Facing the prospect of a second state government shutdown, Gov. Granholm on Friday signed the six remaining state department budgets and announced a series of line-item vetoes to complete the fiscal year (FY) 2010 state budget. Overall, the governor vetoed 75 additional items totaling $127 million -- including $52 million in school aid announced last week -- to solve the $2.8 billion structural budget deficit.

Before the budget bills were signed, the MHA sent a second letter to the governor asking her to veto the Medicaid cuts to hospitals and other providers. Despite the direct appeal and a protracted advocacy campaign by the MHA and its members, the governor signed the Michigan Department of Community Health (MDCH) FY 2010 budget that includes an 8 percent Medicaid rate cut to all providers. The 8 percent cut will reduce hospital payments by $135 million annually ($36 million in general fund and $99 million in federal matching dollars). The governor's veto also eliminated more than $3 million for prenatal care services and the entire $5 million disproportionate share hospital funding distributed to facilities that received $900,000 or less from the existing $45 million pool in FY 2007.

The Michigan House of Representatives attempted to alleviate the 8 percent cut by passing legislation to create a Quality Assurance Assessment Program (QAAP) for physicians. The Senate discharged the physician QAAP bill from the Health Policy Committee last week; however, the bill was ultimately defeated 32 to 4. After a series of procedural actions, the physician QAAP bill remains on the Senate floor; but it appears unlikely the Senate will reconsider the bill, since such action requires 19 votes.

In the announcement surrounding the vetoes, the governor stated, "This is the budget we have, but it is not the budget we need. I do not agree. I do not support ... this is not the last chapter."  This statement suggests the governor will continue to press for new revenues to restore some of the cuts. However, Senate Majority Leader Mike Bishop (R-Rochester) continues to say Senate Republicans do not have the votes to pass additional tax increases to fund the governor's priorities and do not intend to take up any more revenue bills. Instead, the Senate Republicans plan to offer long-term structural reforms next week that could save the state money.

The MHA continues its work with the state budget office and the MDCH Medical Services Administration to identify ways to lessen the fiscal impact on hospitals. For more information on the FY 2010 Medicaid budget or talking points on the physician provider QAAP, contact David Finkbeiner or David Seaman at the MHA.

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Speaker of the U.S. House of Representatives Nancy Pelosi (D-CA) released last week the leadership version of health care reform, Affordable Health Care for America Act, which would cost $894 billion over 10 years and include a public option. Due to the lack of support for a robust public health insurance option, the bill now includes a public option that would compete with private insurers and other benefit providers and would require the U.S. Department of Health & Human Services Secretary to negotiate rates with providers that fall between average Medicare payment limits and average commercial insurer rates. Health care providers would not be required to participate in the public option; however, enrollment would be available to approximately 96 percent of the population. MHA members are urged to contact their U.S. representative to let them know the public option is too broad and the rating mechanism is unlikely to generate adequate reimbursement for patient care.

Also last week, U.S. Senate Majority Leader Harry Reid (D-NV) sent the leadership health care reform bill to the nonpartisan Congressional Budget Office (CBO). The CBO is evaluating the cost of the bill and the number of people expected to become insured over the next 10 years if the bill were passed. Reid announced the legislation includes a public health insurance option that would allow residents to participate in the public option unless states enact an "opt-out" provision by 2014. Action by the full Senate will not begin until the CBO estimates are released and reviewed. It is widely reported there is not sufficient support for the current version of the bill; therefore, Reid will likely release a second proposed bill.

For more information about federal health care reform legislation or talking points on the various proposals, contact Laura Appel at the MHA.

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On Oct. 24, President Obama officially declared the 2009 H1N1 influenza pandemic a national emergency to allow health care facilities to quickly implement disaster plans should they become overwhelmed during the pandemic. The declaration specifically provides the Secretary of the Department of Health and Human Services (HHS) with the ability to waive certain regulatory requirements for health care facilities in response to emergencies under Section 1135 of the Social Security Act.

Last week, the Secretary of HHS notified Congress of her intent to waive certain regulatory requirements related to Medicare, Medicaid and the Children's Health Insurance Program (CHIP), the Emergency Medical Treatment and Labor Act (EMTALA), and the Health Insurance Portability and Accountability Act (HIPAA). These requirements were established to provide protections for patients under normal circumstances, but during an emergency situation they may hinder a health care facility's ability to ensure appropriate care to patients under disaster operations plans. For example, EMTALA requirements prohibit a hospital from sending a patient off-site for screening, but this action may become routine during the H1N1 pandemic. Specific waivers or modifications under Section 1135 will allow health care facilities to provide care during this emergency period, even if they are out of compliance with certain requirements. Waivers are permitted nationwide to the extent they ensure that sufficient health care items and services are available to meet the needs of Medicare, Medicaid and CHIP beneficiaries.

