MHA CEO Report — Staying Resilient Through the Ongoing Pandemic

MHA Rounds Report - Brian Peters, MHA CEO

“If you’re going through hell, keep going.” — Winston Churchill

MHA Rounds Report - Brian Peters, MHA CEOHere are the facts, and they are not pretty: as we enter the final month of 2021, the situation confronting our Michigan hospitals is as dire as it has been since the start of the pandemic. A prolonged fourth surge has driven COVID-19 inpatient hospitalizations above 4,600 and ICU occupancy rates to nearly 90% — both metrics hovering near our all-time record highs. Michigan hospitals are also dealing with extraordinarily high volumes of non-COVID patients — likely the result of months of pent-up demand for healthcare from Michiganders who have delayed seeking treatment for a wide range of issues. Throughout the state, elective procedures are being deferred, emergency departments are placed on diversion, patients ready for discharge are stuck in hospital beds due to transportation shortages and wait times in emergency departments can often be measured in hours. As if this wasn’t enough, we are now beginning to see the first flu cases arrive in our hospitals, at the same time that the specter of yet another new COVID-19 variant looms on the horizon. In short, we’re going through hell.

Given this reality, it is no wonder that the significant workforce challenges that predated the pandemic have only gotten worse by the month (it doesn’t help that the rates of violence, either verbal or even physical, are increasing as patients and their families become impatient with longer wait times or visitor restrictions due to infection control protocols). Many of our caregivers have headed to jobs in other fields or retired altogether. The end result of this phenomenon: nationally, hospitals and health systems remain nearly 100,000 jobs below their pre-pandemic February 2020 peak. And here in Michigan we have approximately 800 fewer staffed hospital beds today than we did one year ago — in essence, this is the inpatient capacity equivalent of shuttering one of our largest hospitals. The workers who remain are facing unprecedented stress and fatigue. Already, three Department of Defense medical teams have been called in to provide staffing support to some of our hospitals. We welcome this support, but much more is needed.

However, Michigan’s healthcare community is coming together to advocate for solutions that address healthcare workforce sustainability in both the short and long term. Together with long-term care, medical transportation providers and higher education leaders, we are advocating for funding to support healthcare workforce staffing and growing the talent pipeline.

House Bill (HB) 5523 was introduced Dec. 8 and includes $300 million for healthcare workforce recruitment and retention payments. We are extremely appreciative of this appropriation and encourage lawmakers and the administration to quickly approve the funding for the healthcare workforce before the holiday break. Our communities depend on our hospitals both for life-saving treatment and as economic engines. An investment today will help set Michigan on a path forward to addressing this crisis.

In addition, first hearings were held Nov. 30 on HBs 5556 and 5557, which would allow community colleges to offer four-year bachelor of science in nursing degrees. The MHA supports this legislation that would improve the long-term nursing talent pipeline and would increase access to high-quality nurses in some areas served by Michigan’s small and rural hospitals where a four-year school does not currently exist.

At the MHA we have a mantra: “no data without stories, and no stories without data.” It takes both to move the needle on public opinion and, hence, public policy. We have heard countless stories about the current environment from nurses, doctors, hospital and health system leaders, patients and others. The stories range from insightful, to heartbreaking, to maddening. Now here is some compelling data, which points to what all Michiganders can do to help: 76% of COVID-19 hospital inpatients are unvaccinated, 87% in the ICU are unvaccinated and 88% on ventilators are unvaccinated. The data is clear; vaccines are safe and effective at preventing severe illness. It is quite literally the most powerful tool in our toolbox. While we recently surpassed 70% of the population age 16 and older receiving at least one dose of COVID-19 vaccine, we have a long way to go on this front. The vaccine uptake among eligible children ages 5-11 now stands at just 16.2%, with large disparities existing between suburban communities and their rural and urban counterparts.

What we need to do to get out of this current COVID-19 surge is simple, and the message from our hospitals is clear: get vaccinated, have your children vaccinated and receive your booster dose when eligible. Adhere to the Michigan Department of Health and Human Services mask advisory in large indoor gatherings. And if you do visit a healthcare facility, whether for a medical emergency or to accompany a loved one, please be patient and display some grace and empathy toward our healthcare workers. The pandemic is clearly not over, and they need your help and support now more than ever.

As always, I welcome your thoughts.

MHA CEO Report — Our Strategic Action Plan

MHA Rounds Report - Brian Peters, MHA CEO

Love and compassion are necessities, not luxuries. Without them humanity cannot survive.

