The Senate Appropriations Subcommittee on the Michigan Department of Community Health is scheduled to meet tomorrow and report out its proposed fiscal year (FY) 2010 budget recommendations for Medicaid and other health care spending.

It is expected that the subcommittee will recommend eliminating nearly $200 million in general fund support for health care. When combined with lost federal matching funds, the cut could grow to more than $600 million.

Hospitals will likely face continuation of the current 4 percent cut to inpatient and outpatient rates, resulting in lost funds totaling more than $56 million ($16 million in general funds and $40 million in federal matching funds). Additionally, elimination of optional Medicaid services that occurred in the current fiscal year - podiatric, chiropractic, optometric, hearing and dental - are expected to continue into FY 2010. However, significantly deeper cuts will be necessary to achieve the $200 million general fund savings target established by the subcommittee, which could include further rate reductions for hospitals and other providers. After the subcommittee acts, the budget will be sent for consideration of the full Senate Appropriations Committee, which is expected to report the bill to the full Senate on Wednesday.

In response to this legislative action, a Hospitals-ACT Action Alert was issued, urging MHA members to contact members of the Senate Appropriations Committee and leadership and encourage them to use new federal stimulus funds to protect vital health care funding for all patients, not just those who rely on Medicaid for coverage. The MHA continues to press lawmakers on the critical importance of maintaining and enhancing funding for the hospital safety net through the use of federal stimulus funds in this time of economic crisis. Members with questions should contact Dave Finkbeiner at the MHA.

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The Michigan Association of Healthcare Advocates (MAHA) hosted its 60th Annual Meeting and Educational Institute last week at the Grand Hotel on Mackinac Island.

In conjunction with the MAHA's anniversary, conference attendees learned about the history of the Lilac Festival, which is also celebrating its 60th anniversary, from renowned Mackinac Island historian Larry Parel. Additionally, workshops were offered on the MAHA's governance process, the importance of health screenings, and the positive impacts of volunteerism.

Nancy Schlichting, chair of the MHA Board of Trustees, installed the 2009-2010 officers: Mary Lou McFadden, Allegiance Health, Jackson, president; Cathy Crimmins, Marquette General Health System, president-elect; Betty Bierman, North Ottawa Community Hospital, Grand Haven, vice president education; Sheryll Mithen, St. Joseph Health System, Tawas City, secretary; Sharon Flewelling, Mercy Hospital Cadillac, treasurer; and Vicki Chatland, MidMichigan Medical Center-Midland, counselor.

The MHA and its 144 nonprofit hospital members thank the hospital volunteers for supporting their community hospitals and the patients they serve for the past 60 years. The hospital community would not be as successful without the input, action and support of the many dedicated volunteers across the state. Members with questions should contact David Finkbeiner at the MHA.

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The Health PAC fundraising campaign continues to advance toward its 2009 goal. However, MHA-member hospitals/systems that have not met their organizational goal are strongly encouraged to take the necessary steps to initiate or complete their fundraising campaigns by June 30. At a minimum, the Health PAC Board is encouraging 100 percent participation from every hospital administrator.

As of June 10, the MHA Health PAC had raised more than $283,000 toward the $350,000 statewide goal. Eight additional hospitals/systems have achieved their organizational goals: Borgess Health Alliance, Kalamazoo; Community Health Center of Branch County, Coldwater; Detroit Receiving and University Health Center; Hayes Green Beach Memorial Hospital, Charlotte; Huron Valley-Sinai Hospital, Commerce Township; Rehabilitation Institute of Michigan, Detroit; Sheridan Community Hospital; and St. Joseph Mercy Hospital, Ann Arbor.

All those who contribute to the campaign secure membership to one of the following clubs: Chairman's Circle ($1,000+), Trustees' Club ($750+), President's Club ($500+), Capitol Club ($350+) and Century Club ($250+). For more information on the campaign, goal achievers and club members, visit the Health PAC Web site.

Hospitals/systems with exceptional fundraising performance will be recognized at the MHA Annual Membership Meeting later this month. Members with questions should contact Stacy Dowdy at the MHA.