To petition for a waiver, hospitals and health care providers should contact their state or CMS regional office. The CMS e-mail address serving the Midwest Consortium (including Michigan) is ROCHISC@cms.hhs.gov. Information on the facility and justification for requesting the waiver will be required. The American Hospital Association provided last week a list of questions and answers regarding the waivers as they relate to the H1N1 pandemic. For more information, contact Morgan Stocking at the MHA.

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The 2009 Michigan Harvest Gathering food drives included the generous participation of 83 hospitals and health systems across Michigan to benefit the Food Bank Council of Michigan and its member food banks. For 12 years, the MHA and its members have served as a primary sponsor of the statewide campaign. The hospital community has contributed more than $600,000 and nearly 2 million pounds of food to the Food Bank Council and its member food banks since joining the Michigan Harvest Gathering.

Hospitals participating in this year's campaign are reminded to submit their required post-food drive report form. Doing so will ensure that the overall MHA-member contribution includes all participants' totals. Hospitals that submit their report form by Nov. 4 will be listed as donors at the celebration luncheon that will be held Nov. 12 at the University Club of Michigan State University in Lansing. To learn more about the MHA's participation in the 2009 Michigan Harvest Gathering, contact Paige Hathaway at the MHA.

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Last week, the Michigan House Judiciary Committee heard testimony on House Bill (HB) 4915, sponsored by Rep. Robert Jones (D-Kalamazoo). HB 4915 would substantially reduce the regulatory compliance exemption under the Consumer Protection Act, which is meant to prohibit certain business practices that deceive or mislead consumers. The MHA, as part of a larger coalition that includes businesses, organized medicine and other interest groups, opposes HB 4915. In its testimony, the coalition argued that the bill is unnecessary, counterproductive and would ultimately lead to costly litigation against many businesses, trades and professions (including hospitals) that are already regulated and subject to penalties under state and federal law. Judiciary Committee Chairman Rep. Mark Meadows (D-East Lansing) indicated that there may be a vote on HB 4915 at a later date.

In the House Education Committee, chaired by Rep. Tim Melton (D-Auburn Hills), several groups testified regarding HB 4837, sponsored by Rep. John Walsh (R-Livonia). This bill would enable community colleges to grant baccalaureate degrees in nursing, cement technology, maritime technology and culinary arts. The Michigan Organization of Nurse Executives and the MHA do not currently have a position on the bill; however, the legislation will be considered at the MHA's Dec. 3 Legislative Policy Panel meeting. If passed, the bill could create more opportunities for qualified candidates to receive bachelor's degrees in nursing. Consideration of HB 4837 by the House Education Committee will be taken up at a later date. For more information on state legislation, contact Chris Mitchell at the MHA.

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The Agency for Healthcare Research and Quality (AHRQ) recently announced that it awarded the Health Research & Educational Trust (HRET) nearly $7 million to support projects aimed at preventing health care-associated infections, such as central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections.

The supported projects will include a national expansion of an MHA Keystone Center for Patient Safety & Quality project that, within 18 months, successfully reduced the rate of CLABSIs in more than 100 Michigan intensive care units and saved 1,500 lives and $200 million. As a result of support from the AHRQ and a private foundation, hospitals from all 50 states, the District of Columbia and Puerto Rico have the opportunity to participate in a Comprehensive Unit-based Safety Program, known as CUSP, to help prevent infections related to the use of central line catheters. This national initiative should reduce rates of CLABSIs and improve organizational safety and culture.

The project, "On the CUSP: Stop BSI," is led by HRET in partnership with the Johns Hopkins University Quality & Safety Research Group and the MHA Keystone Center. For more information, contact Sam R. Watson at the MHA.

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Former Medicaid director Paul Reinhart passed away Thursday morning after a long battle with lung cancer. Reinhart, one of Michigan's visionary health care leaders, directed the Medicaid program from April 2003 until January 2009, when Steve Fitton became acting Medicaid director.

