delayed
Joint Commission Requests Review of Blood Management Performance Measures
Trauma Symposium Planned
Members in the News
National American Arab Nurses Association Convention
News to Know

Governor Signs Fiscal Year 2009 Medicaid Budget

On July 17, Gov. Granholm signed legislation that will provide funding for the Michigan Department of Community Health (MDCH) and the Medicaid program, for fiscal year (FY) 2008-2009 which begins Oct. 1. Work on Senate Bill (SB) 1094, the MDCH budget bill, was completed by the legislature in late June. A top priority of the MHA Board of Trustees was assuring that the state retention of funds from the hospital Quality Assurance Assessment Programs (QAAP) be maintained at a level that is reasonable and can be sustained. The FY 2009 budget contains a state retention of $117.5 million of the hospital QAAP, which is a reduction from the $126 million proposed by the state budget office. In addition, special earmarks for funds financed by hospital provider taxes that were in the FY 2008 budget were eliminated. Two other key priorities achieved in the legislation signed by the governor were restoration of Medicaid funding and eligibility for 19- and 20-year-olds, as well as restoration of the $5 million disproportionate share hospital (DSH) payments. Finally, the MHA and members were also successful in preventing any reductions to Medicaid provider rates, graduate medical education funding or the traditional DSH line. SB 1094, now signed by the governor, has become Public Act 246 of 2008. Members with questions may contact Dave Finkbeiner at the MHA.

Michigan Hospitals Take Top National Quality Awards

Michigan hospitals are taking home the highest quality honors in the nation awarded by the American Hospital Association. Four hospitals were selected from a nationwide competition, with Munson Medical Center, Traverse City, winning the top honor — the American Hospital Association-McKesson Quest for Quality Prize. Equally notable, the University of Michigan Health System, Ann Arbor, was named the "sole finalist" of the competion, representing the next highest award given. Rounding out the winners, Citations of Merit were awarded to Avera McKennan Hospital & University Health Center, Sioux Falls, South Dakota, and Saint Vincent Health Center, Erie, Pennsylvania.

The American Hospital Association-McKesson Quest for Quality Prize is presented annually to honor leadership and innovation in quality, safety and commitment in patient care. Winners must demonstrate organizational commitment to achieving the Institute of Medicine's six quality aims — safety, patient-centeredness, effectiveness, efficiency, timeliness and equity. The award honors organizations that are making progress in quality improvement on all six aims and sharing models that can be replicated in other hospitals. Common elements include recognizing that organizational leadership is critical, that what is measured is what gets attention and that patient and family involvement is integral to quality improvement.

The competition required hospitals to complete a rigorous self-nomination application, from which a small number were selected to receive site visits from the prize judges. For more information on the award, visit the Quest for Quality Web site.

Senate Subcommittee Reviews Quality Assessment Assurance Programs

Sen. Roger Kahn (R-Saginaw Twp.), chair of the Senate Appropriations Subcommittee on the MDCH budget, held a subcommittee hearing earlier this month to focus on Quality Assurance Assessment Programs (QAAP). The intent of the hearing was to assist committee members in better understanding QAAP programs which bring significant federal funding to Michigan and provide the state with funds to offset general fund shortfalls.

An overview of the various QAAP programs in existence with Medicaid providers was presented by the Medicaid Services Administration. The MHA, along with the Michigan Association of Health Plans, the Michigan Pharmacists Association and the Michigan Association of Ambulance Services, provided testimony. The MHA testimony included the historical perspective on why the hospital community initially embraced the concept to voluntarily tax hospitals and that, despite the federal funding gained through this program, the QAAP does not provide adequate funding so that hospitals' Medicaid payments are equivalent to Medicare rates. In addition, the MHA outlined the MHA Board legislative priorities for the QAAP and explained that the viability of the program can only be maintained through a long-term collaborative partnership with the state, legislature and Michigan hospitals. Members with questions should contact Peter Schonfeld or Dave Finkbeiner at the MHA.

Occupational Mix Survey Due Sept. 1

By Sept. 1, 2008, hospitals paid under the Medicare inpatient prospective payment system (IPPS) must submit a completed Medicare occupational mix survey to National Government Services for the 12-month period, July 1, 2007, through June 30, 2008. As mandated by the Benefits Improvement & Protection Act (BIPA) of 2000, the Centers for Medicare & Medicaid Services is required to collect this data every three years for purposes of adjusting for hospital occupational mix. The data currently being collected will be used to adjust the fiscal year (FY) 2010-12 Medicare area wage index. To assist hospitals with completion of this survey, the MHA is hosting two audio conferences, scheduled for today and Aug 5, with registration still available for the Aug. 5 session.

