Headline Roundup: Price Transparency, Workforce Challenges and Contrast Media Shortages

Brian Peters

Brian PetersThe MHA responded to several media requests the week of May 16 on topics including the RAND 4.0 Hospital Price Transparency Study, hospital workforce challenges and the shortage of contrast media from GE Healthcare.

MiBiz and Crain’s Detroit Business published stories on the latest RAND report that includes multiple quotes from MHA CEO Brian Peters discussing the flaws associated with the study, including the use of Medicare as a reimbursement benchmark and the limited data set. The MiBiz story also cites recent findings from the American Hospital Association and Kaufman Hall on significantly increasing hospital expenses.

“So it’s not a comprehensive set. It’s looking very specifically at Medicare reimbursement rates, which we know in Michigan and other states as well does not cover the true cost of care,” said Peters to MiBiz. “Hospitals do everything they possibly can just to break even, at best, and still lose money on Medicare.”

Michigan Radio aired a feature on May 16 following an interview with Peters on workforce challenges impacting hospitals.

“We are losing employees to McDonald’s for a job that pays better and is less stressful,” said Peters. “And we are incredibly limited in our ability to compete with rising wages in other industries.”

Crain’s Detroit Business published an additional article May 18 on the topic that cited the Michigan Radio story and quotes Peters. Laura Appel, executive vice president of government relations and public policy, MHA, also spoke with WZZM-TV Channel 13 for a story on workforce challenges that aired May 19.

The Detroit Free Press and Fox 2 Detroit also reached out earlier in the week on the reported shortage of contrast media from GE Healthcare. A general statement was provided to reflect the varying impacts from the shortage on hospitals throughout the state.

Combating the Novel Coronavirus (COVID-19): Week of May 9

MHA Covid-19 update

MHA Covid-19 updateCOVID-19 hospitalizations in Michigan have been rising in recent weeks, with 875 adults hospitalized with confirmed or suspected cases on May 11; 77 of that number were in intensive care units. In addition, 36 children were in the hospital with confirmed or suspected cases on that date. A daily average of over 2,700 cases were confirmed from May 5 through 11.

The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

MDHHS Shares Updated FDA Guidelines for Johnson & Johnson COVID-19 Vaccine

The Michigan Department of Health and Human Services (MDHHS) has reminded providers of updated guidelines from the Food and Drug Administration (FDA) for use of the Johnson & Johnson/Janssen COVID-19 vaccine. The new guidelines essentially limit use to individuals 18 and older who cannot or will not take one of the other approved vaccines. The risk of thrombosis with thrombocytopenia syndrome (TTS) warrants limiting the authorized use of the vaccine. TTS is a syndrome of rare and potentially life-threatening blood clots in combination with low levels of blood platelets. Members are encouraged to review the provider guidelines. For more information regarding vaccines, contact Ruthanne Sudderth at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

Media Recap: Implicit Bias Training & Medicaid Maternal Health Coverage

Brian Peters

The MHA received media coverage the week of May 9 on the upcoming Public Health Code Rules requiring implicit bias training for all professions licensed or registered under the Public Health Code and the recently approved extension by The Centers for Medicare & Medicaid Services of Michigan Medicaid and Children’s Health Insurance Program coverage for 12 months after pregnancy.

Bridge published May 11 a story on the healthcare industry’s reaction to the June 1 implementation date of the implicit bias training requirement. MHA CEO Brian Peters is quoted in the article expressing the positive reaction from hospitals on the requirement and their commitment to eliminate health disparities.

“There’s been no push back,” said Peters. “Everyone realizes this is the right thing to do.”

State of Reform also published May 10 an article on the increase in coverage for postpartum mothers from 60 days after birth to a full year in Michigan. Laura Appel, executive vice president of government relations and public policy, MHA, spoke with State of Reform on the importance of this coverage extension towards addressing maternal mortality and racial disparities.

“It feels counterintuitive to why healthcare coverage for women would end 60 days after they gave birth,” said Appel. “You would in no way expect coverage to end so quickly.”

