Lame Duck Session Begins in Senate

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capitol buildingThe 2022 lame-duck session in the legislature got off to a slow start in the Senate during the week of Nov. 28. Several bills impacting hospitals saw unsuccessful votes on the floor, including legislation to make changes to the operation of the 340B drug pricing program and a package to integrate behavioral and physical health for state regulated insurance plans.

The 340B legislation, Senate Bill (SB) 1088, threatened to strike important protectionist language that was secured in Public Act 12 of 2022. That bill signed into law in February prohibits a pharmaceutical manufacturer from requiring the use of a modifier on non-Medicaid claims, protecting 340B entities from industry implemented administrative hurdles. Removing this language would negatively impact the communities served by Michigan 340B hospitals. The MHA and its member hospitals have been working hard to advocate to elected officials the importance of the program. SB 1088 was introduced as a vehicle bill by Sen. Curt VanderWall (R-Ludington) and was discharged and substituted on the floor before voting. The vote on SB 1088 on Nov. 29 ultimately failed twice on the floor and it is not clear if the legislation will be considered again.  The MHA will continue to oppose SB 1088 and other threats to the 340B program.

SB 597 and 598, the Senate’s behavioral health integration package, also did not find the votes to pass on the floor. Introduced by Sen. Majority Leader Mike Shirkey (R-Jackson) and Sen. John Bizon (R-Battle Creek), the package would create new specialty integrated plans (SIPs) that would replace the current prepaid inpatient health plans (PIHPs) and contract with each community mental health (CMH) services program to deliver physical and behavioral health services to Michigan’s Medicaid population. The bills would also eliminate language requiring CMH entities to coordinate substance use disorder (SUD) and school based behavioral health services and create a new statewide ombudsman.

The Senate’s Health Policy and Human Services Committee also met to advance several bills to the floor for a potential vote in the final days of session. Among those bills was House Bill (HB) 6086, introduced by Rep. Jeff Yaroch (R-Richmond). HB 6086 would establish an alternate licensure process for paramedics in Michigan. HB 6086 would require the state to develop a new Michigan-specific certification course, separate from the currently required course from the National Registry of Emergency Medical Technicians. The MHA is opposed to HB 6086, which could have implications for a paramedic’s ability to work in multiple states. The National Registry of Emergency Medical Technicians certification is currently used in 48 states and is required for all newly licensed paramedics in Michigan.

The MHA will continue to monitor all these bills for any further action in the coming weeks. Members with questions about these issues or other state legislation related to healthcare can be directed to Adam Carlson at the MHA.

MHA Keystone Center 2021-2022 Annual Report Highlights Collaboration and Partnership

The MHA Keystone Center 2021-2022 Annual Report

The MHA Keystone Center recently released its 2021-2022 Annual Report, which showcases the center’s commitment to working alongside members to improve safety and quality in healthcare. Through support from Blue Cross Blue Shield of Michigan, this report highlights the profound impact collaboration and partnership amongst the Michigan healthcare community can have on Michigan’s communities.

Report highlights include:

  • An introduction to the MHA Keystone Center’s Health Equity Task Force, which was assembled to provide guidance to members in their efforts to redesign and implement interventions that address disparities in care.
  • An overview of the well-being program (WELL-B) launched in partnership with Duke Center for Healthcare Safety and Quality to address workplace burnout in healthcare.
  • A birds-eye view of the collaboration taking place to address increasing opioid use disorder cases.

Printed copies are available upon request.

Members with questions about the report should contact the MHA Keystone Center.

MHA CEO Report — Pediatric Capacity Crisis

MHA Rounds Report - Brian Peters, MHA CEO

Every child begins the world again.Henry David Thoreau

MHA Rounds Report - Brian Peters, MHA CEOIn all of my life experiences to date, none have been so challenging in every sense as those times when my young children were hospitalized in the NICU, fighting for their very lives. We were incredibly fortunate to have positive outcomes with both of them, thanks to the efforts of our Michigan hospitals and the incredible people who work there every day.

I share this perspective because there is a crisis throughout Michigan that truly hits home with me. I know the angst and exhaustion being felt by far too many parents right now – emotions that are also being acutely felt by our heroic caregivers. In short, it feels like déjà vu in Michigan’s children’s hospitals, but instead of a surge of COVID-19 patients stressing capacity to the limits, our facilities are strained by a high number of pediatric patients suffering from respiratory illnesses largely driven by RSV. Similar tactics that have been implemented in prior years, such as initiating incident command systems, have been in operation to ensure appropriate direction and communication is occurring throughout those systems impacted by this crisis.

