The fiscal year (FY) 2011 Michigan Department of Community Health (MDCH) budget, Senate Bill (SB) 1152, was reported out of the Senate Appropriations Subcommittee on the MDCH last week. Sen. Roger Kahn (R-Saginaw Twp.), chair of the subcommittee, reported that the state budget deficit of $1.6 billion would force the 8 percent cuts to Medicaid provider reimbursement implemented in FY 2010 to be carried forward into FY 2011. In addition, the committee recommended elimination of Medicaid funding for certain optional populations (19- to 20-year-olds and caretaker relatives) in the fourth quarter of FY 2011 to create a savings of nearly $20 million for the state.

Despite these negative elements, the subcommittee recognized that Michigan's health care system is in a state of crisis and rejected the tie-bar proposed in the executive budget recommendation that would have resulted in additional hospital rate cuts if a quality assurance assessment program for physicians was not approved. The subcommittee also protected graduate medical education funding and traditional disproportionate share hospital (DSH) payments; added $137 million in funding to account for increases in the Medicaid caseload and utilization; and restored funding for dental, optical and podiatric services. Funding for the $5 million DSH pool was also restored and increased to a total of $10 million.

Other key MHA budget priorities included in the Senate Subcommittee recommendations are the assumption of the enhanced federal matching assistance percentage continuing for two quarters in FY 2011 (generating an additional $500 million for Medicaid), the rejection of the Senate Majority recommendation to further reduce currently covered optional Medicaid services, and - in direct response to MHA advocacy - the application of the entire $101 million in Medicaid savings related to the Medicare Part D prescription drug program, also known as the "clawback," to support Medicaid in FY 2011.

SB 1152 now heads to the full Senate Appropriations Committee for consideration, with an expected vote on the MDCH budget within two weeks. Members are strongly encouraged to contact members of the Senate Appropriations Committee and their local lawmakers and urge them to address the budget priorities identified recently by the Partnership for Michigan's Health. Members with questions should contact David Finkbeiner at the MHA.

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Last week, the U.S. Senate passed the American Workers, State and Business Relief Act (H.R. 4213) that included a six-month extension of Medicaid assistance for the states and a significant delay of a scheduled Medicare physician payment cut.

The enhanced federal medical assistance percentage (FMAP), a program that brings federal matching dollars to states to aid in funding state Medicaid programs, is currently scheduled to expire Dec. 31, 2010. However, last week's Senate action would extend the enhanced FMAP through June 30, 2011, and bring an additional $514 million to Michigan to support Medicaid. Both Gov. Granholm's executive budget (see Feb. 15 related article) recommendations and the state Senate Appropriations Subcommittee on Community Health budget recommendations assumed the receipt of the additional federal funds (see related article).

H.R. 4213 would also delay a scheduled Medicare physician payment cut that, without congressional action, would decrease Medicare physician reimbursement by 21 percent effective April 1, 2010. The Senate action would delay the payment reduction until Oct. 1, 2010. The bill passed the U.S. Senate on a 62-36 vote, with the support of Michigan Sens. Debbie Stabenow (D-Lansing) and Carl Levin (D-Detroit). The U.S. House of Representatives must now act on the Senate version of H.R. 4213 before it is sent to President Obama for his signature.

The bill also changes the definition of a hospital-based physician under the Health Information Technology for Economic and Clinical Health (HITECH) Act, which will ensure that physicians who practice in hospital-based outpatient centers and clinics can qualify for electronic health record incentive payments. In addition, it includes extensions for Consolidated Omnibus Budget Reconciliation Act (COBRA) benefits, unemployment benefits and other measures. For more information, contact Laura Appel at the MHA.  

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Several representatives of Oakwood Healthcare Inc., met with legislators during GME Advocacy Day. Shown here are (left to right) Rep. Richard LeBlanc (D-Westland); Karen Weaver Granata, MD; Mary Zatina, senior vice president, Government Relations, Corporate Planning and Communications; Rep. Douglas Geiss (D-Taylor); Jason Hampton, MD; Mark Hannis, MD, senior vice president and director of medical education; and Abigail Schildcrout, MD.

