Last week, the state Legislature met for the final time in 2011. Due to the advocacy and public awareness efforts of the MHA and member hospitals, House Bill (HB) 4936 was not taken up for action and will, instead, be further scrutinized as the debate to reform Michigan's auto no-fault law continues into 2012.

As currently written, HB 4936 imposes lifetime caps on auto injury benefits between $500,000 and $5 million; mandates government price controls in the form of workers' compensation fee schedules on healthcare providers treating auto accident victims; sets attendant care and nursing payment rates for persons caring for victims; and blocks voters from their constitutional right to seek a referendum to overturn the legislation. In short, the legislation would result in traumatically injured people receiving grossly inadequate coverage for their care, rehabilitation and accommodations following a catastrophic auto accident.

The sustained public awareness efforts of the healthcare community, auto accident victims and advocates have created an opportunity for dialogue with legislative leaders and the Snyder administration to explore viable options that would achieve sustainability while protecting the best no-fault system in the country. In 2012, the MHA will pursue open, data-driven discussions with the governor and lawmakers about the current expenditures within the auto no-fault system and the opportunities for finding savings and process improvement.

The MHA asks its member hospitals to join with the association, the Coalition Protecting Auto No-fault, patients and advocates to communicate the value of Michigan's existing auto no-fault system in the new year. The MHA will continue to engage member hospitals in 2012 to help ensure Michigan maintains an auto no-fault system that protects drivers, accident victims and the healthcare services they need. Members with questions should contact Laura Appel at the MHA.

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Last week, the U.S. House of Representatives passed the Middle Class Tax Relief and Job Creation Act of 2011 (H.R. 3630), which would cut more than $17 billion in nationwide hospital funding. Part of a year-end tax and unemployment package that includes a two-year remedy for physician payment under Medicare, the act's impact to Michigan hospitals is at least $700 million over 10 years. Although the MHA supports eliminating the reduction of 27.4 percent in Medicare payments to physicians that is scheduled to begin Jan. 1, the association does not believe its elimination should be funded by reducing payments to hospitals. Extensions of certain Medicare provisions that are significant to Michigan hospitals, including holding sole-community hospitals harmless to the outpatient prospective payment system and the section 508 area wage index adjustment, were not included in H.R. 3630. Without these extensions, Michigan hospitals would lose millions more in Medicare reimbursement.

Two provisions of the House bill would negatively impact hospitals. One would reduce hospital outpatient department payments for evaluation and management services by an estimated $6.8 billion from fiscal year (FY) 2012 to FY 2021, which would cut funding to Michigan hospitals by an estimated $440 million over the next 10 years. The second provision would reduce reimbursement for Medicare bad debts from 70 percent to 55 percent, phased-in between 2013 and 2015. This would result in a cut across all provider types of more than $10 billion over the next 10 years, representing a loss to Michigan hospitals of $262 million over the course of a decade.

The MHA continues its work with the American Hospital Association to support the important effort to avoid the pending cut to Medicare physician reimbursement without incurring further cuts to Medicare hospital reimbursement. Members are encouraged to reach out to Sens. Carl Levin (D-Detroit) and Debbie Stabenow (D-Lansing) and urge them to oppose further cuts to hospitals. For more information, contact Laura Appel at the MHA.

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Last week, U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced that the MHA Keystone Center for Patient Safety & Quality was one of 26 state, regional and national health organizations that were awarded federal funds to support the goals of the Partnership for Patients. The MHA Keystone Center was selected as a Hospital Engagement Network from a highly competitive field to build on the work that has already proved successful in Michigan and to address issues that the state has yet to undertake.

As a Hospital Engagement Network, the MHA Keystone Center will engage hospitals statewide in interventions to reduce inpatient harm by 40 percent and reduce preventable readmissions by 20 percent over a three-year period. These goals will be achieved by focusing on 10 areas where harm is known to occur: central-line-associated bloodstream infections, catheter-associated urinary tract infections, adverse drug events, falls and immobility, obstetrical harms, pressure ulcers, surgical site infections, venous thromboembolism, ventilator-associated pneumonia and preventable readmissions. Advancements across these areas will require improvements in teamwork, a culture of safety, and commitment from leadership to improve the quality of care.

