The MHA Board of Trustees conducted its first meeting of the program year Sept. 16, focusing much of its attention on the design of a 2009-2010 action plan. Using the association's four strategic pillars (access, funding, quality and health improvement) and specific advocacy objectives, the board designed a work plan with particular priorities around national health care reform, the state Medicaid budget process, Blue Cross Blue Shield of Michigan rebasing discussions, the activities of the MHA Keystone Center for Patient Safety & Quality, hospital data reporting to the MHA Patient Safety Organization, and completion of the hospital trans fat elimination program.

Additionally, the board directed the association to actively pursue two strategic design opportunities. First, with a sense of urgency, the board called for the design of a program to expand coverage through a special Medicaid waiver, with a goal of covering all patients who earn below 300 percent of the federal poverty level. Secondly, the board requested a program that, by leveraging quality improvements, cost efficiencies and reductions in variations of care, will reduce Michigan hospital cost trends to bring overall annual cost growth below the national average.

The board also reviewed key activities in the government relations arena, including progress toward national health care reform, such as focused MHA initiatives around durable medical equipment and patient safety opportunities. At the state level, the board discussed the ongoing deliberations regarding the fiscal year 2010 state budget and its implications for Medicaid funding, encouraging the association to bring attention to the impact on health care providers. In addition, the board directed staff to model strategies to address shortfalls through expansion of the Quality Assurance Assessment Program.

Additionally, the board engaged in a strategic conversation about advocacy communication during these tumultuous times. The board discussed traditional advocacy (HealthPAC, grassroots and traditional media efforts) and new forms of communication advocacy (social media such as Facebook and Twitter and heightened community outreach, including virtual town-hall meetings and robocalls). In light of issues surrounding the use of social media, the association will be forwarding to members legal guidance on permissible lobbying activity and sample Internet computing guidelines.

Turning its attention to the new Internal Revenue Service guidelines concerning the reporting of community benefits data, the board received updated information on hospital performance in the arenas of charity care, bad debt and government underpayment. In light of growing interest about hospitals' tax-exempt status and the current absence of data from numerous Michigan hospitals, the Board of Trustees approved a motion urging all MHA member hospitals to submit their community benefit data to the association as soon as possible.

Finally, the board authorized the MHA to seek amicus curiae standing in the matter of Moses/Irons v. Providence, a case that significantly alters the laws regarding hospital stabilization requirements under the federal Emergency Medical Treatment and Active Labor Act; approved the membership application of Polsinelli Shugart, PC, a law firm headquartered in Kansas City, MO; and approved special board resolutions honoring retiring member chief executive officers Jack Denton (Eaton Rapids Medical Center) and Joseph Wasserman (Lakeland Regional Health System) for their long and honored service to Michigan's health care community. Questions regarding the board's activities should be directed to David Seaman at the MHA.

Back To Top

A final solution to the state's $2.8 billion ($1.8 billion general fund and $1 billion school aid fund) fiscal crisis remains in question as Gov. Granholm, Senate Majority Leader Mike Bishop (R-Rochester) and Speaker of the House Andy Dillon (D-Redford) struggle to create an agreement. By law, the state must have a balanced budget for fiscal year (FY) 2010 by Oct. 1 or nonessential government services will shut down.

The tentative Michigan Department of Community Health (MDCH) general fund budget reduction target is $568 million less than the governor's original executive budget recommendation and will likely result in maintaining a Senate-passed proposal that cuts all Medicaid providers by 8 percent. Dillon indicated last week that the House of Representatives would pass the nearly $1.2 billion in cuts passed by the Senate in June and use federal stimulus funds to balance the budget; however, the House had not passed any budget bills as of Friday.

For Michigan hospitals, an 8 percent cut to inpatient and outpatient rates would total more than $135 million ($36 million general funds and $99 million in lost federal matching funds). In response to this proposal, the MHA issued a Hospitals-ACT Action Alert last week urging members to contact House leadership and their state representatives to urge rejection of any proposal that contains health care funding reductions.

The federal government recognized the importance of maintaining access and coverage for Medicaid patients by allocating nearly $2.2 billion in emergency stimulus funding for FYs 2009, 2010 and the first quarter of 2011. To date, the Legislature has diverted nearly all of these funds to nonhealth-care spending and is again proposing to use a portion of these funds to fill other FY 2010 budget holes. Lawmakers must be encouraged to use Medicaid stimulus funds as they were intended - for health care.