Hospitals operating at capacity is nothing new and the staffing challenges that continue to result in Michigan operating with 1,700 fewer staffed beds than we had prior to the pandemic are well documented. What we’re seeing today is the real impact of what those staffing challenges mean: longer wait times in the emergency department, lack of available beds for patient transports (particularly in rural Michigan) and pediatric ICUs operating at beyond 100% capacity.

There are few professionals in the world that have proven to be more resilient than healthcare workers, whether they are physicians, nurses, respiratory therapists, environmental service workers…the list goes on and on (and I am proud to say that the MHA Keystone Center has played an important role with the launch of our WELL-B initiative that continues to provide resiliency tools for our clinicians and other team members). But as residents of our communities, we can no longer take our healthcare workers and the access to care they provide for granted. These workers, and their organizations, need help.

Thankfully, the Michigan Legislature provided funding earlier this year through Public Act 9 to improve the recruitment, retention and training of healthcare workers. So far, over 69,000 healthcare workers have benefitted from that funding and it has helped to stabilize existing staffing levels. Hospitals are also exploring innovative ways to grow the talent pipeline, such as investment in higher education partnerships and other apprenticeships. However, while impactful, this funding is a finger in the dyke. Without additional attention, the problem will persist.

Addressing the strain on our children’s hospitals is a multi-pronged approach, and in addition to the aforementioned work of our MHA Keystone Center, we are also deriving input and guidance from our MHA Council on Children’s Health, led by Laura Appel, executive vice president for government relations and public affairs, as well as our system chief medical officer (CMO) group, led by our own CMO Gary Roth, DO.

While the MHA will continue to pursue legislative and regulatory solutions to the staffing crisis, there are actions anyone can undertake to help our healthcare workers caring for very sick children across Michigan, particularly as COVID-19, RSV and the flu converge to drive hospitalizations.

First and foremost, ensure that both you and your children are up to date on all the relevant vaccinations that are now readily available. The MHA is a long-time supporter of I Vaccinate which is a good source of information on vaccines, and our MHA Senior Vice President of Public Affairs and Communications Ruthanne Sudderth continues to be our point person with this organization. Second, practice proper hygiene, including handwashing and staying home when sick. Third, seek the appropriate setting for care; visit the hospital for emergencies but contact your primary care physician or an urgent care facility for testing or care for mild symptoms. Lastly – and very importantly – be sure to express some grace and appreciation for any healthcare worker you meet. As we approach the winter and holiday season, they are here to provide exceptional care to all who need it and deserve to be treated with respect both on and off duty.

If you have not done so already, please join me in sharing this messaging within your networks. Our hospitals need the support from our partners in healthcare, the business community and in Lansing and Washington, DC to weather this storm. Respiratory illnesses will always be here, but there are many small actions we can take to care for the health and wellness of our communities well into the future.

As always, I welcome your thoughts.

Expanded Scope of Practice Creates Opportunities

To optimize cost savings, patient experience and staffing, hospitals and health systems are using multidisciplinary teams working to deliver care. Fortunately, new legislation expanded certified registered nurse anesthetists (CRNAs) abilities to practice without direct physician supervision.

The CRNA’s Role in the Future of Clinical Operations webinar on Jan. 12, 2023 will include panelists Steve Barnett, president and CEO of McKenzie Health System, Robert Casalou, president and CEO of Trinity Health Michigan & Southeast Regions and Jeremiah J. Hodshire, president of Hillsdale Hospital. They will review how their organizations have increased CRNA duties and responsibilities and tactics to build support and operationalize CRNA practice. MHA staff will outline advocacy efforts to expand CRNA’s scope of practice and answer questions about reimbursement.

The webinar is cosponsored by the Michigan Association of Nurse Anesthetists (MANA) and is open to MHA and MANA members. Chief executives and presidents, financial and operational team members, medical, nurses and compliance officers are encouraged to register.

Members with questions should contact Erin Steward at the MHA.