The MHA Keystone Center will assess and prioritize the 10 areas each participating hospital will address. As part of the contract, hospitals may work with only one Hospital Engagement Network. MHA members that have not already committed to working with the MHA Keystone Center are encouraged to submit a statement of interest by Wednesday.

Launched in April 2011, the Partnership for Patients consists of more than 6,500 partners, including 3,167 hospitals, along with employers, health plans, physicians, nurses, patient advocates, and state and federal government officials, who have pledged to work together to improve care and lower costs. Achieving the Partnership for Patients' objectives would mean approximately 1.8 million fewer injuries to patients in the hospital, saving more than 60,000 lives over three years and allowing more than 1.6 million patients to recover from illness without suffering a preventable complication requiring rehospitalization. Members with questions should contact Sam R. Watson at the MHA.

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The MHA Health Foundation Winter Leadership Conference, scheduled for Feb. 16 and 17 at the Grand Traverse Resort & Spa near Traverse City, examines the essentials of strategy, structure and systems in a new healthcare delivery model, but also moves beyond the measurements and focuses on meaning. Keynote speaker Wayne Sensor of Leavitt Partners, Salt Lake City, UT, will discuss strategies to prepare for new models of payment; case studies will outline innovative partnerships among community stakeholders that provide access to care and result in improved health; and Dan Sinnott, chief executive officer of Sinnott Executive Consulting in Wilmington, DE, will help attendees hone the new skills needed to shepherd employees, community leaders and citizens to the new healthcare frontier. An early registration discount is available through Jan 23. For more information or assistance with registration, contact Erin Steward at the MHA.

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Last week, the MHA submitted comments to the Medical Services Administration (MSA) regarding the proposed policy to update the Medicaid outpatient reduction factor effective for Medicaid outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) services provided on and after Jan. 1, 2012. The MSA uses the Medicare outpatient payment rates, excluding an area wage adjuster, as a basis for Medicaid outpatient payment rates for hospital outpatient and ASC services. Although the proposed policy indicates a 2.9 percent inflationary increase to Medicare outpatient rates for 2012, the MHA noted that the actual Medicare OPPS rate change was 1.7 percent for 2012. The MSA has acknowledged the discrepancy and will be revising the factor. Based on the Medicare OPPS final rule published in the Nov. 30 Federal Register, the 2012 Medicare rate change is 1.7 percent after the 3 percent marketbasket update is reduced for the adjustments mandated by the Affordable Care Act and a cancer hospital budget-neutrality adjustment. In addition, the MHA expressed concern about the financial impact of the Medicaid rates; the MSA proposes to pay hospitals just 54.8 percent of Medicare rates, excluding an area wage adjuster, when the latest data for Michigan hospitals indicate a negative 14 percent margin for Medicare outpatient services. The MHA urges hospitals to submit their comments to Meghan Sifuentes at the MSA by Jan. 1. Members with questions should contact Vickie Kunz at the MHA.

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In January, the American Hospital Association (AHA) RACTrac survey will open for hospitals to submit data on their interactions with Medicare's Recovery Audit Contractors (RACs) during the final quarter of 2011. This free, Web-based survey captures information on the impact of the RAC program on America's hospitals.

In addition, the AHA is hosting a free webinar, scheduled from 2 to 3:30 p.m. Jan. 4, during which AHA staff will provide an update on the RAC program and an overview of the RACTrac initiative, including reports on last quarter's data collection. Webinar registration is available online. Questions about RACTrac should be directed to the RACTrac support email, and more information on RAC activities in Michigan can be obtained from Marilyn Litka-Klein at the MHA.

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Hospitals helped many Michigan families in need this fall during the 2011 Michigan Harvest Gathering food- and fundraising campaign for the Food Bank Council of Michigan (FBCM). The healthcare community donated more than 105,300 pounds of food and nearly $101,600. Michigan hospitals came together in the midst of the distressed economy to ensure that all shelves of regional food banks were stocked to supply local food banks, soup kitchens, shelters and pantries. In turn, these agencies provided food for hungry Michigan families and individuals whose health and well-being would otherwise be compromised.