— Dalai Lama XIV

MHA Rounds Report - Brian Peters, MHA CEO

At the beginning of every MHA program year (which officially kicks off every July 1), in close consultation with our MHA Board Chair and Board of Trustees, we develop a “strategic action plan” that serves as a road map for our important efforts over the coming 12 months. While the process involved in crafting the 2021-2022 plan was very similar to prior years, the environment was anything but.

One thing every Michigander surely has in common: we are all eager to see a significant decline in COVID-19-related positivity rates, hospitalizations, morbidity and mortality, and the unprecedented disruption brought about by the pandemic. Every day, we closely examine the data and – equally important – the real-time stories from the administrative leaders and clinicians in our member hospitals and health systems throughout the state. As I write this report, we unfortunately remain mired in a pandemic that simply will not fully release its grip. Hospital beds are filling up with both COVID-19 patients (over 2,000 as of today) as well as patients who likely delayed seeking treatment for a range of other, non-COVID-19 issues. Supply chain issues persist, and clinical and nonclinical staffing challenges are as severe as ever. Any notion that we are out of the woods is misguided; we must remain as vigilant as when the pandemic began.

Against that backdrop, our action plan has been designed with our association mission in mind: we advance the health of individuals and communities. The following synopsis represents just a few highlights:

  • Policy and Advocacy: Our hospitals and their front-line caregivers need fair and adequate funding support now more than ever. Our priorities here include full funding for the Healthy Michigan Plan (our Medicaid expansion plan which now covers over 950,000 Michiganders), pools that protect access in rural communities and obstetrical care, graduate medical education, and the preservation of our robust provider tax program and Medicaid payment rates. We successfully achieved all of these objectives in the budget that just began Oct. 1; in addition, the budget includes new special appropriations specific to hospitals, including $3 million to fund the stroke/STEMI system of care to mirror the trauma system; ensured a continuation of the direct care worker increase at long-term care facilities to $2.35/hour; raised ground ambulance service reimbursement to the highest possible rate, valued at $54 million; and extended funding for 12 months of Medicaid coverage postpartum to improve maternal and infant health. As soon as one budget is finalized, the planning and negotiations begin for the next – and we are already gearing up to do right by our members and the patients they serve.
  • Workforce Sustainability: We must find ways to remove unnecessary barriers that prevent the recruitment and education of qualified individuals, and we must provide our healthcare workforce with the critical assistance they need to continue caring for and supporting our communities. In the short term, the MHA has formed both a Human Resources Council and a Human Resources Subcommittee of the MHA Service Corporation Board of Directors to convene leaders in the field to closely monitor the staffing crisis and provide guidance on our emerging efforts. This is an “all-hands-on-deck” affair for the association and will be on the agendas of every MHA council, committee and task force this year. In the days and weeks ahead, you will hear more about our very specific request related to healthcare workforce sustainability in the state budget supplemental process – just one aspect of a multiprong strategy that will also include regulatory flexibility, a renewed push to join the multistate nurse licensure compact, immigration policies, expanding scope of practice, virtual health, and addressing workplace violence and burnout.
  • COVID-19: The MHA will also continue to respond to immediate COVID-19 issues, which includes continuing to promote the effectiveness and safety of vaccines. Our vaccine focus areas will also move toward third doses and boosters, childhood vaccination for those ages 5-11, federal mandates for employers and healthcare providers, and flu vaccines. The MHA will also continue to work closely with the American Hospital Association on ensuring the federal mandates provide consistency between the upcoming Centers for Medicare & Medicaid Services and Occupational Safety and Health Administration rules on how the federal mandates will be enforced for hospitals.
  • Behavioral Health: The MHA has already requested $125 million to expand inpatient pediatric capacity and improve psychiatric services in the emergency department, where far too many patients have been treated due to a lack of suitable alternative psychiatric care settings and providers. We are engaging in the public policy process to make sure that those Michiganders in desperate need of behavioral health services will ultimately have access to compassionate, high-quality care.
  • Health Equity: I am proud that all Michigan hospitals and health systems have signed on to our Board-approved pledge to address racism and health inequities. Through information gained from the Health Equity Organizational Assessment (completed by 113 hospitals to date), we will now identify and implement meaningful and actionable steps to address gaps and disparities in care to support the unique needs of individuals and local communities, particularly those that are underserved.

Other important priorities in this year’s action plan include the preservation of a robust certificate of need program, prevention of harmful nurse staffing ratio legislation, development of new data collection and analysis opportunities, safety and quality improvement, physician integration and cybersecurity.

