At last week's annual May Consensus Revenue Estimating Conference, State Treasurer Robert Klein and representatives from the House and Senate Fiscal Agencies determined that the fiscal year (FY) 2010 state budget, beginning Oct. 1, will be short by nearly $1.7 billion (general fund and school aid dollars).

Lawmakers recently addressed a $1.3 billion deficit for the current fiscal year (2009) by cutting more than $349 million in general funds through Executive Order 2009-22 (EO) and using federal stimulus money to fill the remaining gap. The EO included a 4 percent cut to hospitals for July 1 through Sept. 30, 2009, representing a $14 million reduction when lost federal matching funds are included ($4.3 million in general funds and $9.7 million in federal matching funds). If the FY 2009 EO cuts are not carried forward to FY 2010, the state budget shortfall will balloon to approximately $2.5 billion (general fund and school aid dollars).

In response to the projected FY 2010 budget shortfall, every state department is now looking to cut 8 percent from the originally proposed executive FY 2010 budget recommendations. Additionally, elected officials have indicated that the FY 2009 EO cuts will likely be carried into FY 2010. If the 4 percent cut to hospitals is annualized in the FY 2010 Medicaid budget, the cut would total $56 million (estimated to be $15 million in general funds and $41 million in federal matching funds).

Recognizing that the Michigan Department of Community Health (MDCH) is required to reduce spending beyond the FY 2009 EO cuts, and that Medicaid is the largest budget item for the department, the MHA is imploring the hospital community to immediately contact members of the Senate Appropriations Subcommittee on the MDCH to convey the critical importance of preventing further cuts to health care providers and the patients they serve.

A still greater risk exists if the FY 2009 cuts are carried into the next fiscal year AND additional cuts are implemented. Should this happen, Michigan hospitals could see more than $100 million in Medicaid funding reductions when federal matching dollars are included. A funding cut of this magnitude would devastate an already crippled health care delivery system.

The MHA recently activated its traditional grassroots network - Hospitals-ACT - and initiated a new social media campaign to convey the message to lawmakers that Medicaid reductions leave millions of dollars in federal funding on the table and are devastating to all patients, not just those who rely on Medicaid for health care.

The MHA is receiving feedback that many lawmakers have NOT heard from their hospitals on the impact of the FY 2009 cuts. These contacts are essential in bringing the impact of additional cuts closer to home. The importance of a concerted and highly visible advocacy campaign over the next few weeks cannot be underestimated, as lawmakers must understand the impact of Medicaid cuts to their community hospitals and constituents.

Members with questions should contact David Finkbeiner or Peter Schonfeld at the MHA.

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Last week, the Michigan House Regulatory Reform Committee, chaired by Rep. Bert Johnson (D-Detroit), advanced House Bill (HB) 4377, introduced by Rep. Lee Gonzales (D-Flint), to the House Floor. The bill would prohibit smoking in all workplaces, including bars and restaurants, but would provide exemptions for casino gaming areas, cigar bars and tobacco retail establishments (tobacco stores receiving a minimum of 75 percent of their revenue directly from tobacco product sales).

While the Partnership for Michigan's Health (the MHA, the Michigan State Medical Society and the Michigan Osteopathic Association) is supportive of the concept of smoke-free workplaces as outlined in HB 4377, providing protection from secondhand smoke to all Michigan workers remains the ultimate goal. Health care advocates, including the American Cancer Society, agree that this legislation would improve the health status of many Michigan residents, but maintain that secondhand smoke is responsible for 3,000 deaths in Michigan annually and that comprehensive smoke-free workplace laws are in the best interest of Michigan citizens.

Similar smoke-free legislation was introduced last session; however, the bill died in a joint conference committee of House and Senate members. Should HB 4377 pass, Michigan would join 37 other states and Washington, D.C., in eliminating the presence of secondhand smoke in indoor workplaces. However, due to ongoing budget negotiations, it is unclear when further action will be taken on the bill. For more information, contact Chris Mitchell at the MHA.

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With Michigan hospitals facing a fiscal crisis brought on by the state and national recession, the credit market collapse and a growing number of patients who are unable to pay for health care, political advocacy is more important than ever to the vitality of Michigan hospitals and health systems.