This week is critical for final decision-making on Medicaid funding recommendations. As a result, lawmakers must hear from the hospital community how the proposed 8 percent cut will severely jeopardize health care for patients seeking treatment in Michigan hospitals. Additionally, lawmakers must be reminded that millions of dollars in federal health care funds will be lost if Medicaid cuts are approved. For every $1 Michigan spends on Medicaid, the federal government sends an additional $2.74 to the state. So for every $1 the Legislature cuts from Medicaid, Michigan patients and providers lose $3.74 in essential health care funding.

After legislative leadership and Gov. Granholm reach an agreement on the amount of spending reductions, conference committee members who will strive to forge a final agreement on the MDCH budget figures include Reps. Gary McDowell (R-Rudyard), Richard Hammel (D-Mount Morris Twp.) and Kevin Green (R-Wyoming) and Sens. Roger Kahn (R-Saginaw Twp.), John Pappageorge (R-Troy) and Deborah Cherry (D-Burton).

The association continues to mobilize its traditional grassroots efforts and social media campaigns to urge resolution of the state's budget crisis with an infusion of new federal stimulus dollars, not continued cuts. Members are strongly encouraged to immediately contact their state lawmakers and urge rejection of the Senate-passed cuts. Members with questions should contact David Finkbeiner at the MHA.

Back To Top

Sen. Max Baucus (D-MT), chairman of the U.S. Senate Finance Committee (SFC), last week released his version of health care reform. The SFC is scheduled to begin work on amendments to the Baucus plan Tuesday afternoon and will take several days to complete.

Key provisions affecting hospitals include coverage expansion to 94 percent of the U.S. population through Medicaid expansions and an individual mandate to purchase insurance. The plan would create state-based insurance "exchanges" and new nonprofit cooperatives instead of a public plan option. To date, the Baucus plan is estimated to cost more than $856 billion. To pay for reform, hospital Medicare and Medicaid marketbasket updates and disproportionate share hospital payments would be reduced. However, payment reductions are linked to increases in coverage enrollment. Earlier this year, the American Hospital Association (AHA) reached an agreement with the SFC that would forgo $155 billion in government health care reimbursements over the next 10 years to help finance health care reform.

The Baucus plan establishes a policy on preventable hospital readmissions for eight select conditions and allots $500 million over 10 years for transitional care programs to help reduce avoidable readmissions. Rehospitalizations that were planned or unavoidable are excluded.

There is also a $2.6 billion increase over 10 years in graduate medical education (GME) funding by providing Medicare payment bonuses to primary care physicians and general surgeons and a redistribution of unused GME residency slots to increase access to primary and generalist physicians. Lastly, the plan includes a number of provisions assisting rural hospitals, such as extending the Medicare Dependent Hospital program and the hold-harmless provision for the outpatient prospective payment system. On Sept. 16, the AHA issued a Special Bulletin that provides more detailed information on the key components affecting hospitals.

Now that Chairman Baucus' legislation is available, additional work will need to be done to adjust the language to further reflect the principles of the AHA's agreement. Information, including updates on the SFC work, will be posted on the MHA's National Health Reform Update Web site as it becomes available. For more information on health care reform, contact Laura Appel at the MHA.

Back To Top

Nancy McKeague, senior corporate vice president, MHA Corporate Support Services Division (left), and Sheryl Welsh, assistant director of human resources, MHA, are pictured with the association's Sloan Award.

At an awards ceremony last week, the MHA was presented with a 2009 Alfred P. Sloan Award for Business Excellence in Workplace Flexibility. Part of the When Work Works project, the award honors organizations and worksites nationwide that are using workplace flexibility as a strategy to increase workplace effectiveness and yield positive business results and to help employees succeed at work and at home.

Applicants for the Sloan Award are evaluated through a two-step process. The employer's application is compared to nationally representative data and then corroborated through a survey of employees.

The MHA and other winners of the 2009 Sloan Award will be featured in the 2010 edition of the Guide to Bold New Ideas for Making Work Work, published by the Families and Work Institute. This nonprofit, nonpartisan research organization studies the changing workforce, family and community and is a partner in the When Work Works project, along with the Institute for a Competitive Workforce and the Twiga Foundation.