Last week 35 physician residents, directors of medical education and government relations officers visited the State Capitol to advocate for graduate medical education (GME) funding. MHA members represented included St. John Providence Health System, Warren; Detroit Medical Center; Beaumont Hospitals, Royal Oak; Ingham Regional Medical Center, Lansing; Henry Ford Health System, Detroit; Oakwood Healthcare Inc., Dearborn; University of Michigan Health System, Ann Arbor; and Trinity Health, Novi. Joining hospital advocates were representatives of the Wayne State University School of Medicine, Detroit; Synergy Medical Education Alliance, Saginaw; the Michigan State Medical Society, East Lansing; and the Michigan Academy of Family Physicians, Okemos.

Rep. Kathy Angerer (D-Dundee) spoke to the group, providing guiding principles to effectively address the GME issue with legislators before the advocates visited with their individual lawmakers. Legislators were asked to protect the current state investment in GME. MHA members emphasized the value of physician residence to patient care, and informed legislators that the clinical training provided in Michigan helps keep physicians in the state, which is crucial to addressing health care workforce shortages. For more information, contact Laura Appel at the MHA.

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The MHA Patient Safety and Quality Symposium, Keeping the Promise: Putting Patients at the Center of Safety, is the Michigan event where health care providers can connect with patient safety thought leaders - international, national and those in Michigan - and learn strategies for making patients safer through new ways of thinking and communicating. An early registration discount fee will expire Friday. Until then, the symposium two-day early registration fee is $200 for attendees from hospitals participating in collaboratives of the MHA Keystone Center for Patient Safety & Quality and $295 for all other attendees. Clinical teams, health care executives, and business leaders are encouraged to attend the symposium April 19 and 20 at the Hyatt Regency, Dearborn.

This activity has been planned and implemented in accordance with the Accreditation Elements and Policies of the Michigan State Medical Society through the joint sponsorship of Sparrow Health System and the Michigan Health & Hospital Association. Sparrow Health System is accredited by the Michigan State Medical Society to provide continuing medical education for physicians. Sparrow Health System designates this educational activity for a maximum of 11.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. The Michigan Board of Nursing recognizes approval granted by the Accreditation Council for Continuing Medical Education. Questions about registration should be directed to Janice Jones at the MHA.

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The Centers for Medicare & Medicaid Services will host a conference call from 1 to 2:30 p.m. March 23 to provide an overview of the updated claims coding system, International Classification of Diseases-10-Clinical Modification (ICD-10-CM), that will take effect Oct. 1, 2013. The conference call will address the following:

• ICD-9-CM codes will not be accepted for services provided after Oct. 1, 2013.
• Benefits of ICD-10-CM.
• Key similarities and differences between ICD-9-CM and ICD-10-CM.
• New features in ICD-10-CM.
• Common myths and misperceptions about ICD-10-CM.
• Impact of ICD-10-CM on medical record documentation.

Participants are asked to register by 1 p.m. March 22 and can obtain materials online for reference during the call. Members with questions should contact Vickie Seal at the MHA.

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In early March, the Michigan Department of Human Services (MDHS) hosted a meeting with representatives from hospitals, the MHA, and the Michigan Department of Community Health (MDCH) to provide status on resolving issues with the Bridges eligibility system including recent system updates. In August 2009, this new eligibility system for all Michigan social service programs, including cash assistance, food stamps and Medicaid, was expanded statewide. Record Medicaid enrollment levels coupled with limited MDHS and MDCH staff resources and the learning curve associated with a new system has led to significant delays in obtaining Medicaid coverage for patients, resulting in dramatic increases in Medicaid pending and accounts receivable balances for Michigan health care providers.

A key issue identified by hospitals relates to delays in the enrollment of newborns into Medicaid health maintenance organizations (HMOs) when the mother is enrolled in an HMO at the time of birth. At the recent Medical Services Administration (MSA) hospital work group meeting, the MSA estimated that this issue has resulted in a current backlog of approximately 9,000 babies who are not yet in the system because the enrollment process that was previously completed in about 30 days now takes approximately 90 days. The MDCH has added staff and is working aggressively to eliminate this backlog by April 30. Another issue identified relates to newborn coverage being activated back to the date of birth. Despite a one-time system fix implemented in November, this continues to be a problem and creates a gap in coverage for the baby and unrecovered revenue to providers. The MDHS is working to resolve this matter as well.

