MHA Board of Trustees Chair Nancy Schlichting (left) welcomed MDCH Director Janet Olszewski to last week's meeting.

The MHA Board of Trustees met last week and was joined by Bill Ballenger, editor of Inside Michigan Politics, who reviewed election results and discussed their likely impact on public policy over the next two years and beyond. He indicated there will be a major move toward the political left. If not reversed in the 2010 elections, that shift will likely result in a significant reshaping of the political landscape, since reapportionment would provide a vehicle for the Democratic Party to control the design of legislative districts through 2020. He also noted that the election of Judge Diane Hathaway to the Michigan Supreme Court and the broadened Democratic majority in the state House of Representatives could give rise to additional issues in both the human resources and labor relations arenas.

Following his remarks, Janet Olszewski, director of the Michigan Department of Community Health (MDCH), provided an overview of what will command the attention of both the MDCH and the governor's office over the next several months. Olszewski indicated that pursuit of a federal economic stimulus package will be a priority, including the infusion of funds through the Federal Medical Assistance Percentage (FMAP) formula and the anticipated reauthorization/expansion of the State Children's Health Insurance Program (SCHIP). She also encouraged the MHA to continue its campaign to connect human faces to the Medicaid program and invited the hospital community to provide additional ideas and guidance as the MDCH crafts new rules to govern the recently approved legalization of medical marijuana within the state.

In an effort to strengthen the already successful efforts of the Partnership for Michigan's Health, leaders from the Michigan Osteopathic Association and the Michigan State Medical Society highlighted key activities of their respective organizations and identified potential intersections with the hospital field. Ideas generated through discussion included joint Medicaid advocacy, efforts to expand health coverage, strategies to address the supply of physicians, joint support for lame duck passage of smoke-free workplaces legislation, and other ideas concerning both scope of practice and tort reform protections. The three organizations will meet to design a more structured agenda for the 2009 calendar year.

The board also approved an initiative to voluntarily eliminate trans fats from food served in hospitals. This endeavor would be modeled after the successful smoke-free hospital campuses program conducted in 2007-2008. The board encouraged the association to actively promote the elimination of trans fats in all sectors of the hospital dietary arena (cafeteria, patient nutrition and vending machines) by Jan. 1, 2010. The board also endorsed the recommendations of the MHA Patient Safety Organization, encouraging all hospitals using patient alert wristbands to adopt the use of three standardized colors (purple for do-not-resuscitate, red for allergy, and yellow for fall risk) to eliminate confusion and increase patient safety and quality. Each Michigan hospital is being asked to commit to this change by June 1, 2009 (see related article).

Additionally, the board reaffirmed its long-standing policy supporting the continuation of the Certificate of Need law as a means of maintaining access and preserving high-quality care in the community hospital setting, while avoiding unnecessary facilities and services.

In conducting its ways and means functions, the board granted the association the authority to seek amicus curiae standing to challenge an Appellate Court decision that would entitle plaintiff attorneys to assess fees against providers for legal expenses incurred in pursuit of workers' compensation claims. It also approved the membership applications submitted by Vibra of Southeastern Michigan as a Type I-B member and by GME Architects-Engineers and Reliable Delivery, both as Type III-A members. Questions regarding the actions of the MHA Board of Trustees should be directed to David Seaman at the MHA.

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At its meeting last week, the MHA Board of Trustees approved the initiative recently advanced by the MHA Patient Safety Organization, asking all MHA-member hospitals that currently use patient alert wristbands to standardize the colors used to indicate allergy (red), fall risk (yellow) and do-not-resuscitate (purple). Chief executive officers, chief operating officers, directors of patient safety and quality, and chief nursing officers at MHA-member hospitals received a survey Nov. 13 to assess how many facilities are currently using color-coded patient alert wristbands. Representatives of facilities that currently use the wristbands have also been asked to sign a pledge form indicating they will standardize to the three colors by summer 2009. MHA members should identify the appropriate staff member to complete the survey, sign the pledge if applicable, and attend upcoming educational sessions that have been scheduled for late January. All facilities are urged to submit survey responses by Dec. 1. Members with questions regarding the patient alert wristband standardization initiative should contact Morgan Martin at the MHA.