Representing more than 85 MHA-member organizations, volunteer project leaders and their teams conducted food and finance drives in their facilities. Most participating organizations have reported their results; however, many hospitals choose to conduct their campaigns closer to the holiday season and have not yet completed their donation drives. Those organizations can report their collection totals online when the results are available. As of last week, the donations of the MHA and its members, combined with those of state employees, businesses and individuals from across the state, totaled more than $524,000 and nearly 137,500 pounds. These numbers will grow as the FBCM continues to receive reports.

The FBCM and the MHA extend thanks and congratulations to each of the healthcare organizations that participated in the 2011 campaign. Members with questions about the MHA's involvement in the Michigan Harvest Gathering should contact Paige Hathaway at the MHA.

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Improving transitions of care is a key strategy to preventing avoidable hospital readmissions, according to the Centers for Medicare & Medicaid Services. Moving beyond discharge planning to better coordinate care and transitions requires changes to the processes, culture and individual behavior. The MHA Health Foundation webinar Preventing Avoidable Hospital Readmissions will outline healthcare reform provisions designed to reduce preventable hospital readmissions; a checklist of critical intervention elements needed for enhanced care coordination and transitions of care, including involvement of the patient's family and medication management; various stakeholder involvement to ensure success and analysis support essential to tracking progress; ways to connect hospital improvement with partnering community organizations; and a series of questions transition-of-care leaders must answer before beginning to reduce avoidable readmissions. In addition, participants will hear the implementation strategies of high-performing hospital teams and how team members coordinated the readmission reduction initiatives with community partners. The webinar will be held from noon to 1 p.m. Feb. 2 and MHA members can register for a connection fee of $195. For more information, contact Leigh Anne Jewison at the MHA.

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The Joint Commission has announced the field review of Leadership Standard LD.04.03.11, which addresses management of the flow of patients throughout the hospital. The proposed revision is in response to the ongoing issue of emergency department overcrowding and boarding. Specifically, a recommended revision to the element of performance includes "the hospital measures and sets goals for mitigating and managing the boarding of patients who come through the emergency department." This element of performance will not affect the accreditation decision until Jan. 1, 2014. The Joint Commission is accepting comments on the proposed revisions until Jan. 20.

To address issues facing emergency departments, the MHA Keystone Center for Patient Safety & Quality operates MHA Keystone: Emergency Room, which aims to prevent harm to emergency patients by improving safety practices and attitudes, reducing boarding/overcrowding and wait times, and supporting the early treatment of sepsis using evidence-based best practices. The collaborative uses Lean methodologies to improve patient flow in the emergency department. For more information, please contact Sam R. Watson at the MHA.

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The government and healthcare stakeholders are working to begin to bend the healthcare cost curve by implementing contracting and payment strategies designed to improve value and efficiency. Quality metrics and patient satisfaction scores will have a significant impact on how much hospitals and physicians get paid in the near future. The MHA Health Foundation webinar Healthcare Reform's Impact on Contracting and Reimbursement and How Hospitals and Physicians can Position for Success shares industry-proven solutions to difficult contracting and reimbursement issues. This offering will cover how a health system practically moves from volume-based to value-based reimbursement, while avoiding erosion in margins; whether to focus on the Medicare strategy, commercial payer strategy, or both; and action plans to prepare for new payment methodologies. The webinar is scheduled from 1 to 2 p.m. Feb. 7 and MHA members can register for a connection fee of $195. For more information, contact Leigh Anne Jewison at the MHA.