News to Know – Nov. 21, 2022

  • DataGen is hosting a national webinar to review the 2023 Medicare fee-for-service outpatient prospective payment system final rule and hospital impact analysis at 3 p.m. on Nov. 30, 2022. This webinar is available free of charge but registration is required. The MHA will provide hospitals with an impact analysis of the final rule within the next few weeks. Members with questions should contact Vickie Kunz the MHA.
  • MHA Endorsed Business Partner NextJob is hosting a free webinar on Actionable Neuroscience Insights for Improved Workplace Performance at noon ET Dec. 7, 2022 to educate employees about the brain processes of perception, cognition and neuro-linguistics and share tips to help improve performance at work. MHA members are invited to register and share information about the webinar with their colleagues. To learn more, visit the business partner profile page for NextJob or contact Paul Dzurec at NextJob.

Urge Congress to Support Hospitals by Enacting Key Priorities in Lame-duck Session

The American Hospital Association (AHA) recently released an action alert to impress upon lawmakers the immediate need to support hospitals and health systems. It is important the last session days of the year are used as an opportunity to advance key priorities at the federal level. The AHA has already urged congressional leaders to include a number of important provisions in a year-end legislative package to ensure that hospitals and health systems can continue their mission of caring for the communities they serve.

Lawmakers need to hear how managing the aftermath and aftershocks of the biggest public health crisis in a century has left hospitals and health systems facing significant financial and workforce challenges that are jeopardizing access to care for patients. Members are asked to contact their legislators today and continue to make the case why additional support and resources are needed.

Lawmakers should be urged to:

  • Prevent any further damaging cuts to health programs, including stopping the forthcoming 4% Statutory Pay-As-You-Go (PAYGO) sequester.
  • Establish a temporary per diem payment targeted to hospitals to address the issue of hospitals not being able to discharge patients to post-acute care or behavioral facilities because of staffing shortages.
  • Extend or make permanent the low-volume adjustment and the Medicare-dependent hospital programs — critical rural programs that are due to expire on Dec. 16.
  • Make permanent the expansion of telehealth services and extend the hospital-at-home program.

Participate in AHA Advocacy Day on Capitol Hill: Members are asked to inform the MHA if they will be in Washington, D.C. on Dec. 6 and would like to be included in the schedule for visits with members of Congress.

Contact Laura Appel at the MHA for more details.

Webinar Outlines CRNA’s Role in the Future of Clinical Operations

Michigan legislation in 2022 modernized the scope of practice for certified registered nurse anesthetists (CRNAs), eliminating the state requirement that a CRNA must work under direct physician supervision. Hospitals can now choose the anesthesia care model that best fits their location, staffing and resources to offer safe and effective patient care.

The CRNA’s Role in the Future of Clinical Operations webinar on Jan. 12, 2023 will include panelists Steve Barnett, president and CEO of McKenzie Health System, Robert Casalou, president and CEO of Trinity Health Michigan & Southeast Regions and Jeremiah J. Hodshire, president of Hillsdale Hospital. They will review the CRNA duties and responsibilities in their settings and tactics to build support and operationalize CRNA practice. MHA staff will outline advocacy efforts to expand CRNA’s scope of practice and answer questions about reimbursement.

The webinar is cosponsored by the Michigan Association of Nurse Anesthetists (MANA) and is open to MHA and MANA members. Chief executives and presidents, financial and operational team members, medical, nurses and compliance officers are encouraged to register.

Members with questions should contact Erin Steward at the MHA.

Recapping 2022 Midterm Election Results

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Midterm election results are in, bringing new leadership to the Michigan Legislature and a returning administration at the top of the ticket. Election 2022 will bring significant change to Lansing, as Democrats will now control the Governor’s office and both chambers of the state legislature for the first time since 1984.

Below is a snapshot of some of the key election results:

  • Top of the ticket Democrats won safely. Governor Gretchen Whitmer, Secretary of State Jocelyn Benson and Attorney General Dana Nessel all swept the top of the ticket by 8+ points.
  • Supreme court incumbents will return as well, with Justices Richard Bernstein and Brian Zahra winning reelection. Democratic-nominated justices will maintain a 4-3 advantage on the court.
  • Democrats flip a congressional seat to win a 7-6 edge on Michigan’s congressional delegation. Hilary Scholten (D-Grand Rapids) was able to defeat opponent Republican John Gibbs (R-Grand Rapids), while Elissa Slotkin (D-Lansing) was able to hold off a challenge from Tom Barrett (R-Potterville).
  • Democrats win majority in the Michigan House of Representatives for the first time since 2010. The new majority will be led by Michigan’s first Black speaker, Rep. Joe Tate of Detroit.
  • Democrats win majority in the Michigan Senate for the first time since 1984. The new majority will be led by Michigan’s first female Senate Majority Leader, Sen. Winnie Brinks of Grand Rapids.
  • All three of the ballot proposals succeeded handily. Michigan’s constitution will be amended to include term limit adjustments, expanded voting rights and reproductive freedom.