For more information on this recognition of the MHA's workplace flexibility, contact Nancy McKeague at the MHA.

Back To Top

Representatives of the MHA, the Food Bank Council of Michigan and the Michigan Association of Health Care Advocates spoke at a news conference on the Capitol steps Thursday to kick off the 2009 Michigan Harvest Gathering campaign. Acting as emcee, former U.S. Rep. and court of appeals judge Bill Schuette discussed the hurting economy and increased need for food. He also introduced the new "Fill Michigan's Fridge" online food drive to give organizations and individuals an easy way to help feed hungry Michigan families. Donors have the option of making a monetary donation via an interactive site that allows them to choose what types of foods they would like to have purchased with their donation. Other speakers included First Gentleman Dan Mulhern, Secretary of State Terri Lynn Land, Michigan Department of Agriculture Secretary Don Koivisto, and Rep. Kim Meltzer (R-Clinton Twp.).

The MHA, the Michigan Association of Healthcare Advocates (MAHA) and their members have acted as primary sponsor of this statewide food- and fundraising effort since 1998. To date, nearly 80 Michigan hospitals and related organizations have registered to collect food and funds in their facilities this fall to help feed the increasing numbers of hungry Michigan residents.

MHA-member organizations can continue to register to participate in the Michigan Harvest Gathering. To do so, a Project Team Leader Form should be submitted as soon as possible to designate the contact person for the facility's campaign. The MHA Web site includes information to help facilities run their food drives, such as an order form to request free posters, stationery and other materials to help publicize this effort. To learn more about the Michigan Harvest Gathering and the MHA's participation in it, contact Paige Hathaway at the MHA.

Displaying the MHA's corporate donation "check" for the 2009 campaign are (left to right) Meltzer, Koivisto, Food Bank Council of Michigan Executive Director Jane Marshall, MHA President Spencer Johnson, MAHA Counselor Vicki Chatland, Mulhern, Land and Schuette.

Back To Top

The Medical Services Administration (MSA) recently distributed correspondence to hospitals regarding timely completion of the disproportionate share hospital (DSH) eligibility form for fiscal year 2010. This information will be used for determining hospital eligibility for payments from the $45 million DSH pool, $5 million DSH pool and the tax-funded outpatient uncompensated care DSH pool. Hospitals are encouraged to complete and submit the form to the MSA by Oct. 2, 2009, to ensure they receive their DSH payments. (Note that the letter from the MSA contains an incorrect deadline of Oct. 2, 2010.) The form is available on the Michigan Department of Community Health DCH-File Transfer application and can be submitted via either the DCH-File Transfer or e-mail. Members with questions should contact Vickie Seal at the MHA or Cindy Drumm at the MSA.

Back To Top

The Michigan Department of Community Health (MDCH) recently sent a letter to hospital chief executive officers to share important reminders as hospitals ramp up for the upcoming influenza season, which will include the 2009 novel H1N1 influenza. The MDCH recommendations include:

• the early identification and appropriate isolation of potentially infectious patients
• a comprehensive respiratory hygiene program that includes educating patients and staff to cover their cough
• strict hand hygiene for health care workers, patients and visitors
• the vaccination of health care workers

Shipments of the seasonal influenza vaccine have arrived this month and clinicians are being encouraged to vaccinate early. The 2009 novel H1N1 influenza vaccine is currently undergoing clinical trials and the state has indicated that limited shipments of the anticipated two-dose regimen will become available in October.

In addition to efforts by the MDCH, the state Legislature is currently considering Senate Bill 722, sponsored by Sen. Roger Kahn (R-Saginaw Twp.), which would require hospitals to establish a seasonal influenza vaccination plan consistent with regulations set forth by the U.S. Centers for Disease Control and Prevention. The MHA Legislative Policy Panel will be considering the legislation at this week's meeting. For more information, contact Chris Mitchell at the MHA.

Back To Top

ProMedica Health System, based in Toledo, OH, has announced that Randy Oostra will become its new president and chief executive officer (CEO) effective Oct. 1. He will succeed Alan W. Brass, who has served as ProMedica's CEO since 1998 and will become its CEO Emeritus Oct. 1. Bixby Medical Center, Adrian, and Herrick Medical Center, Tecumseh, are included in ProMedica Health System's North Region. Oostra joined the health system in 1997 and has served in several executive leadership positions, most recently as president and chief operating officer. Prior to joining ProMedica, he held leadership positions at St. Anthony's Health System, Alton, IL; Spectrum Health, Grand Rapids; and Allina Health System, Minneapolis. He holds a doctorate in management from Weatherhead School of Management at Case Western Reserve University, Cleveland.