In addition to reviewing the occupational mix survey, these sessions will review documentation requirements, including hospital administrative and general contracted services for Medicare wage index purposes in FY 2009 and future years. Previously, these costs were not included in determining the wage index. Since the Medicare wage index is an annual calculation, it is important that Michigan hospitals capture all applicable costs each year to ensure the Medicare wage index is accurately stated. Hospitals are encouraged to register and participate in one of these audio conferences, which are available at no cost. Members with questions should contact Vickie Seal at the MHA.

BCBSM Unveils Transparency Initiative

Last week, Blue Cross Blue Shield of Michigan (BCBSM) conducted a series of forums to collect hospital feedback on a new BCBSM transparency Web site being developed and scheduled for a Jan. 1, 2009 launch. The BCBSM Web site and transparency initiative is a response to patient and employer requests for greater transparency of hospital pricing.

The site would include payment ranges for 41 common, elective procedures. Inpatient procedures listed will include newborn deliveries, hip and knee replacements, laminectomy, laparoscopic gall bladder removal and spinal fusion. Outpatient surgeries to be listed will include anterior cruciate ligament (ACL) repair, breast biopsy, carpal tunnel surgery, cataract removal, knee and should arthroscopy, tonsillectomy, and heart catheterization. Outpatient procedures listed include endoscopy, mammograms, CT scans, MRIs, and physician visits. Outlier claims will be excluded from the calculations.

In August, BCBSM will provide hospitals with their own payment data to validate the payment ranges that will be posted on the Web site. When the site is complete in 2009, BCBSM will link to the MHA MI Hospital Inform Web site that features charge, quality and payment information. The new BCBSM Web site will not yet include information for enrollees to determine the patient co-payment, which is a planned future development. For further information, contact Peter Schonfeld at the MHA.

Vote in the Upcoming Primary Election Tuesday, Aug. 5

Due to legislative redistricting and historically low voter turnout, primary elections are increasingly growing in importance during critical election years. Political analysts have estimated that as many as 90 percent of the general election winners will essentially be chosen at the Aug. 5 primary.

The primary ballot will include a U.S. Senate seat, all 15 seats in the U.S. House of Representatives and 110 state representatives. The race for President of the United States will not appear until the November general election ballot.

MHA members are urged to support the candidates of their choice on Aug. 5 and to be prepared to advocate on behalf of candidates who pledge to support Michigan's hospitals and the patients they serve in the Nov. 4 general election. Voters should remember to bring a valid driver's license or other acceptable picture ID to the polls.

For more information, please visit the Michigan Web Voter Information Web site or contact David Finkbeiner at the MHA.

Proposed Policy Mandates Pregnant Women Enroll into Medicaid HMOs

The Medical Services Administration (MSA) recently issued a proposed policy that would require newly Medicaid eligible pregnant women to enroll in a Medicaid Health Maintenance Organization (HMO), effective Oct. 1, 2008, pursuant to Public Act 123 of 2007. Currently, women may choose to enroll in either the Medicaid fee-for-service program or a Medicaid HMO. In addition, this policy would require all Maternal Infant Health Program (MIHP) providers to submit claims to the Michigan Department of Community Health for services provided to beneficiaries enrolled in Medicaid HMOs, effective Oct. 1, 2008.

Hospitals are encouraged to review the proposed policy and provide comments to Penny Dipple at the MSA prior to the Aug. 18 due date. Members with questions should contact Jason Jorkasky at the MHA.

Governor's Veto Prompts CON Commission to Revise Standard

The state Certificate of Need (CON) Commission held a special meeting last week to revise the standard for megavoltage radiation therapy (MRT) in response to Gov. Granholm's recent veto of the provisions originally proposed by the commission. The veto focused on language in the MRT standard requiring a single statewide consortium for the provision of proton beam therapy services, an emerging radiation treatment alternative for certain cancers. The governor expressed concerns that the language created undo burdens on the proposed consortium which could delay access to care and indicated that it also raised potential anti-trust questions. New language approved by the commission for public hearing last week amended the original language to address these concerns, while still requiring a consortium for the provision of services it now labels 'High MRT Units.' These services include heavy particle accelerators such as proton beam therapy, as well as newer cancer treatment technologies that utilize carbon ions and other particles that also target tumor growths. At the CON meeting, several hospitals testified in support of an alternative to the consortium-based proposal that would apply a radiation therapy volume requirement on applicants instead of requiring a consortium.