To successfully achieve all the action plan priorities – as well as effectively respond to the “wild-card” events that inevitably occur during the program year – will require all arms of our organization: our traditional trade association, our 501(c)(3) MHA Health Foundation and MHA Keystone Center, and our for-profit MHA Service Corporation and Endorsed Business Partners.  We are fortunate to have such a strong platform from which to launch our current and future efforts.

There is no doubt that the pandemic has been the biggest disruptor in my professional career. In an ecosystem that was already becoming more integrated, value-driven and transparent, the pandemic exposed all the inherent weaknesses within American healthcare delivery. Yet, throughout the past 20 months, the MHA staff and members have demonstrated our resolve and resiliency. As a result, I have full confidence that at the conclusion of this program year, we will be able to demonstrate strong success on our strategic action plan objectives and, accordingly, will have positioned hospitals to improve the health and wellness of their communities. And we will do so with love and compassion.

As always, I welcome your thoughts.

CEO Report — Our Commitment to Safety and Quality

MHA Rounds Report - Brian Peters, MHA CEO

If you can’t describe what you are doing as a process, you don’t know what you’re doing.” — W. Edwards Deming

MHA Rounds Report - Brian Peters, MHA CEOThe last week has been an eventful and successful one for the MHA. The Michigan Legislature and Gov. Gretchen Whitmer came to an agreement on the state budget for the new fiscal year, which fully preserves all our hospital and healthcare funding priorities — needed more than ever as our hospitals continue to combat COVID-19 and deal with extraordinary staffing challenges. We were officially honored by Modern Healthcare with the Best Places to Work in Healthcare distinction. And finally, we received great news when Blue Cross Blue Shield of Michigan (BCBSM) announced a $5 million commitment through 2024 to support the MHA Keystone Center’s expanded quality and safety improvement programs. I would like to personally thank BCBSM CEO Dan Loepp for his support of this continued partnership, which is the right thing to do for all Michiganders.

Since its inception in 2003, the MHA Keystone Center has provided leadership and facilitation that has directly resulted in improved patient care and quality outcomes — in other words, we have demonstrably saved lives and saved healthcare dollars. No wonder that the MHA Keystone Center has earned both national and international acclaim.

Our first flagship initiative involved central line associated bloodstream infections (CLABSI). Through that work, Michigan hospitals saw a 22% improvement in CLABSI rates. Initial BCBSM funding also supported work that saw a 31% improvement in catheter-associated urinary tract infections (CAUTI) and a 5.9% improvement in venous thromboembolism.

Following our initial successes, the Great Lakes Partners for Patients (GLPP) Hospital Improvement Innovation Network (HIIN) was created, allowing us to collaborate with our colleagues in Illinois and Wisconsin. Our HIIN efforts from Sept. 2016 to March 2020 produced a total cost savings of nearly $293 million, saved 3,350 lives and avoided 25,204 incidents of harm among hospitalized patients.

The MHA is now one of eight organizations participating in the Superior Health Quality Alliance, a Centers for Medicare & Medicaid Services (CMS)-contracted organization that seeks to improve the quality of health and healthcare through innovation, effectiveness and efficiency in designing and implementing CMS Network of Quality Improvement and Innovation Contractors initiatives that are person-centered and integrated across the continuum of care and services. This important work with federal contracts is yet another way we can improve quality in the acute care setting.

High reliability work has been a focal point for the MHA for several years, which was initiated with our members in 2015. This work ensures exceptional quality of care is consistently delivered for every patient, every time. In 2018, the MHA Keystone Center launched a Reliability Culture Implementation Guide in partnership with our fellow state hospital associations from Illinois, Minnesota and Wisconsin. This guide provides resources available for front-line staff, executive leaders and board members to help identify areas of opportunity.

Over the past year, CEOs representing all our community hospitals have signed the MHA Pledge to Address Racism and Health Inequities, demonstrating our members’ unified commitment to address disparities, dismantle institutional racism and achieve health equity. Recent examples of tangible steps taken to accomplish those goals include the publishing of the Eliminating Disparities to Advance Health Equity and Improve Quality guide and offering a virtual series to address four diversity, equity and inclusion concepts: equitable conversations, equitable messaging, partnership building and diversity pipeline development. The Health Equity guide is geared to assist organizations in addressing health disparities to achieve equitable care by providing key strategies, recommendations for action, implementation levels, and resources to support progress.

