Last week, President Obama signed into law the Patient Protection and Affordable Care Act (H.R. 3590), a sweeping reform measure that is expected to expand health care coverage to 32 million Americans who are currently uninsured. The MHA supported the legislation's potential to expand coverage, but expressed reservations about some of the provisions affecting hospitals. "Achieving universal health care coverage has been a goal of the MHA and the American Hospital Association for more than a decade, and this progress is a step in the right direction toward increased coverage and access for all," said MHA President Spencer Johnson. "However, many coverage expansion provisions will not truly begin until 2014, translating into several more years of hospitals and other health care providers struggling to keep the health care system patched together to protect patients."

A reconciliation bill (H.R. 4872) to amend H.R. 3590 passed both the U.S. Senate and House of Representatives Thursday and was sent to the president for his signature. The nonpartisan Congressional Budget Office (CBO) estimates the complete package (H.R. 3590 amended by H.R. 4872) will cost $938 billion over 10 years. Much of that cost will go toward Medicaid expansion and providing subsidies for the purchase of private health care coverage through new insurance exchanges. The CBO also estimated that the reform package will reduce the federal deficit by $143 billion over 10 years due to revenue provisions such as changes to Medicare, insurer taxes and provisions related to high-cost health plans.

Hospitals will see decreases in Medicare reimbursement beginning in 2012, even though major coverage expansion does not begin until 2014. Over time, coverage expansion is predicted to make sizable reductions in uncompensated care, which should offset the government program payment adjustments. The reform legislation also makes major changes to health insurance regulation and disease prevention and implements a number of strategies to contain health care costs over the next decade.

Assuming that H.R. 4872 becomes law, MHA members are encouraged to review an implementation timeline that tracks the changes made to hospital reimbursement, health insurance regulations, coverage requirements and the health care delivery system.

On a related note, after President Obama signed H.R. 3590 into law, Michigan Attorney General Mike Cox joined his counterparts from 12 other states in filing a lawsuit challenging the constitutionality of the act's mandate that requires uninsured individuals to purchase health care coverage. The outcome of the lawsuit is expected to take several months and is being challenged by Gov. Jennifer Granholm. For more information about national health care reform, contact Laura Appel at the MHA.

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Last week, the state Senate completed action on the fiscal year (FY) 2011 Michigan Department of Community Health (MDCH) budget, Senate Bill (SB) 1152. The Senate-passed version is essentially unchanged from the budget proposal approved by the Senate Appropriations Subcommittee on the MDCH Budget earlier this month.

Prior to the vote, the Partnership for Michigan's Health submitted a letter to all state senators urging them to restore the 8 percent cut to provider payment rates. The letter also requested restoration of funding for caretaker relatives and 19- to 20-year-olds that is scheduled to be eliminated in the last quarter of FY 2011.  Restored funding was also requested for the cut to physician rates that would reduce payments in FY 2011 by an additional 4 percent to all specialties other than obstetrics, primary care, emergency room and pediatrics.

Partnership lobbying efforts to restore the cuts were supported through amendments made by Sens. Deb Cherry (D-Burton) and Mickey Switalski (D-Roseville), but they were ultimately rejected. The MHA budget advocacy effort was also bolstered last week at the annual MHA Health Care Advocacy Day (see related article). Hospital volunteers and representatives met with their lawmakers and explained to them why, when it comes to the Medicaid budget, some cuts hurt more than others they may consider.

SB 1152 now moves to the House Appropriations Subcommittee on the MDCH Budget chaired by Rep. Gary McDowell (D-Rudyard), where consideration of the Senate plan will begin after the legislative spring break concludes in mid-April. Members with questions should contact David Finkbeiner at the MHA.

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Among the Advocacy Day attendees were (left to right) Frank Sardone, president/chief executive officer, Bronson Healthcare Group Inc., Kalamazoo, and chairman of the MHA Board of Trustees; Karol Pokley, president, Michigan Council of Directors of Volunteer Services, and director, Marquette General Hospital Volunteer Services; Mary Lou McFadden, president, Michigan Association of Healthcare Advocates, and community partner, Allegiance Health, Jackson; and MHA President Spencer Johnson.

More than 250 volunteers and staff from hospitals across the state gathered Wednesday in Lansing for Health Care Advocacy Day. Using the theme Spring Forward: A Season of Change, the event began with a heartwarming and awe-inspiring keynote presentation from LeAnn Thieman, RN, co-author of Chicken Soup for the Caregivers Soul. Thieman captured the audience as she described her experiences with Operation Airlift for orphaned babies during the Vietnam War. She shared her views on caregiving and outlined the vital role of volunteers, both inside and outside of hospitals, and the importance of caring for themselves so they can care for others.