Reinhart used his honest assessment skills and creativity to improve health care coverage for thousands of Michigan's children, mothers, seniors and disabled residents. He served the state's citizens with no political bias, working under both Democratic and Republican governors in a variety of roles over the course of more than three decades, including eight years as director of the Office of Health and Human Services in the governor's budget office.

For much of his career, Reinhart developed Medicaid and human services policies, and as the Medicaid program has grown and faced numerous financial crises, he was a partner with the MHA and Michigan's hospitals in seeking creative ways to resolve serious fiscal problems in ways that did no harm to Medicaid beneficiaries or the providers that render their care. In 2007, the MHA presented Reinhart with the MHA Special Recognition Award for his significant contributions to health care in the state.

MHA President Spencer Johnson said of Reinhart, "The people of Michigan have witnessed the loss of a public servant whose intellect and integrity allowed him to work across party lines, and the hospital community and the MHA have experienced the loss of a valued friend."

Funeral services have been set for 2 p.m. Tuesday at the Estes-Leadley Greater Lansing Chapel, with visitation held today from 2 to 4 p.m. and 6 to 8 p.m. Memorial donations may be made to the Greater Lansing Food Bank. For more information, contact Peter Schonfeld at the MHA.

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The MHA Health Foundation is committed to providing first-class educational opportunities to MHA members, allowing them to stay abreast of changes taking place in health care. Three upcoming programs address diverse issues currently affecting Michigan hospitals.

Coaching staff toward excellent outcomes is among the most valuable, yet most difficult, challenges that leaders face. To help staff achieve their professional goals and prepare for adversity, managers are encouraged to attend the audioconference Instilling Accountability at the Front Line and Elevating Staff Performance, scheduled for Nov. 18.

Billing and coding personnel who would like guidance on the Centers for Medicare & Medicaid Services (CMS) final rule to update the Medicare impatient prospective payment system are encouraged to attend the MHA Health Foundation webinar Inpatient Prospective Payment System 2010 Update, scheduled for Dec. 3. Projecting reimbursement changes and the impact on operations is imperative for revenue cycle managers and reimbursement specialists, who will find this program on the 2010 updates particularly beneficial.

Medication errors represent the largest percentage of medical mistakes made in health care today, making medication management a key issue with the CMS and The Joint Commission. In the MHA Health Foundation webinar Fifty Tips to Reduce Medication Errors and Comply with CMS and The Joint Commission Standards, patient safety expert Sue Dill Calloway will provide guidance found in evidence-based literature for detecting errors and improving safety. The webinar will be offered Dec. 10.

For more information or to register for these valuable programs and others hosted by the MHA Health Foundation, visit the MHA Health Foundation online. Members with questions should contact Sara Miller at the MHA.

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Keener	Hillbom

Two Michigan hospital executives have been appointed to the Gift of Life Michigan Advisory Board. Timothy Keener is the senior vice-president of strategy and organizational development for Allegiance Health, Jackson. Rick Hillbom is the chief operating officer - outpatient services for the Oakwood Hospital and Medical Center, Dearborn. "Both [men] have a long track record of supporting Gift of Life Michigan and will be great additions to our Advisory Board," said Rich Pietroski, executive director of Gift of Life Michigan, which serves as the state's organ recovery organization. Keener and Hillbom will begin their three-year terms at the organization's Nov. 19 board meeting.

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• The MHA Board of Trustees will meet at 9 a.m. Wednesday at MHA headquarters, Lansing. The board will receive a report on progress toward national health care reform, including focused MHA advocacy around hospital-based durable medical equipment funding, geographic variation protections, rural assistance, and patient safety and quality practices. For more information, contact David Seaman at the MHA.

• The MHA will host a Medicare Area Wage Index Workshop from 9 a.m. to 12:30 p.m. Wednesday at Providence Park Hospital, Novi. This workshop will focus on the statewide Medicare Area Wage Index Data Improvement Project for federal fiscal year 2011. For more information, contact Vickie Seal at the MHA.

• Late last week, U.S. Department of Health & Human Services Secretary Kathleen Sebelius announced that the U.S. Senate unanimously confirmed Regina R. Benjamin, MD, MBA, as the nation's Surgeon General.  Benjamin is founder and chief executive officer of the Bayou La Batre Rural Health Clinic in Alabama, the immediate past chair of the Federation of State Medical Boards of the United States, and previously served as associate dean for rural health at the University of South Alabama College of Medicine.