Final Procedural Step for CRNA Legislation Completed

Legislation enhancing hospital flexibility for anesthesia care went into full effect May 10 following official confirmation from the Centers for Medicare & Medicaid Services (CMS) that it had received the letter of attestation sent by the governor. This was the final step needed for the provisions in House Bill (HB) 4359 to go into full effect in Michigan.

The MHA-supported HB 4359 was signed into law by Gov. Gretchen Whitmer and took effect Oct. 11, 2021. Sponsored by Rep. Mary Whiteford (R-Casco Township), the bill modernizes the scope of practice for certified registered nurse anesthetists (CRNAs) and allows flexibility for each hospital to choose the anesthesia care model that best fits its location, staffing and resources to offer safe and effective patient care by eliminating the state requirement that a CRNA must work under direct physician supervision.

Federal provisions have allowed states to request exemption from physician supervision of CRNAs under 42 CFR 482.852 upon passage of applicable laws and a letter of attestation from the governor to the CMS.

Members with questions on the new law may contact Adam Carlson at the MHA, while questions regarding amending their facility policies should contact Amy Barkholz at the MHA.

Appel Addresses Specialty Integrated Plans with State of Reform

Laura Appel

Laura AppelState of Reform published an article May 2 that reviewed a panel discussion from the 2022 Michigan State of Reform Health Policy Conference on bills in the Michigan Legislature that would create specialty integrated plans to cover specialty behavioral health benefits. Participating on the panel was Laura Appel, executive vice president of government relations and public policy, MHA.

Appel expressed the MHA’s supportive position on Senate Bills 597 and 598 due to the need to integrate and reform behavioral health in Michigan, while also mentioning the role workforce sustainability has in that process.

“Here’s the thing about our current system, there are hundreds of people who don’t have a provider to worry about losing,” said Appel. “Our shortage of behavioral health professionals is dire. When a person is in crisis, any change is frightening, but the system is just not adequate right now.”

Peters Focuses on Rural Hospital Challenges in Rural Innovation eXchange Story

MHA CEO Brian Peters

MHA CEO Brian Peters

Rural Innovation eXchange interviewed MHA CEO Brian Peters for a story published April 28 that examines the challenges facing rural hospitals in Michigan.

Peters discussed staffing shortages and efforts to improve workforce sustainability, the impact of COVID-19 on hospital finances and cybersecurity threats.

“The [workforce] pipeline is going to be so important,” said Peters. “The pipeline as it exists today is not adequate, particularly in rural areas, which are significantly older than non-rural areas and have older and sicker patients. This also means that the phenomenon of folks leaving the field is felt more acutely in rural communities.”

Other healthcare executives appearing in the story include John T. Foss, vice president of operations, Mercy Health Lakeshore Campus; Steve Barnett, president and CEO, McKenzie Health; and JJ Hodshire, president and CEO, Hillsdale Hospital.

The MHA also provided comment to Michigan Radio for a story published April 27 on increasing COVID hospitalizations due to the omicron BA.2 variant.

“…[B]ut there are clear indications that the severity of illness is down and so we hope there will not be a surge of COVID hospitalizations like the state has experienced previously,” said John Karasinski, director, communications, MHA.

Combating the Novel Coronavirus (COVID-19): Week of April 11

MHA Covid-19 update

MHA Covid-19 updateThe number of confirmed and suspected cases of COVID-19 in Michigan went up April 7-13 from the previous week, rising from an average of 750 per day to 1,104 per day. Out of the 7,725 confirmed and suspected cases that week, 81 Michiganders died. On April 13, 482 adults and 14 children were hospitalized in Michigan with confirmed and suspected COVID-19, with 104 in intensive care units and 40 using ventilators to breathe. The state is currently reporting this information once a week. Nationwide, the daily average case rate was 29,401 as of April 13, with 452 deaths per day attributed to COVID-19. Federal officials have warned of an uptick as the BA.2 variant spreads and many locations drop mask requirements and social distancing measures.