Federal citizenship requirements have increased the administrative burden for the MDHS and hospitals. Effective March 1, 2010, Bridges no longer pends or denies Medicaid applications when potential beneficiaries are unable to verify citizenship or identity. If all other eligibility requirements are met, Bridges will activate the Medicaid coverage as required by policy, thus reducing the administrative burden for both hospitals and the MDHS. To further reduce administrative tasks, beginning in April, the Bridges system will receive citizenship information on a nightly basis from the Social Security Administration. It is expected that most individuals applying for Medicaid will have their citizenship verified through this interface. If a match is not found, it may require further clarification by the applicant, resulting in case closure if not resolved. The MHA will provide additional information as it becomes available. Members with questions should contact Vickie Seal at the MHA.

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Ninety-nine percent of health care professionals have seen disruptive behavior on the job and about one-third see it every week. While disruptive behavior is a sensitive subject that may involve prominent physicians or employees, the issue must be addressed to ensure the best patient care. In fact, The Joint Commission now requires hospitals to address disruptive behavior by physicians and other staff members to maintain accreditation.

Health care organizations need to be committed to a culture of zero tolerance and to develop policies and procedures that define appropriate behavior standards to hold staff accountable for their actions. The MHA Health Foundation webinar Disruptive Behavior - Diagnosis and Response, scheduled for 10 a.m. March 31, will review the four domains of eliminating disruptive behavior - education, leadership commitment, clear process and effective interventions - and suggest specific action steps, including:

• The key contributing factors to disruptive behavior, such as fatigue, substance abuse and poor communication.
• How executive teams and leaders can model, coach and require appropriate behavior of all physicians, nurses and staff.
• The importance of being proactive and intervening early to avoid crisis mode, poor morale, or even lawsuits.
• The need for clear standards, available reporting systems, peer review, non-retaliation policies, and follow-up to help eliminate disruptive behavior.

For more information about the webinar or how to register, contact Sara Miller at the MHA.

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Medicare fiscal intermediaries are participating in a revalidation effort to ensure that the Centers for Medicare & Medicaid Services (CMS) has current enrollment Medicare information for all hospitals. This effort focuses particularly on hospitals that have not updated their information in the past six years. These hospitals are encouraged to consider voluntarily submitting a CMS-855A enrollment form or the Internet-based provider enrollment chain and ownership system (PECOS) enrollment application and supporting documentation before the CMS begins its provider enrollment revalidation initiative later this year. By submitting an enrollment application on a voluntary basis, hospitals will avoid the time pressures associated with a CMS revalidation request, which allows only 60 days to complete and submit the Medicare enrollment application and applicable supporting documentation. Additional information is available on the CMS Web site. Members with questions should contact Vickie Seal at the MHA.

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Beginning April 5, all U.S. hospitals will be able to access RACTrac - the American Hospital Association's (AHA's) free, online survey tool for tracking the impact of Medicare Recovery Audit Contractors (RACs). To prepare for the nationwide launch, hospitals are invited to participate in a free March 25 webinar that will provide an update on the RAC program and an overview of the RACTrac initiative. Data from hospitals that used the survey tool to report RAC activity in the last quarter of 2009 provide valuable insights that hospitals, the AHA and state hospital associations can use to track the impact of the RAC program and advocate for needed changes.

All hospital representatives may register for the upcoming RACTrac Nationwide Launch webinar to learn how hospitals can benefit from participating in the survey. Next week, hospitals leaders will receive an e-mail instructing them how to register to receive the RACTrac tool, which they are encouraged to share with appropriate staff. Members with questions should contact Marilyn Litka-Klein at the MHA.

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Cover the Uninsured is a national effort to create awareness of Americans living without health insurance and to help identify and advance solutions in partnership with community and political leaders. This week, March 14-20, the annual efforts to provide ongoing education and awareness to address the crisis of the uninsured will be renewed.

Approximately 46 million Americans, including approximately 1.15 million Michigan citizens, are living without health care coverage, and the number of uninsured residents continues to grow. As the state's unemployment rate has ballooned to a nation-high 14.3 percent, the economy continues to struggle through a recession, and the national health care reform debate continues, the 2010 Cover the Uninsured Week mission is especially significant.