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The 2009 MHA Government Relations Retreat scheduled for July 29-31 at the Grand Traverse Resort in Acme has been canceled. The state Legislature plans to remain in session through the end of July to ensure the fiscal year 2010 state budget is balanced (see related article), making it imperative that hospital government relations staff be present in Lansing to voice the needs of hospitals and the patients they serve.

To share the information that was planned for discussion during the retreat, a one-day seminar will be scheduled in Lansing. The MHA will provide information on this event in coming weeks. Members with questions should contact Stacy Dowdy at the MHA.

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During last week's Medical Services Administration (MSA) hospital work group meeting, the MSA reported that it will finalize the fiscal year (FY) 2009 disproportionate share hospital (DSH) ceiling calculations in the near future. DSH ceilings will be impacted by the 4 percent Medicaid rate cut required by the recently approved Executive Order 2009-22 and the mandated shift of pregnant women from Medicaid fee-for-service to managed care, potentially affecting hospital payments from all three hospital DSH pools - the historical $45 million and $5 million pools and the hospital provider tax-funded $60 million outpatient uncompensated care DSH pool.

The MSA anticipates distributing payments from the $45 million and $5 million DSH pools in August and the $60 million pool in either August or September, with the corresponding tax collected shortly after payments are distributed. The $60 million pool allocates $30 million to small and rural hospitals and $30 million to all others. The MHA will provide additional information as soon as it becomes available. Members with questions should contact Jason Jorkasky or Vickie Seal at the MHA.

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Executive Order 2009-22, recommended by the governor and approved by the House and Senate Appropriations Committees in May, mandates unpaid furlough days for state employees to help eliminate the state's fiscal year 2009 budget deficit. The Michigan Department of Management and Budget recently announced six days when a majority of state government offices will be closed to accommodate the unpaid furlough of state employees:

•  Friday, June 19
•  Monday, July 6
•  Friday, July 24
•  Friday, Aug. 7
•  Friday, Aug. 21
•  Friday, Sept. 4

Some state services, including those vital to public health and safety, will not be closed. These include the Michigan State Police road patrols, correctional facilities, state psychiatric hospitals, veterans' homes and youth facilities, emergency human services programs, and the Unemployment Insurance Agency. Additionally, driver licenses and vehicle license plates that expire on a day when state offices are closed may be renewed the following day without penalty.

Impact to MHA-member hospitals will be minimized, as most hospitals currently file Medicaid patient claims electronically. However, any claims that require manual intervention to be resolved may be processed later than normal. Additionally, the reduced work schedule may result in longer time frames to resolve routine transactions with the state. Members with questions should contact David Finkbeiner at the MHA.

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In partnership with the Small Business Association of Michigan, the MHA has publicly launched today the Michigan's Wellness Resource Web site to help small businesses build wellness programs and use services and information available at their local hospitals to do so.

In addition to serving as a hospital resource guide for small businesses, Michigan's Wellness Resource offers case studies from the business community, a wellness DVD and a toolkit detailing the steps involved in building a successful wellness program.

The site also serves as an educational and resource guide for individuals and families striving to build healthier lifestyles. The public can find tools such as menu planners, food and activity diaries, helpful hints for involving children in healthy meal planning and cooking, and links to Michigan hiking and biking trail maps. Members with questions should contact Paige Hathaway at the MHA.

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As a reminder, MHA-member hospitals are invited to apply for participation in the initiative and are encouraged to do so by the Friday, June 19, deadline.

Fifteen Michigan hospitals will initially be selected to participate in the initiative and improve patient care transitions through interventions that include enhanced patient communication and timely follow-up after hospital discharge. The effort will target rehospitalizations that are not expected/scheduled, but whose reason is clinically related to the initial admission.

The STAAR initiative will also exchange best-practice information with Care Transitions, a pilot project in 14 regions across the nation (including Lansing) to reduce preventable hospital readmissions through improved care coordination. Ultimately, the goal is to apply what is learned from these two pilot programs to statewide and regional efforts. Members with questions should contact Sam Watson or Morgan Martin at the MHA.