This year's MHA Government Relations Retreat is scheduled for July 29-31 at the Grand Traverse Resort in Acme. Attendees will hear directly from elected officials on their legislative priorities and receive a preview of state and federal health care legislation. Additionally, a detailed analysis will be provided regarding the condition of Michigan's economy and how federal American Recovery and Reinvestment Act funds will be directed to health information technology.

MHA members interested in attending the retreat must complete and submit the hotel room reservation form directly to the Grand Traverse Resort by July 4. Event registration is available online or by submitting the event registration form to Stacy Dowdy at the MHA. Coordinators of political or grassroots advocacy activities in MHA-member hospitals are strongly encouraged to attend; however, multiclient lobbyists who represent MHA-member hospitals are ineligible.

Conference attendees are responsible for all travel, lodging, and recreation-related expenses. The MHA will provide on-site meals and cover conference-related expenses. Members with questions should contact Stacy Dowdy at the MHA.

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The 2009 MHA Annual Membership Meeting will highlight Michigan nonprofit hospitals' steadfastness, commitment and contribution to communities and the patients they serve. The meeting will feature many renowned speakers, including Robert Wachter, MD, and Dick Vitale, and social events for attendees and families. Though an original registration deadline of May 18 was established, the deadline for submitting both registration and lodging materials has been extended to June 5.

In addition, the meeting will feature the Links Fore Health nine-hole golf tournament, hosted by the MHA Health Foundation and event partner Kitch, Drutchas, Wagner, Valitutti & Sherbrook. The tournament will raise funds for the foundation's work with hospitals and their neighborhood partners striving to improve community health. Registration to play in the outing remains open and organizations interested in becoming tournament sponsors should contact Erin Steward at the MHA.

Discount coupons (sponsored by Advomas) for Shepler's Ferry tickets are now available. Members with questions regarding registration for the 2009 MHA Annual Membership Meeting should contact Leigh Anne Jewison at the MHA.

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MHA Keystone: Surgery participants attend a May 13 workshop in Dearborn.

The MHA Keystone Center for Patient Safety & Quality Keystone: Gift of Life collaborative was one focus of a presentation at the May 12 Transforming Lives through Leadership Organ Donation Executive Summit in Chicago. A presentation on the strength of partnerships between hospitals, state hospital associations and organ procurement organizations was given by Anthony Armada, chief executive officer, Henry Ford Hospital and Health Network, Detroit; T. Anthony Denton, senior associate director and chief operating officer, University of Michigan Health System, Ann Arbor; and Richard Pietroski, CEO, Gift of Life Michigan. During the MHA Keystone Center and Gift of Life Michigan's four-year partnership, the state organ donor conversion rate has risen to 80 percent, surpassing the national goal of 75 percent. Additionally, 17 Michigan hospitals have received the U.S. Department of Health and Human Services' Medal of Honor for consistently having organ donation rates of 75 percent or more.

The following day, MHA Keystone: Surgery held a workshop in Dearborn that featured the collaborative's surgical teams presenting their successes regarding pre-operative briefings and post-operative debriefings (communication tools designed to help teams prevent surgical mishaps and improve patient safety culture), and the prevention of mislabeling surgical specimens. Materials from the workshop are available to MHA members on the MHA Keystone Center Web site by clicking on "MHA Keystone: Team Members Site" and then "MHA Keystone: Surgery."

For more information, contact Sam Watson at the MHA.

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The Michigan Department of State is now issuing an optional driver's license that also acts as a secure document for identification at the U.S. border. Beginning June 1, residents may only use travel documents approved by the Department of Homeland Security (e.g. enhanced driver's license or enhanced identification card, U.S. passport) to cross the international border by land or sea.

In addition to indicating identity and citizenship, the new enhanced driver's license includes improved features to help health care professionals recognize a patient's needs and wishes at the time of medical care. The "Donor ♥" symbol located in the lower-right corner of the card indicates organ and tissue donor wishes and will only be printed on the face of enhanced licenses or ID cards. A donor sticker will continue to be issued to individuals with a standard license or ID card and to those who enroll on the Organ Donor Registry after obtaining an enhanced license or ID card. Space on the back of the card has also been provided for a Medical Alert box. By marking an "x" in the box, the cardholder alerts emergency responders that the cardholder is carrying a separate emergency medical card.

Michigan residents who are U.S. citizens may apply for the enhanced driver's license at any Secretary of State SUPER! Center or at select branch offices statewide. For more information, contact the Department of State Information Center at (888) 767-6424. Members with questions should contact Chris Mitchell at the MHA.