The Michigan Cover the Uninsured Network, supported and sponsored by several Michigan community hospitals, the MHA and many of its other member organizations, will host enrollment events in communities across the state to provide education and resources to local residents and reduce the number of uninsured. In addition, the network will host a Health Care Expo for the Uninsured and Underinsured that is expected to be attended by more than 5,000 people. The event will be held Friday, April 23 from 9 a.m. to 5 p.m. at the Cobo Convention Center in Detroit. To participate, contact Lorenzo Lopez, deputy director at Wayne County Patient Care Management, at (313) 833-3438.

For more information, contact Patty McCarthy at the Michigan Cover the Uninsured Network or Kevin Downey at the MHA.

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The MHA Health Foundation, in conjunction with management training and consulting firm The Advisory Board Company, based in Washington, DC, is offering a webinar series on today's hottest health care topics.

The webinar Payment Navigation Initiative will be held at 10:30 a.m. April 27, featuring a best-practices approach to estimating and collecting patient obligations through case studies from progressive institutions that are effectively capturing patient payments prior to service.

Learn techniques to significantly reduce escalating employee health benefits costs by participating in the webinar Reining in the Spiraling Cost of Health Benefits, scheduled for 10:30 a.m. May 12.

This summer, the webinar Physician Alignment and Performance Management: Medical Staff Collaboration to Drive Performance on Key Quality and Cost Metrics will examine a physician-centered method for sharing physician performance data and driving change through transparency. It will be held at 10:30 a.m. June 3.

Each program has a connection fee of $195 per member organization. To find more information on each topic or to register, visit the MHA Web site and click on "Events" and then "Event Registration." Questions on these webinars should be directed to Sara Miller at the MHA.

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State Sen. Tom George, MD (R-Kalamazoo), chairman of the Senate Health Policy Committee, joined the MHA Business Advisory Council last week to provide an overview of the current status of health reform discussions in the state Legislature and the impact on Michigan businesses and hospitals. George praised the exceptional quality of care provided by Michigan hospitals and physicians, but expressed his strong belief that, to combat rising costs within the Medicaid program, appropriate incentives are needed to encourage patients to lead healthier lifestyles.

George also indicated that he continues to work with Rep. Marc Corriveau (D-Northville), chairman of the House Health Policy Committee, to develop a workable solution to individual market reform. He expressed his desire to complete action on this issue before the initiation of the post-election lame duck session, given the typical uncertainties associated with that period.

The council also heard a presentation from Matthew Rush, president and chief executive officer, Hayes Green Beach Memorial Hospital, Charlotte, on the hospital's innovative AL!VE concept, which seeks to partner with regional employers to improve community health status. Council members also heard a presentation from an AT&T representative on emerging health information exchange models in other states. Members with questions should contact Brian Peters at the MHA.

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• The Hospital Affiliated Legislative Officers will meet from 8:30 to 9:30 a.m. Tuesday at the MHA Capitol Advocacy Center, Lansing. Participants will discuss recommendations made by the Senate Appropriations Subcommittee on the Department of Community Health regarding the fiscal year 2011 Medicaid budget. For more information, contact David Finkbeiner at the MHA.

• The Medicare Outpatient Prospective Payment System Reports webinar will take place from 3 to 5 p.m. Tuesday. Participants will review Outpatient Prospective Payment System (OPPS) detail reports, data sources, and how to interpret and use the data. For more information regarding OPPS, contact Vickie Seal, or for information on how to register for the webinar, contact Donna Conklin at the MHA.

• The MHA Keystone: Gift of Life March webinar will begin at 1 p.m. Wednesday. The agenda for this webinar focuses on death by neurological criteria. For more information, contact Brittany Bogan at the MHA.

• The MHA Quality & Accountability Committee Meeting will take place from 10:30 a.m. to 2:30 p.m. Wednesday at MHA headquarters, Lansing. The committee will discuss creation of the new Michigan Health Services Inspector General office and the automotive industry action group quality training program. For more information, contact Sam R. Watson at the MHA.