Thanks to funding from the Michigan Health Endowment Fund, the MHA Keystone Center recently launched its second Age-Friendly Health Systems Action Community free of charge to MHA members. The Action Community builds on existing practices of participating organizations and combines them to reliably implement the evidence-based framework of high-quality care with all older adults in the system. With Michigan’s aging population, this work is exceptionally important and timely.

One way to help instill a safety culture within a healthcare organization is empowering all members of a care team to speak up if they think something may be wrong. Our patient safety organization created the quarterly Speak-up! Award program five years ago to honor healthcare staff who spoke up to prevent harm, which has prevented nearly $12 million in avoidable costs.

We have also done our part to address the tragedy of opioid overdoses, which lead to more deaths in Michigan than automobile accidents. The GLPP HIIN recently created the Midwest Alternatives to Opioids (ALTO) program; participating hospitals collectively have seen an 11.32% decrease in opioid administration and a 13.38% increase in ALTO administration. Because the COVID-19 pandemic has only worsened the opioid epidemic, we are committed to expanding this important work.

The MHA advocacy and policy departments also assisted in the creation of Project Baby Deer, a rapid Whole Genome Sequencing project to improve pediatric intensive care units and outcomes in Michigan. Genetic disorders are a leading cause of morbidity and mortality in infants. Early diagnosis of genetic disease has the potential to change clinical management in many meaningful ways, including initiating lifesaving treatments, avoiding unnecessary tests and procedures, shortening hospital stays and empowering families with real-time diagnoses to help with their understanding and decision-making. In addition to improving outcomes, Project Baby Deer also can prevent avoidable healthcare costs.

As you can see, we have a rich history that we can be incredibly proud of. And without question, BCBSM has been an instrumental partner with us on this journey, providing some $16 million in direct funding support to date. This new BCBSM funding will help to ensure that our critical work in safety and quality continues into the future. Specifically, it will allow the MHA Keystone Center to increase hospital participation in the Michigan Alliance for Innovation on Maternal Health (MI AIM), increasing implementation of pre- and post-partum Obstetric Hemorrhagic Risk Assessment, increasing implementation of Quantitative Blood Loss Assessment, and increasing the percentage of women who receive timely treatment of severe hypertension. It will accelerate our work on the opioid epidemic by maximizing the use of medication-assisted therapy, and it will allow us to expand our efforts to address healthcare workplace injuries — thereby ensuring that hospitals are as safe as possible for our front-line caregivers.

In each example noted above, we have helped to establish a clear process that people can understand, trust and execute.

Lastly, I want to stress that all Michigan hospitals and their team members voluntarily participate in MHA Keystone Center initiatives to advance safety for patients and workers and quality of care. There is no mandate in place to require hospitals to participate in this work, but they each choose to do so because of their missions to care for the sick and vulnerable. The pandemic has shined a bright light on the unselfishness of our healthcare heroes and their participation in these efforts is another terrific example of the lengths they go to improve care for their patients. I want to thank both BCBSM and our member hospitals for believing in this vital work and taking the steps necessary to ensure evidence-based best practices are implemented to the point that they make a difference in patients’ lives. This is mission-driven work that all Michiganders can be proud of

As always, I welcome your thoughts.

CEO Report — Healthy Communities, Healthy Economies

MHA Rounds Report - Brian Peters, MHA CEO

“We are all in the gutter, but some of us are looking at the stars.”― Oscar Wilde

MHA CEO Brian PetersThroughout Michigan, hospitals are critical to their communities not only because of the services they perform, but because of their role as leading employers as well. Regardless of where you live, you very likely know someone who works in a community hospital or in the healthcare field. In fact, in 2018 one in every five employed people in Michigan were in positions directly or indirectly related to healthcare. In total, hospitals in our state provide 234,000 jobs, supporting family members, neighbors and other local businesses. Taken as a whole, healthcare provides more jobs than automotive manufacturing and education combined; as a result, when healthcare operations are impacted, there is a clear trickle-down impact throughout an entire community.

With a death toll that just passed the 20,000 mark, it is no secret that the COVID-19 pandemic has had a profound detrimental impact on the health of Michigan communities and has battered healthcare workers physically and mentally. The most pressing challenge today for the leaders of our member hospitals and health systems is clear: workforce sustainability — in other words, how to best support the front-line caregivers who are working so hard to provide care to our patients and communities and how to recruit and retain enough healthcare professionals to continue providing this care into the future. 