Peter Pratt, senior vice president, Public Sector Consultants, Lansing, presented an overview of the newly signed Patient Protection and Affordable Care Act and the reconciliation legislation, H.R. 3590 (see related article), that will initiate health care reform in the United States. Pratt outlined major aspects of the bills, including the establishment of coverage for more than 32 million additional people and the new mandates for individuals and employers that will be phased in over the next five years. He explained how the government intends to pay the cost of covering more people, health insurance exchanges and new health insurance regulations, and then answered a number of questions on the effects of health care reform on Medicare and local hospitals.

David Finkbeiner, senior vice president, advocacy, MHA, gave a presentation highlighting Michigan hospitals as a valued community asset and explaining that the failure of government programs to cover the cost of care puts the state's health care safety net in jeopardy. Michigan is facing a projected fiscal year (FY) 2011 budget deficit of $1.6 billion, including $1.2 billion in the state's general fund, and Finkbeiner encouraged attendees to urge their legislators to pass a FY 2011 Medicaid budget that allocates federal money intended for health care to health care and does not divert the funding to other state programs.

To complete the 2010 Health Care Advocacy Day, more than 30 state legislators attended a luncheon to meet with health care advocates from their districts and discuss health care policy and local priorities. Attendees were encouraged to take the advocacy messages presented throughout the day back to their community hospitals to inform and include hospital colleagues in grassroots advocacy efforts. Members with questions should contact Stacy Dowdy at the MHA.

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The MHA Keystone Center for Patient Safety & Quality's second annual patient safety and quality symposium, Keeping the Promise: Putting Patients at the Center of Safety, is scheduled for April 19 and 20 at the Hyatt Regency, Dearborn. The conference agenda focuses on making patients safer through new ways of thinking and communicating and includes in-depth sessions on leading change across an organization and adopting practices of highly reliable organizations. Throughout the conference, clinical teams, health care executives and business leaders will explore ways to continue to stimulate patient safety by partnering with patients and families and to produce system improvements using innovative techniques.

An overnight room rate of $129 has been secured for participants at the Hyatt Regency, Dearborn, through April 1. Registrants are encouraged to make room reservations by this date to ensure availability.

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. Questions about registration should be directed to Janice Jones at the MHA.

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Flying a Donate Life flag is an excellent way to honor those in a community who have been touched by organ donation and to encourage people to join the Michigan Organ Donor Registry, the database that provides "first-person consent" for donation of organs and tissue after death. Last week, the MHA Keystone Center for Patient Safety & Quality mailed Donate Life flags to its member acute-care hospitals to be prominently displayed during April in honor of Donate Life month. The flags were sent to the attention of contacts for the MHA Keystone: Gift of Life collaborative and/or public relations directors.

Flag-raising ceremonies are ideal to include with activities for Donor Drive 2010, a campaign that includes a goal for hospitals to add 100,000 names to the donor registry this year. The campaign can be implemented by any facility, regardless of organ donation potential, and the MHA and Gift of Life encourage those facilities that have not yet joined the Donor Drive to do so. For more information on these efforts to increase organ donation and save lives, contact Britt Bogan at the MHA.

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The Michigan Legislature acted on several bills pertinent to the health care community prior to adjourning for a two-week, in-district work period. Last week, Senate Bill (SB) 605, sponsored by Sen. Roger Kahn (R-Saginaw Twp.), was reported out of the House Health Policy Committee. The legislation would require hospitals to meet the conditions of participation of the Centers for Medicare & Medicaid Services as they apply to registered professional nurses performing circulating duties in the operating room. The MHA has remained neutral on SB 605, maintaining that the legislation is unnecessary as all Michigan hospitals appropriately staff operating rooms with nurses at this time. The bill now moves to the full House for consideration.

The full House unanimously approved House Bill (HB) 4583, sponsored by Rep. Roy Schmidt (D-Grand Rapids). The bill is supported by the MHA and would remove the mandate that requires people to sign a consent form before receiving an HIV test. Currently, Michigan is one of only a few states that still use this practice. The MHA and other supporters argue that the existing mandate is an unnecessary requirement that, if eliminated, would better align state law with current recommendations of the U.S. Centers for Disease Control and Prevention. HB 4583 now moves to the Senate for consideration.

The full House also voted to repeal the mandatory motorcycle helmet law by passing HB 4747, legislation that the MHA has historically opposed. If passed, Michigan's mandatory motorcycle helmet law would be repealed for persons 21 years of age and older, allowing these riders to operate or be a passenger on a motorcycle without wearing a crash helmet. The MHA and other opponents of the legislative repeal, including most automobile insurers and health care providers, argue that crash helmets reduce the severity of injury, the likelihood of death and the overall cost of medical care. The governor has vetoed similar bills in previous legislative sessions due to public safety and health care concerns. For more information, contact Chris Mitchell 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 Leigh Anne Jewison at the MHA.