James (Chip) Falahee Jr., senior vice president of legal and legislative affairs and corporate compliance officer with Bronson Healthcare Group, Kalamazoo, was recently appointed to the state Certificate of Need Commission. He succeeds Norma Hagenow in representing hospitals for a term expiring April 9, 2010. The commission reviews and determines the need for new institutional health services, facilities or organizations in Michigan. In his role at Bronson Healthcare, Falahee provides executive direction on all legal matters for the health system and is Bronson′s principal contact with state and federal legislators. He is also responsible for implementing and overseeing Bronson′s corporate compliance program and code of conduct.

Kramer	Sevillian

Modern Healthcare recently named two Michigan hospital executives 2009 "Up & Comers" in health care. As vice president and chief medical information officer (CMIO) of Trinity Health, Novi, J. Michael Kramer serves as the physician champion of Project Genesis, Trinity's systemwide clinical information technology program, which dates back to the late 1990s. According to Kramer, the most important professional skill for a CMIO is the ability to influence and collaborate across departments with people from multiple professional backgrounds. Kramer received his medical degree from Cleveland's Case Western Reserve University School of Medicine and completed a residency in internal medicine and pediatrics at the University of Michigan in 1999. He then worked in urgent care, as a hospitalist and as a medical officer on duty with the Veterans Affairs Department, all at hospitals in Ann Arbor. Clarence Sevillian was appointed president and chief executive officer of Doctors' Hospital of Michigan, Pontiac, in November 2008. After a long and successful career in health care in Michigan, he is currently charged with rebuilding the hospital's staff, patient base and community standing in a difficult economy. Sevillian is a former professional football player turned physical therapist, who went on to earn a Masters of Business Administration degree and launch his career in health care administration.

Back To Top

The 2010 MHA Membership Directory will be published in December and may now be ordered at a pre-publication price. Nowhere else can organizations and individuals access comprehensive contact information for every MHA-member organization, including mailing and e-mail addresses, phone numbers, fax numbers, Web site addresses and more. The list of member employees includes such titles as chief information officer, compliance officer, managed care director, human resource director and chief of staff. The 2010 directory also includes a listing of MHA staff and services.

The regular cost of the directory is $125 for MHA members and $300 for non-MHA members. However, individuals who place an order before Nov. 20 receive a 20 percent discount, making the cost $100 for members and $240 for non-MHA members. For more information, contact Paige Hathaway at the MHA.

Back To Top

Dean Sienko (left) and Sandra Frank

An Infant Safe Sleep Day at the Capitol event was held last week in the Capitol Rotunda in Lansing. Among those participating were Rep. Barb Byrum (D-Onondaga) and Sens. Randy Richardville (R-Frenchtown Twp.) and Tom George (R-Kalamazoo). Dean Sienko, MD, MS, chief medical examiner of the Ingham County Health Department, spoke at the Infant Safe Sleep Day at the Capitol, while Sandra Frank, executive director of Tomorrow's Child/Michigan SIDS, emceed the event. It marked the third observance of Infant Safe Sleep Month in Michigan, which was declared to help stem the growing tide of infant deaths caused by unsafe sleeping environments. Infant Safe Sleep Month provides an opportunity to remind professionals and organizations that care for families of the importance of safe sleep practices. For more information, contact Paige Hathaway at the MHA. 

Back To Top

• The MHA Health Foundation will host the webinar Breach Reporting Regulations under the HITECH Act from 1:30 to 2:30 p.m. Tuesday. The webinar will focus on the detailed requirements of the federal breach reporting regulations that take effect this week and suggest practical steps for implementing those regulations. For more information, contact Sara Miller at the MHA.

• The MHA Legislative Policy Panel will meet from 9:30 to 11:30 a.m. Thursday at the MHA Capitol Advocacy Center, Lansing. Participants will receive an update on the state fiscal crisis threatening Medicaid services and recent developments in the national health care reform debate. In addition, the committee will consider pending legislation regarding flu vaccinations. For more information, contact David Finkbeiner at the MHA.