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The Centers for Medicare & Medicaid Services (CMS) recently revised the letter used to demand the return of alleged overpayments from healthcare providers under the Medicare Recovery Audit Contractor (RAC) program. Beginning in January, under a CMS policy change announced earlier this year, Medicare administrative contractors or fiscal intermediaries (MAC/FI) will assume responsibility for sending the letters that were previously sent by the RAC. A sample of the new letter, with the changes highlighted, can be found online. According to the CMS, the "R" before the letter number is intended to help providers identify the letter as a RAC-initiated claim and redirect it to the appropriate staff. Despite hospital input recommending these letters be sent to the hospital RAC contact, the MAC/FI will be sending these letters to the address on file for vouchers and checks. Members with questions should contract Marilyn Litka-Klein at the MHA.

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Chelsea Community Hospital recently named Nancy Kay Graebner president and chief executive officer (CEO), effective in January. Graebner, an Ann Arbor native, succeeds retiring president and CEO Kathleen Griffiths. Currently executive vice president of physician strategy and services for Bon Secours St. Francis Health System, Inc., Greenville, SC, Graebner has more than 25 years of health system administration experience. She previously served as physician network executive for Ambulatory Management Services at Saint Joseph Mercy Health System, Ann Arbor; chief operating officer at Michigan Physician Services, Bloomfield Hills; and vice president of practice management at Health Directions, Inc., Chicago.

Jean Meyer, MSN, RN, was recently named to the newly created position of president/executive vice president, Acute Care Operations, at St. John Providence Health System (SJPHS), Warren. Most recently serving as president of Providence Park Hospital, Novi, she will now be responsible for overseeing business and clinical/patient care operations for the system's five hospitals. Meyer joined SJPHS in 2008 as senior vice president and chief nursing officer and was later appointed chief operating officer of the Providence Region. She previously held several leadership roles with St. Vincent's Hospital, Indianapolis. Joe Hurshe, currently vice president of operations, Providence Park Hospital, will serve as interim president at the hospital while a search is under way for a permanent president.

Detroit Medical Center (DMC) has appointed Shawn Levitt, MHSA, RN, CPHQ, to the position of senior vice president, chief nursing officer. She has been chief operating officer at Children's Hospital of Michigan, Detroit, for four years after serving as DMC's corporate director of medical and academic affairs. She was instrumental in the successful systemwide launch of the health system's electronic medical record initiative. Levitt is a member of the American College of Healthcare Executives, the Michigan Healthcare Executive Group and Associates, and Inforum, and is certified in healthcare quality and managed care nursing.
 

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Last week, the Medical Services Administration (MSA) completed the last of three meetings scheduled with four stakeholder workgroups that were charged with providing input into the state's plan to integrate care for individuals covered by both Medicare and Medicaid. The four workgroups were care coordination and assessment; education, outreach and enrollee protections; performance measurement and quality management; and service array and provider network.

Michigan was selected as one of 15 states that received up to $1 million to develop a program to coordinate all acute-care services covered by Medicare, pharmacy benefits, behavioral health services and all long-term care services provided by Medicare and Medicaid. The goal of the program, established by the Affordable Care Act, is to reduce avoidable healthcare costs, including readmissions; expand access to needed care; and improve the lives of these patients.

Approximately 200,000 Michigan residents are eligible for both programs, representing 12 percent of the state's total Medicaid population, but accounting for 38 percent of its Medicaid spending. According to the MSA, 2010 spending was approximately $7.7 billion, with Medicaid representing $3.6 billion and Medicare $4.1 billion.

The MSA will assemble the input from the workgroups in developing its plan, scheduled for submission to the Centers for Medicare & Medicaid Services in April. Members with questions should contact Marilyn Litka-Klein at the MHA.  

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• The MHA Keystone Center Advisory Board will meet from 2 to 4 p.m. Thursday, Jan. 5, via webinar. Participants will receive an update on the MHA Keystone Center's status as a Hospital Engagement Network (see related article). For more information, contact Sam R. Watson at the MHA.

• Gov. Rick Snyder has scheduled his first State of the State address for the evening of Jan. 18. In addition, President Barack Obama will present the State of the Union address Jan. 24. For more information, contact Laura Appel at the MHA.

• In honor of the Christmas and New Year holidays, the MHA Monday Report will not be published Dec. 26 and Jan. 2. The next issue will be dated Jan. 9. Have a happy and healthy holiday season!