The commission agreed to receive public comment on both approaches before taking final action at its next meeting. The delay caused by the veto means that at least one applicant for proton beam therapy services will be approved under the old MRT standards, which contained no specific provisions for the emerging technology. It is thought that the proposed MRT language will allow one additional 'High MRT Unit' in the state. The date for the public hearing has not yet been scheduled, but it will occur before the commission's next regular meeting Sept. 16. CON standards, proposed language, and CON Commission meeting dates may be accessed online. For more information, contact Amy Barkholz at the MHA.

Governor Signs Booster Seat Bill into Law

Senate Bill 82, sponsored by Sen. Michelle McManus (R-Lake Leelanau), was signed into law earlier this month by Gov. Jennifer Granholm. The new law, Public Act 43 of 2008, requires all children under 8 years of age or 4 feet 9 inches in height be properly secured in a child safety seat when riding in a motor vehicle. Public Act 43 was supported by the MHA during the legislative process, making Michigan the 40th state with some form of child-passenger safety law that protects older children. The law is designed to ensure that children are properly restrained and kept safe while riding in cars, as traffic accidents continue to be the largest cause of death for children under age eight. For more information about the new booster seat law, contact Chris Mitchell at the MHA.

Announcement of Recovery Audit Contractor Delayed

Last week, the Centers for Medicare & Medicaid Services (CMS) indicated that the announcement of the Recovery Audit Contractor (RAC) for Michigan was delayed from the end of July until approximately Sept. 30. The MHA requests hospitals identify individuals to act as their primary contacts for communication about Medicare RAC issues. This will allow direct communication of emerging issues to the individuals responsible for RAC activities at each hospital. Notification of the RAC contacts should arrive at the MHA by July 31. For further information on RAC activities, contact Marilyn Litka-Klein at the MHA.

Joint Commission Requests Review of Blood Management Performance Measures

The Joint Commission has announced that it is seeking stakeholder comments regarding proposed blood management performance measures. The Blood Management Performance Measures Technical Advisory Panel (TAP) has identified 19 Blood Management Candidate Measures addressing key aspects of Blood Management.

Review and responses to the candidate measures is available using a Web based survey and are due by Tuesday, Aug. 19. A candidate measure profile is provided for each measure, along with a series of statements. The statements will guide the rating of each of the candidate measures relative to overall importance, scientific acceptability, usability/interpretability and feasibility. Project inquires should be directed to Harriet Gammon at The Join Commission or Sam R. Watson at the MHA.

Trauma Symposium Planned

The Michigan Department of Community Health and the Michigan College of Emergency Physicians (MCEP) are jointly hosting a Trauma Symposium Aug. 18 in Lansing. The one-day program will focus on recent legislative changes that strengthen Michigan's statewide trauma and emergency medical system, the importance of trauma systems in dealing with mass casualties, future challenges and funding strategies.

Presenters include Brooks Bock, MD, president, Harper/Hutzel Hospital, Detroit Medical Center and chairman, Department of Emergency Medicine, Wayne State University. Hospital administrators, as well as trauma and EMS physicians, nurse coordinators, and other trauma and emergency personnel are encouraged to attend. The registration fee is $25 and more information is available online. Members with questions should contact Amy Barkholz at the MHA.

Narinder Sherma, MD

Members in the News

Narinder Sherma, MD, was recently elected chief of medical staff at DMC Sinai-Grace Hospital, Detroit, after serving two years as vice-chief. An expert in cardiovascular disease and internal medicine, Sherma has served at Sinai-Grace since 1981 and as the hospital's delegate to the medical staff section of the American Medical Association since 1983. After completing his education in India and serving as a physician in the Indian army, he completed his internship and residency at Mt. Carmel Mercy Hospital, Detroit, and his cardiovascular fellowship at Wayne State University.

National American Arab Nurses Association Convention

The 2008 National American Arab Nurses Association (NAANA) Inaugural National Convention, themed "Building Cultural Bridges in Health Care: Strength in Diversity," will be held Oct. 9-10 at the Detroit Marriott at the Renaissance Center.

Arab nurses are teaming with Arab doctors through the National Arab American Medical Association (NAAMA) to host the convention. The Filipino, Hispanic and Black nurses associations will also participate by designing sessions targeted at their respective patient populations and the health care workers who serve these ethnic groups.

The convention welcomes health administrators; physicians; residents; medical students; nurses; student nurses; social workers; speech, physical and occupational therapists; human resource professionals; hospital chaplains; educators; researchers; and other key health care professionals responsible for addressing the cultural, social, ethnic and religious practices and beliefs among health care professionals and the patients they serve. This will help ensure cultural competence in the workplace and compliance with Joint Commission and Centers for Medicare & Medicaid Services standards. For more information, visit NAANA online.