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The MHA recently distributed updated hospital-specific data that the Centers for Medicare & Medicaid Services (CMS) released Feb. 22. The data, which will be used to develop the fiscal year 2011 Medicare area wage index that will take effect Oct. 1, 2010, is from hospital cost reports for periods ending between September 2007 and August 2008 and includes both hospital-requested and intermediary-proposed adjustments. Hospitals are encouraged to review their data to ensure that no processing errors were made by the CMS or fiscal intermediary. In cases of errors or disputed adjustments, hospitals must notify both the CMS and the fiscal intermediary in writing by April 21. Members with questions should contact Vickie Seal at the MHA.

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The Medical Services Administration (MSA) recently issued a proposed policy to implement Medicaid coverage and reimbursement for ambulatory surgical centers (ASCs). Although Medicaid has not historically reimbursed or recognized ASCs as a covered provider, the MSA proposes to do so effective Jan. 1, 2011. Consistent with the current Medicaid hospital outpatient prospective payment system (OPPS), Medicaid reimbursement and coverage policy for ASCs will follow that of Medicare. Currently, Medicaid reimburses outpatient hospitals at 57.6 percent of Medicare OPPS rates, excluding an area wage adjuster. Under the proposed ASC policy, Medicaid would also pay ASCs 57.6 percent of Medicare ASC payment rates. To facilitate coordination of benefits, Medicaid will mirror Medicare's current ASC coverage policies, editing and claim submission requirements. To develop the ASC payment system, the MSA has hosted ASC work group meetings over the past several months that have included representatives from the MHA and ASCs. The MHA will make its draft comments available to hospitals by April 12 and encourages hospitals to submit their comments to the MSA prior to the April 20 due date. Members with questions should contact Vickie Seal at the MHA.

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In a recent article, the Centers for Medicare & Medicaid Services (CMS) announced expansion of the number of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis and procedure codes that it will accept and process on institutional claims beginning in 2011. Although the electronic format allows up to 25 ICD-9-CM diagnosis and procedure codes, the CMS currently processes only the first nine diagnosis codes and six procedure codes submitted electronically. The change will add secondary diagnosis codes and associated present-on-admission codes. The MHA, the American Hospital Association and others have advocated for the additional codes. Beginning Oct. 1, 2013, hospitals and other Health Insurance Portability and Accountability Act (HIPAA)-covered entities must comply with the 10th revision of the Procedure Coding System (ICD-10-CM). Members with questions regarding the CMS notice should contact Vickie Seal at the MHA.

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The second annual American Academy of Pediatrics, Michigan Chapter, conference on Obesity Management for the Primary Care Provider is being held May 15 at the Lansing Community College, West Campus. Sponsored by the MHA, this conference is intended for physicians, administrators, billing staff, and all other health care professionals who are interested in combating childhood obesity. The event is designed to promote relationships and partnerships between physicians and early childhood professionals to prevent obesity and promote nutrition and physical activity in young children. The latest coding and billing requirements of Medicaid and Blue Cross Blue Shield of Michigan to assess and treat obesity will be discussed, and participants will be provided with tools to monitor and calculate body mass index. Continuing Medical Education credits are pending approval from the American Academy of Pediatrics. Completed registration forms should be faxed to the attention of Brie at (517) 371-9080. For more information, contact Paige Hathaway at the MHA.

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According to experts, communities will lose an estimated $1.2 million in federal funding for every 100 people who are not counted in the United States 2010 Census. That funding could be used not only for improvements in schools, hospitals, roads and job programs, but also for Medicaid, maternal and child health programs, and other efforts to improve community health status.

Because an accurate census is so important to health care, hospitals are urged to remind their employees, visitors, patients and communities to complete and return their census forms as soon as possible. For 2010, the census form contains 10 simple questions, and the answers to those questions determine where $400 billion in federal funding is allotted. All census information is confidential and used to generate statistics about communities, not individuals.

The Michigan Nonprofit Association provides a variety of suggestions and tools for nonprofits to help increase the census response rate in their communities, such as articles for hospital newsletters and/or Web sites and circulating resources through internal and external networks. In some instances, hospitals will need to gather census information on patients who are in their facilities on April 1. Visit the census Web site for answers to frequently asked questions. Members with questions should contact Morgan Stocking at the MHA.

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• The Blue Cross Blue Shield of Michigan Participating Hospital Agreement Payment Practices Committee will meet Tuesday. For more information, contact Marilyn Litka-Klein at the MHA.

• The MHA Health Foundation webinar Disruptive Behavior - Diagnosis & Response will take place from 10 to 11:30 a.m. Wednesday. This webinar will review the four domains of eliminating disruptive behavior - education, leadership commitment, clear process and effective interventions - and specific action steps. For more information, contact Sara Miller at the MHA.

• To help individuals and families better understand advance directives and health care decisions, National Healthcare Decisions Day will be held April 16. This national effort encourages hospitals to make employees aware of the importance of completing an advance directive and making their end-of-life health care wishes known. Suggestions for recognizing National Healthcare Decisions Day are to hold workshops for employees, provide free advance directive documents, and make attorneys available on-site to help individuals and families draft or complete necessary forms. For more information and resources, visit www.nationalhealthcaredecisionsday.org or www.putitinwriting.org.