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Significant changes to the Stark Law regulations governing physician self-referral will take effect Oct. 1, and as a result, certain common business arrangements between hospitals and referring physicians will need to be reviewed, and perhaps restructured, to ensure continued compliance with the law. The MHA Health Foundation webinar Avoiding an October Surprise: Strategies for Complying with the New Stark Law Rules will focus on changes to the Stark rules that affect hospital services provided "under arrangement" and certain "per-click" or percentage-based leases of equipment or space. From 1 to 2 p.m., June 18, participants will learn how the Stark Law actually changed, the impact on physician-owned under-arrangement service providers, and the restructuring strategies and financial realities necessary for compliance. For more information about the webinar or how to register, contact Sara Miller at the MHA

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In partnership with the Michigan Department of Community Health and in conjunction with the Michigan Smoke-free Hospitals Grant, the MHA will host the smoke-free webinar Tobacco Treatment and Mental Illness from 11 a.m. to noon June 18. This webinar is part of a series of sessions planned throughout 2009 to provide support for the MHA Smoke-Free Hospitals: It's a Matter of Life and Health campaign. Dates and topics for additional sessions are:

• Aug. 27 - Pharmacotherapy and the Quit Process
• Oct. 29 - Tobacco Treatment and the Inpatient
• Dec. 17 - Disparate Populations and the 5 A's

Each webinar is offered free of charge and will be held from 11 a.m. to noon. Registration will open one month prior to the webinar date listed, and a reminder for each webinar will be included in upcoming issues of the Monday Report. For additional information, contact Paige Hathaway at the MHA.

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Donna Moyer, DO, was elected president of the Michigan Osteopathic Association (MOA) May 13 at MOA's House of Delegates meeting in Dearborn. Moyer, who will serve as president for 2009-2010, is a board-certified radiologist and has been in the medical field for more than 20 years, including 10 years as chief of radiology for Carson City Hospital. In addition to serving on the MOA Board of Trustees, Moyer is the immediate past president of the Central Michigan Association of Osteopathic Physicians and Surgeons and is a member of the American Osteopathic Association, the American Osteopathic College of Radiology and the Society of Nuclear Medicine.


 

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Cost and quality information about Blue Cross Blue Shield of Michigan (BCBSM) physicians and facilities is now accessible to providers online via BCBSM's new Healthcare Advisor™, a WebMD self-service tool. BCBSM made online cost and quality information available to members Jan. 1, 2009; that information is now also accessible via provider, group customer and agent portals.

To access the tool, providers should log in to Provider Secured Services with their web-DENIS ID and password and click on "Healthcare Advisor" in the left column. Healthcare Advisor™ provides the following information:

• Facility quality: a link to hospital quality scores on the MI Hospital Inform Web site
• Facility cost: facility-specific payment ranges for 33 common procedures, based on BCBSM reimbursement rates
• Physician quality: ratings based on successful treatment of chronic conditions
• Physician cost: preferred provider organization physician fees for office and preventive visits, average costs for Lasik (vision correction) surgery and chiropractic services

BCBSM posts quality score data about physicians participating in its Physician Group Incentive Program. Quality scores attributed to a physician are those of the parent physician organization. BCBSM continually works with participating systems and providers to reflect accurate and representative data.

For questions about web-DENIS and navigating Healthcare Advisor™, participating providers may call BCBSM at (877) 258-3932. With questions about hospital costs on bcbsm.com, contact Doug Darland at (248) 448-3905 at BCBSM.

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• The MHA offices will be closed today to observe the Memorial Day Holiday, but will reopen tomorrow for regular business hours.

• The MHA Patient Safety Organization (PSO) established a June 1, 2009, deadline to standardize three color-coded patient alert wristbands in Michigan hospitals. MHA-member hospitals still have time to provide the MHA PSO with a progress update, as well as feedback on the overall standardization process, by completing a brief questionnaire. To learn more, visit the MHA PSO online or contact Morgan Martin or Sam R. Watson at the MHA.

• The Blue Cross Blue Shield of Michigan (BCBSM) Utilization Management and Quality Assessment Committee hosted Serious Adverse Event (SAE) Hospital Forums May 6 and 19. The forum presentations, which reviewed BCBSM SAE policies and how hospitals have implemented them, are available on web-DENIS. For more information, contact Cassandra Burke at the MHA.