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The American Recovery and Reinvestment Act (ARRA) has made funds available for the National Health Service Corps (NHSC) Loan Repayment Program, administered by the Health Resources and Services Administration (HRSA), and to provide an opportunity for the U.S. Centers for Disease Control & Prevention (CDC) to enhance immunization programs across the country.

NHSC clinicians care for those who live in communities where health care resources are scarce. In exchange for two years of service at an eligible, high-need site, the NHSC Loan Repayment Program offers repayment of up to $50,000 in qualifying educational loans for clinicians who are providing full-time clinical services. The new ARRA funding will allow more than 7,000 service sites that are already eligible to post more new vacancies and increase the number of clinicians eligible for loan repayment awards at their sites. Additional sites are also being approved on a daily basis. For the first time, primary health care clinicians who are interested in the loan repayment program do not need to be employed at the site at the time they apply for the funds. For more information and application forms, call (800) 221-9393.

The CDC will use its ARRA funding to conduct time-limited enhancements of its immunization partners' program through the creation of new partnerships. Hospitals are among the eligible applicants that may apply for one or more of three unique funding categories:

• technical assistance and training for immunization coalitions and health departments
• development and implementation of materials and programs to educate nurses about immunization issues
• development of vaccine safety communication materials and curriculum for medical residents

The application deadline for the CDC immunization education grants is July 6. For more information, contact the CDC at (770) 488-2700.

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Tersigni

Anthony R. Tersigni, EdD, FACHE, has been selected as vice chairperson/chairperson-elect of the Catholic Health Association of America (CHA) Board of Trustees and will lead the association in fiscal year 2010-2011. Tersigni is president and chief executive officer (CEO) of Ascension Health, St. Louis, MO, the parent organization of Michigan health systems Borgess Health, Kalamazoo; Genesys Health System, Grand Blanc; St. John Health, Detroit; St. Joseph Health System, Tawas City; and St. Mary's of Michigan, Saginaw. Colleen Scanlon, RN, JD, senior vice president, Advocacy, Catholic Health Initiatives, Denver, has been installed as the chairperson of the group for the current year. In addition, Joseph R. Swedish, MHA, FACHE, president and CEO, Trinity Health, Novi, was elected to a second three-year term on the board.

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The deadline for submission of the 2009 Leapfrog Hospital Survey is June 30, and results will be reported in July. Only hospitals that report by June 30 will be considered for Leapfrog's Top Hospitals list. Because heavy user demand is expected in late June at the online survey site and the Help Desk, it is strongly recommended that hospitals consider completing and submitting the online survey by June 18. However, the survey will be open throughout the year for updates to responses.

Rural hospitals should focus on at least two of the four "leaps." They may submit responses for the Leapfrog Safe Practices section and the Evidence-based Hospital Referral section, if they perform any of the associated procedures. The safe practices have been designed to create a level playing field for rural hospitals, and rural-specific content regarding safe practice implementation is included in the National Quality Forum Hospital Safe Practices report. Hospitals that complete the ICU (Intensive Care Unit) Physician Staffing and Computer Physician Order Entry survey sections will receive credit as specified for urban hospitals, but will not be penalized if they do not perform certain procedures or are not eligible for certain measures.

The Leapfrog Group is a national nonprofit organization representing health care purchasers, including many of Michigan's largest and most influential employers. As in past years, the Michigan Health and Safety Coalition is assisting in survey administration.

Participating in the survey demonstrates a hospital's commitment to improving patient safety to health care consumers and purchasers nationwide and provides the citizens of Michigan with valuable information on hospital safety. Members with questions should contact Sam R. Watson at the MHA.

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Jeanette Klemczak, RN, chief nurse executive for the State of Michigan, joined the MHA Strategic Planning Committee at its recent meeting in Lansing, providing an overview of the nursing shortage confronting Michigan hospitals and other providers. Klemczak noted that 35 percent of active Michigan registered nurses, and 40 percent of active licensed practical nurses, are over the age of 55. Expected retirements, combined with bottlenecks in the nurse education pipeline, could lead to a nurse shortage of nearly 30,000 by 2020. Committee members observed that nurse staffing challenges have eased significantly in 2009, due to economic pressures that have curtailed patient volume, led many recently retired nurses to return to the workplace, and led existing nurses to increase hours. Klemczak stated that this phenomenon is likely a short-term "blip" that will not significantly alter the projected shortages over the long term. She also credited the MHA and its member hospitals for their leadership on the "ACE Placement" initiative, a Web-based system providing Michigan health care and educational institutions with an automated clearinghouse for all clinical placements for students.