Overall, the legislative election results look positive for the hospital and healthcare community looking into 2023 given the stability within the executive administration and the existing relationships the MHA has established during their tenure in office. Democrats have not had a dual-chamber legislative majority in nearly 40 years, so it is expected that they will have no shortage of legislative priorities to work on.

The MHA is excited to begin working with the new leadership to address the lingering issues hospitals continue to face post-pandemic as well as having the opportunity to collaborate with legislators on new priorities. With 59 first-time legislators this year, the MHA will be working hard to build relationships with the new lawmakers in the coming days and months and encourage members to do the same.

Members with questions or needing assistance identifying their legislator should contact Sean Sorenson-Abbott at the MHA.

The MHA Keystone Center Offers Ongoing Workforce Well-Being Courses

Through a partnership with the Duke Center for Healthcare Safety and Quality, the MHA Keystone Center is pleased to offer the second iteration of its WELL-B webinar series geared to support healthcare workers experiencing burnout.

Live courses will begin on Nov. 17 and take place monthly through Oct. 2023. Each one-hour session includes CME and ANCC credit. The 12 sessions are a continuation of the courses offered earlier this year. Members who did not participate in the spring cohort are encouraged to listen to the recordings to gain foundational knowledge. CME and ANCC credits are also available for the pre-recorded sessions.

Registration will remain open throughout the series.

Registration is also open for a 5-hour WELL-B Essentials cohort opportunity starting in Jan. 2023. The five interactive sessions will center around cultivating work-life balance, gratitude, self-compassion and awe.

Sessions for the WELL-B Essentials cohort are first come, first serve. Registrants will be assigned to the one-hour sessions from noon to 1 p.m. either Jan. 23 – 27 or Jan. 30 – Feb. 3.

Members with questions may contact the MHA Keystone Center.

Legislature Returns for Lame Duck Session

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capitol buildingThe legislature returned during the week of Nov. 7 to vote on legislative leadership and kickoff the 2022 lame-duck session. Only a handful of MHA-tracked bills saw action, including legislation to implement the new federal Rural Emergency Hospital (REH) designation.

During the House Health Policy Committee, Senate Bill (SB) 450 received another hearing and was reported to the full House of Representatives. SB 450, introduced by Sen. Jim Stamas (R-Midland), would ensure visitors of cognitively impaired patients are permitted in healthcare facilities. The bill would prohibit the directors of the Michigan Department of Health and Human Services (MDHHS) or a local health officer from issuing an order that prohibits a patient representative from visiting a cognitively impaired individual in a healthcare facility. As written, the legislation does not prevent a healthcare facility from implementing reasonable safety measures for visitors and will still allow for facilities to limit the number of representatives per patient. The MHA is neutral on the bill and will continue to monitor any action taken.

MHA staff was also in attendance to support House Bill (HB) 6380. Introduced by Rep. Andrew Fink (R-Hillsdale), HB 6380 would make the necessary changes to state law to allow for Michigan hospitals to pursue a new federal designation of REH status. An REH designation comes with significant requirements such as limiting total beds to 50, maintaining an average length of stay of 24 hours or less and a required transfer agreement with a level I or II trauma center. Hospitals that choose to convert to an REH will receive enhanced federal reimbursement to provide critical emergency and outpatient services, especially in geographic areas. The MHA provided testimony on the bill in September and will continue to advocate for its passage before the end of the year.

On the Senate side, the Health and Human Services Committee took action on SB 1172, introduced by Sen. Stephanie Chang (D-Detroit). SB 1172 would amend the Mental Health Code to allow for conservation officers to transport behavioral health patients to the proper care setting. Currently, conservation officers and Michigan’s state parks and public venues are required to contact another form of law enforcement if they encounter someone experiencing a mental health crisis. The MHA is supportive of SB 1172, which will help shorten patient wait times for these particular cases.

If members have questions about these issues or any others impacting healthcare, please contact Adam Carlson at the MHA.