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Last week, the MHA submitted its comments to the Medical Services Administration (MSA) regarding its proposed policy to implement the $60 million outpatient uncompensated care disproportionate share hospital (DSH) payment pool, which was included in the state's final fiscal year (FY) 2009 budget. This program would be funded through an expansion of the hospital provider tax program, resulting in a FY 2009 net benefit to Michigan hospitals of approximately $30 million. In its comments, the MHA requested that the MSA:

• establish a DSH funding hierarchy so that payments from the new DSH pool will be counted toward individual hospital DSH ceilings prior to computation of the certified public expenditure (CPE) and Indigent Care Agreement (ICA) DSH pools
• explain plans for determining hospital-specific DSH ceilings that will account for uncertainties surrounding the Medicaid Access to Care Initiative (MACI) and Hospital Rate Adjustment (HRA) pools as a result of the policy mandating that pregnant women who are newly eligible for Medicaid be enrolled in a Medicaid HMO
• provide hospital-specific DSH ceiling limits on its Web site

The MHA encourages hospitals to review the proposed policy and submit comments to Meghan Sifuentes at the MSA by Nov. 21. Members with questions should contact Vickie Seal or Jason Jorkasky at the MHA.

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Ronald M. Davis, MD, died in his East Lansing home Nov. 6 after a battle with pancreatic cancer. Davis was director of the Center for Health Promotion and Disease Prevention at Henry Ford Health System, Detroit, and 2007-2008 president of the American Medical Association (AMA). Funeral services were held in Lansing last week.

"Dr. Ron Davis was an extraordinary leader who changed the way organized medicine views prevention and health promotion," noted Nancy Schlichting, president and chief executive officer of Henry Ford Health System and chair of the MHA Board of Trustees. "He was the first preventive medicine physician to serve as president of the AMA and worked tirelessly to eliminate smoking as a health hazard on national and local levels. We were privileged to have him as a valued member of the Henry Ford Health System team, and we will miss him greatly," Schlichting said.

Davis was a bastion in the fight against the harmful effects of tobacco. He served under Surgeon General C. Everett Koop as director of the Office on Smoking and Health at the U.S. Centers for Disease Control and Prevention and was later chief medical officer for the Michigan Department of Public Health. He was the founding editor of Tobacco Control, an international publication of the British Medical Journal, and served as North American Editor of that journal for three years.

Davis worked closely with the MHA and others in supporting the Healthy Michigan Amendment (Proposal 4) in 2002, which would have redirected 90 percent of Michigan's tobacco settlement funds to health care and toward comprehensive tobacco prevention and treatment programs. He continued working on smoke-free public places legislation until just weeks before his death.

"Ron Davis had a passion for eliminating preventable disease that has benefited people in Michigan and around the world," said MHA President Spencer Johnson. "He was an exemplary individual, and the health care community has lost a great leader."

Donations in Davis's memory may be made to an endowment fund in his name that will support the AMA Foundation's mission to advance health care through support of programs in medical education, research and public health. Contributions may also be made to the Pancreatic Cancer Action Network to support its work to build awareness of and fight the disease.

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Keeping up with the critical changes occurring within the outpatient prospective payment system and the Healthcare Common Procedure Coding System (HCPCS) code sets is imperative for revenue cycle managers and reimbursement specialists - fair reimbursement depends on it, and coding errors are what representatives from the Centers for Medicare & Medicaid Services Recovery Audit Contractor program will be looking for.

The MHA Health Foundation Webinar Secure Outpatient Prospective Payment System Revenue Integrity: 2009 Updates for your Outpatient Data Cycle will outline the impact of ambulatory payment classification (APC) changes, including transitional pass-through payments; payments for drugs, biologicals and radiopharmaceuticals; and status indicator Q. Participants will also learn how to examine payment, coding and operational challenges for hospital evaluation and management services, along with infusions/injections. This Webinar will help identify each facility's strengths, weaknesses, opportunities and threats related to the outpatient revenue cycle and a strategy to ensure appropriate reimbursement.

The Webinar will be held from 10 a.m. to 3 p.m. Dec. 18. A $275 connection fee per MHA-member organization must be received by Dec. 12. Online registration and additional details are available on the MHA Web site. For more information, contact Sara Miller at the MHA.

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Chris Mitchell (left) and Mary Lou McFadden, MAHA president-elect, represented the two associations at the Michigan Harvest Gathering celebration.

The campaign for the 2008 Michigan Harvest Gathering (MHG) came to an official close last week at a celebration luncheon at the Kellogg Hotel and Conference Center in East Lansing. As of Wednesday's luncheon, the statewide campaign had resulted in donations of more than 157,000 pounds of food and about $627,000 to help buy food and distribute it to needy families across the state.

Representing at least 100 MHA-member organizations, about 80 MHG project leaders and their teams have been conducting food drives at their facilities this fall. Several representatives of MHA-member organizations attended the luncheon and were recognized for their efforts. About 75 percent of participating facilities have now reported their results, showing that Michigan hospitals are quick to respond to the needs of their communities, even in a sluggish economy. As of last week, the MHA, its members and the Michigan Association of Healthcare Advocates (MAHA) had donated nearly 132,000 pounds of food and approximately $75,000 during the 2008 campaign to benefit the Food Bank Council of Michigan and its member food banks. Additional reports are expected as more facilities complete their individual campaign efforts, and an organization-specific report of food drive results will be sent to members in December.