The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Health Secretary Extends Public Health Emergency

U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra announced April 12 that the HHS is extending the COVID-19 public health emergency (PHE) another 90 days effective April 16, pushing the new expiration to mid-July.

The extension will continue the relaxation of several healthcare-related regulations, including:

  • Continued coverage of expanded telehealth services for government and private payer beneficiaries.
  • Continuous enrollment in Medicaid and the Medicaid federal match rate:
    • The 90-day extension of the PHE will extend the enhanced federal match rate through Sept. 30, reducing the provider taxes hospitals pay to support certain Medicaid supplemental payment pools as well as reducing the state’s general fund contribution to the overall Medicaid program.
    • The PHE extension also extends the Medicaid enrollment maintenance of effort (MOE) by 90 days, which means the state will generally not remove individuals from the Medicaid program for another quarter. Michigan Medicaid enrollment is now more than 3 million people due to the current PHE-related MOE.
  • The continuation of permissible use of COVID-19 tests, vaccines and therapeutics still operating under emergency use authorization.
  • Liability protection for certain provider types administering COVID-19 vaccines.
  • Swing bed flexibility.
  • Certain requirements for critical access and rural hospitals.
  • CRNA supervision waived.
  • Other regulations.

MHA members are encouraged to review an overview from the Centers for Medicare & Medicaid Services outlining all federal requirements for healthcare providers that are modified while the PHE remains in place.

The HHS intends to provide states with at least 60 days’ notice prior to any possible termination or expiration of the PHE in the future.

The American Hospital Association and Children’s Hospital Association, with the MHA’s support, have urged the HHS to better define long COVID-19 treatment and coverage plans before ending the emergency. The MHA will keep members apprised of any developments on these topics.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the Michigan Department of Health and Human Services Community Health Emergency Coordination Center (CHECC).

Workplace Safety and Minority Health Recognized in April

National organizations are recognizing April as Workplace Violence Awareness Month and Minority Health Month, each of which are key priorities for the Michigan Health & Hospital Association. The Alliance Against Workplace Violence is leading efforts for Workplace Violence Awareness Month while the U.S. Department of Health and Human Services Office of Minority Health is promoting Minority Health Month.

MHA CEO Brian Peters
MHA CEO Brian Peters

“The mission of the MHA is to advance the health of individuals and communities,” said MHA CEO Brian Peters. “Ensuring the safety of our healthcare workers and improving efforts to address health equity, diversity and inclusion fulfills our mission and is critical to every Michigan hospital and community.”

According to the U.S. Bureau of Labor Statistics, the healthcare sector had the highest distribution of nonfatal occupational injuries and illnesses in the private sector in 2020, while OSHA data indicates healthcare workers are nearly four times more likely on average to experience violence than individuals in other industries.

Improving workplace safety in hospitals has been the focus of the MHA, the MHA Keystone Center and Michigan hospitals since the MHA Workplace Safety Collaborative was launched in 2019 with the goal to reduce injuries and increase safety awareness through educational events, webinar series and insights from subject matter experts.

With reported rates of violence against healthcare workers increasing during surges of COVID-19 hospitalizations, the MHA has actively advocated for House Bill 5682. This legislation would double the fines for assaulting a healthcare employee or volunteer in any healthcare setting. To help increase awareness of protecting healthcare workers, the MHA has developed and provided to MHA members free of charge workplace violence posters.

Diversity, equity and inclusion is another key component of the activities of the MHA Keystone Center. The MHA Board of Trustees endorsed in 2020 the Address Racism and Health Inequities pledge, which has since been embraced by all MHA member hospitals and hospital systems. The pledge expresses the need for hospitals to commit to addressing disparities, dismantling institutional racism and achieving health equity. The MHA Keystone Center also released the Eliminating Disparities to Advance Health Equity and Improve Quality guide, which is to be used by hospitals to assess strategies aimed at reducing disparities, achieving equity and improving quality.