The committee also discussed health care information technology, federal health reform, and potential association activities related to LEAN management, which is currently being used by many hospitals and is a key element of the current MHA Keystone Center for Patient Safety & Quality obstetrics collaborative. Members with questions should contact Brian Peters at the MHA.

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The Joint Commission is proposing accreditation requirements to help hospitals better address effective communication, cultural competence, and patient-centered care. Although many aspects of these issues are currently supported by existing requirements, the proposed requirements have the potential to further improve the safety and quality of care for all patients. At the earliest, any implementation of the proposed requirements would occur in January 2011.

Comments on the proposed requirements are being accepted for six weeks, beginning June 8, and feedback may be submitted online, via e-mail, or by mail. For more information, contact Christina Cordero at the Joint Commission at (630) 792-5845 or Sam R. Watson at the MHA.

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At its meeting in Lansing last week, the MHA Business Advisory Council discussed the potential for cost savings and improved employee productivity associated with improved treatment of chronic headache pain. Joel Saper, MD, FACP, FAAN, founder and director of the Michigan Head Pain and Neurological Institute in Ann Arbor, highlighted the potential overuse of opioids (pain-relieving medications), as well as the success that has been demonstrated through the direct treatment of behavioral factors.

With Michigan's unemployment rate now the highest of any state in the nation, the council also discussed current trends and issues related to unemployment compensation and the implications for Michigan employers, including new exposure to extended benefits for laid-off employees. In addition, the council examined the link between federal economic stimulus funding and a series of bills now under consideration in the Michigan Legislature, which would significantly impact the state's unemployment compensation program. Finally, the council heard updates on federal workers' compensation legislation and received a status report on the activities of the MHA Patient Safety Organization. Members with questions should contact Brian Peters at the MHA.

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• The MHA Health Information Technology (HIT) Task Force will meet from 8 to 10 a.m. Tuesday at MHA headquarters, Lansing, with conference call option available. The task force will provide recommendations to the MHA Board of Trustees regarding health information exchanges (HIEs). For more information, contact Jim Lee at the MHA.

• The MHA Health Foundation Webinar Avoiding an October Surprise: Strategies for Complying with the New Stark Law Rules will be presented from 1 to 2 p.m. Thursday. The webinar 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. For more information, contact Sara Miller at the MHA.

• The Smoke-free Campus Webinar: Tobacco Treatment and Mental Illness will take place from 11 a.m. to noon Thursday. The MHA and the Michigan Department of Community Health, with funding through the Michigan Smoke-free Hospitals Grant, are hosting a variety of smoke-free webinars throughout 2009. Currently, 90 percent of Michigan hospitals are smoke-free campuswide. These webinars are intended to provide support for the MHA Campaign for Smoke-Free Hospitals initiative. For more information, contact Paige Hathaway at the MHA.

• To ensure MHA members remain informed and engaged in the health care reform activity in Washington, D.C., the MHA has created a new section on the MHA Web site to provide direct access to bill summaries, letters, policy papers and other communications among policymakers affecting the debate. In addition, beginning next week, Monday Report will include frequent updates on how this federal activity impacts Michigan hospitals and vice versa. For more information about national health reform developments, contact Laura Appel at the MHA.

• The World Health Organization (WHO) declared a global flu pandemic Thursday as a result of this year's outbreak of the H1N1 influenza A virus, commonly referred to as swine flu. Although it is the first pandemic declared in 41 years, the U.S. Centers for Disease Control & Prevention said, "WHO's decision to raise the pandemic alert level to Phase 6 is a reflection of the spread of the virus, not the severity of illness caused by the virus." For more information about the swine flu outbreak or hospital emergency preparedness, contact Laura Schmidt at the MHA.