Hospitals participating in the MHG are reminded that they must submit report forms for their totals to be included in the overall MHA-member contributions to this important effort. To learn more about the MHA's participation in the Michigan Harvest Gathering, contact Paige Hathaway or Linda Dicks at the MHA.

Food Bank Council Executive Director Jane Marshall (left) presents an award recognizing the MHA's contributions to Chris Mitchell, MHA manager of government relations, who represented the association at the luncheon

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Comments to the Medical Services Administration are due Nov. 28 regarding its proposed policy to update Medicaid hospital diagnosis-related group (DRG) rates and weights and hospital rehabilitation unit per diem rates, effective Jan. 1, 2009. In addition, the Medicaid policy would update to Medicare Severity (MS)-DRG Grouper version 26 that was implemented by Medicare Oct. 1.

While the MSA intends to use the same Medicaid fee-for-service (FFS) paid claims and cost report data used to rebase the Jan. 1, 2008, hospital-specific DRG rates and relative weights, consistent with past years, it proposed updating the hospital wage data. Also consistent with the past, hospital DRG rates will be adjusted to maintain MSA budget neutrality on a statewide basis. While the MSA does not intend to include Medicaid health maintenance organization (HMO) claims data for the Jan. 1, 2009, update, it does plan to include HMO claims for the Jan. 1, 2010, update.

The MHA submitted its comments last week, asking that the MSA:

• Provide hospitals with the opportunity to validate the HMO claims that would be used to update the DRG rates and weights, effective Jan. 1, 2010. The MHA opposes the inclusion of incomplete and/or invalid HMO encounter data.
• Continue the efforts necessary to implement the new DRG grouper effective Oct. 1 each year, rather than Jan. 1.
• Include a detailed description of the methodology used to develop the budget neutrality adjustment and the final adjustment percentage.

The MHA urges all hospitals to review the proposed policy and submit their comments to Meghan Sifuentes at the MSA prior to the Nov. 28 deadline. A final policy is anticipated to be released by Dec. 1 for the Jan. 1 effective date. Members with questions should contact Jason Jorkasky at the MHA.

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The Centers for Medicare & Medicaid Services (CMS) recently released a notice to update the Home Health Prospective Payment System (HH PPS) effective Jan. 1, 2009. The notice includes an update to the 60-day national episode rates and the national per-visit amounts. Highlights include:

• A 0.15 percent rate update resulting from a 2.9 percent marketbasket update that was reduced by a 2.75 percent "behavioral offset."
• An increase in the national standardized 60-day episode rate from $2,270.32 to $2,271.92.
• No change in the case-mix weights.
• Continued use of the pre-rural floor, pre-reclassification hospital wage indexes to adjust the labor portions of the HH PPS rates. The labor-related share will also remain unchanged at 77.082 percent.
• Continuance of the 12 quality measures currently required, with noncompliant HHs receiving a rate update that is reduced by two percentage points.
• Notice of the CMS's intention to implement a process to measure and report results of a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for home health care. The CMS indicated that recruitment and training of vendors will begin in 2009, with further information regarding the national implementation to be published in the 2010 HH rule.
• A full 2.0 percent marketbasket update to the national per-visit amounts for low utilization payment adjustment (LUPA) rates, which are not reduced for the "behavioral offset" adjustment.
• A payment update to $52.39 for nonroutine medical supplies (NRS), subject to the six severity level weights, which are unchanged from 2008.
• Maintaining the outlier threshold fixed-dollar loss (FDL) ratio at 0.89.

Members with questions should contact Vickie Seal at the MHA.

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• The Ensuring Compliance with The Joint Commission 2009 Patient Rights Standards Webinar will be held from 10 to 11:30 a.m. Tuesday. The Webinar will focus on how to integrate the Joint Commission patient rights standards and the Hospital Conditions of Participation of the Centers for Medicare & Medicaid Services. For more information, contact Sara Miller at the MHA.

• The Small or Rural Hospital Council will meet from 12:30 to 2:30 p.m. Tuesday at MHA headquarters, Lansing. The council will discuss rural anesthesia services. For more information, contact Amy Barkholz at the MHA.

• The Blue Cross Blue Shield of Michigan Payment Practices Committee will meet Wednesday. For more information, contact Marilyn Litka-Klein at the MHA.

• The MHA Salary Survey Work Group will meet from 10 a.m. to 1 p.m. Friday at MHA headquarters, Lansing. The work group will discuss changes necessary for the annual salary survey. For more information, contact Laura Schmidt at the MHA.