“I am very proud of the work the MHA Keystone Center has made on both workplace safety and diversity, equity and inclusion,” said Sarah Scranton, MPA, MPP, vice president, safety and quality, MHA, and executive director, MHA Keystone Center. “The safety of caregivers and addressing health disparities can significantly impact the quality and safety of care delivered inside a hospital.”

Health equity is achieved when all members of society enjoy a fair and just opportunity to be as healthy as possible. As defined by the Centers for Disease Control and Prevention, social determinants of health contribute to racial and ethnic minority groups having disproportionate health outcomes and include neighborhood and physical environment, health and healthcare, occupation and job conditions, income and wealth, and education. The MHA and the MHA Keystone Center have long been committed to addressing health disparities, which is a foundational concept that shapes all the organization’s quality improvement and safety efforts.

More information about the MHA’s efforts and resources on workplace safety and health equity can be found at mha.org.

Combating the Novel Coronavirus (COVID-19): Week of April 4

MHA Covid-19 update

MHA Covid-19 update

The Michigan Department of Health and Human Services (MDHHS) reported there were an average of 752 new confirmed and suspected COVID-19 cases per day from April 2 through April 6. As of April 6, 453 adults and 17 children were hospitalized with confirmed and suspected cases; 96 adults were in intensive care units, 39 of them on ventilators. The MDHHS is now reporting this data once a week.

The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

FDA Revokes Sotrovimab Authorization

The Food and Drug Administration (FDA) has revoked emergency use authorization (EUA) for sotrovimab, a monoclonal antibody treatment for COVID-19 patients at risk of developing severe disease. This occurred due to the treatment’s ineffectiveness as a remedy for the omicron subvariant BA.2, which is now responsible for more than half of all U.S. infections.

The FDA authorized a new monoclonal antibody, Eli Lilly’s bebtelovimab, Feb. 11 that remains effective against omicron variants; the bebtelovimab EUA is still in place. The MHA will continue to work with the Michigan MDHHS leadership on therapeutics recommendations and availability in Michigan. Members with questions may contact Laura Appel at the MHA.

President Biden Announces Long COVID-19 Care Planning

President Joe Biden announced April 5 that the U.S. Department of Health and Human Services (HHS) will assemble a cross-government plan to manage “long COVID.” However, it is largely dependent on being funded by Congress.

The plan’s goals are broadening research, detection and treatment access to fight lingering or late-emerging effects of COVID-19 that are estimated to impact between seven million and 23 million Americans. The symptoms include shortness of breath, heart irregularities, kidney problems and more.

The American Hospital Association (AHA) and other federal advocacy groups sent a letter to HHS Secretary Xavier Becerra in March stating that there is “a need for further clinical guidance regarding the symptoms of and best course of treatment for long Covid-19 patients.” According to news reports, the Biden administration needs at least $25 million in the 2023 federal budget to build on tracking and surveillance progress, in addition to the $50 million the Centers for Disease Control and Prevention is already spending.

The long COVID-19 plan further includes establishing a Center of Excellence to treat long COVID-19 patients through in-person, multispecialty and telehealth services. The administration reportedly wants to establish long COVID-19 clinics around the country modeled after a Veterans Affairs clinic setup.

The MHA will continue to work closely with the AHA about the viability of this plan, both operationally and politically, and will keep members apprised of progress or plans that may impact hospitals, health systems and their patients. Members with questions may contact Laura Appel at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

Prior Authorization Bill Signed into Law

capitol building

capitol buildingLegislation to decrease wait times for commercial insurance prior authorization requests was signed into law by Gov. Gretchen Whitmer April 7. Senate Bill (SB) 247, introduced by Sen. Curt VanderWall (R-Ludington), will shorten the timeline for approval to seven calendar days or 72 hours for urgent requests, as well as ensure that emergency care can be provided without prior approval.

Shortening wait times for prior authorization requests has been an MHA priority for several legislative sessions. The MHA provided testimony in support of SB 247 in both chambers and shared a letter with the governor encouraging her to sign the bill. The legislation will take effect June 1, 2023.

Members with questions about SB 247 or other state legislation regarding healthcare should contact Adam Carlson at the MHA.