Our hospitals are operating at near-capacity levels due to high volumes of non-COVID-19 patients, many of whom delayed seeking care during the pandemic and are now presenting in the emergency department with higher acuity, requiring higher levels of care and longer lengths of stay. These patients are members of their local communities, serving as business owners, employees and customers. Much as hospitals are stretched thin due to higher volumes and limited staffing, so are our local businesses. The bottom line: hospital operations, public health, and economic vitality are all inextricably linked in our communities.   

Businesses of all stripes have been stretched to their limits over the past year and a half. From food service and hospitality to retail, manufacturing, academia and beyond, whole industries have been severely impacted by the pandemic due to supply and staffing shortages. While serving on the Michigan Economic Recovery Council during the beginning of the pandemic, I learned from some of Michigan’s top business leaders how significant the impacts were to their workforce, operations and bottom line. Many businesses have had to react by postponing specific service lines or production, reducing hours of operation, increasing prices or all the above. But there is one significant difference between our situation today as compared to the earlier stages of the pandemic: we now have a powerful tool in our toolbox that is proven to work and can help accelerate our return to normalcy. Of course, I am referring to the COVID-19 vaccine.   

Besides the obvious motivation to protect yourself from serious illness, hospitalization and death by following public health guidance and receiving the vaccine, there is a need to do so for the economic vibrancy of your local community. Regardless of political views, I can confidently say we all have shared goals of wanting to see our communities thrive, our children in school and our businesses profitable. When it comes to treating and preventing disease, we always look toward our healthcare experts to guide us on a path to recovery. The MHA Board of Trustees, as well as the clinical leaders within our membership, are unequivocally united when it comes to the importance of vaccinations and appropriate masking. We know these tools work, and the evidence from hospitalizations during Michigan’s spring and existing surges prove it, as the older age groups with the higher vaccination levels experienced smaller increases in hospitalizations than younger age cohorts. In fact, approximately 99% of all COVID-19 deaths have been unvaccinated individuals.

I’ve said this publicly for over a year, and I will say it again: whether a local, state or federal public health mandate exists or not, it does not change the fact that receiving a vaccine, wearing a mask, staying home when sick and practicing proper hygiene are the right things to do. Each of these measures reduces the risk of passing on a highly contagious and deadly virus and saves lives. What it also does is lead us closer to economic prosperity for our communities and allows our businesses to focus on what they do best. Our country’s forefathers established core democratic values as our society’s fundamental beliefs. Included is the common good, where we all should work together for the good of all. It is time we remember this principle for the betterment of our communities and economies.

As always, I welcome your thoughts. 

CEO Report — Addressing Staffing Challenges

MHA Rounds Report - Brian Peters, MHA CEO

“There is time for work. And time for love. That leaves no other time.” — Coco Chanel

MHA CEO Brian PetersHospitals have displayed tremendous resiliency over the past year and a half responding to the COVID-19 pandemic. That resiliency has come from the healthcare heroes who have served on the front lines of this crisis and experienced extreme physical and mental stress over the course of three trying surges. Yet that toll has elevated staffing, an already existing concern, to the top of every hospital executive’s mind.

We have said throughout the pandemic that the most significant determining factor of a hospital’s capacity is not physical space, beds or technology — rather, it is available staffing.  Even before the pandemic, we understood that healthcare staffing was a challenge. We currently have a population where the baby-boom generation is maturing, leading to an increased demand for healthcare services. It just so happens that many of those baby boomers also work in healthcare, and the incredible pressures brought about by the pandemic have accelerated their retirement plans.

On top of that dynamic, it has become very difficult for hospitals to recruit and retain staff in an increasingly competitive labor market where many opportunities exist outside of healthcare that offer competitive wages, signing bonuses, free or low-cost training, and the like. Nationally, 80% of nursing leaders have reported an increase in nurse turnover due to the pandemic. According to a 2021 study by Incredible Health, the demand for intensive care and emergency nurses grew by 186% over the past year. We are simply in a situation where the demand for labor currently outpaces supply, with 1.4 million job openings currently in the national healthcare sector according to the Labor Department’s Job Openings and Labor Turnover Summary. In Michigan, simply visiting the Careers webpage of your local hospitals will likely show the dramatic number of openings that are currently available.

Lastly, pent-up demand for healthcare services has stretched existing staff over recent months, as those who were hesitant to receive care for fear of contracting COVID-19 delayed seeing a provider and are now visiting our emergency departments (EDs) at very high levels. In fact, we have seen a 16% increase in hospital ED visits during the latest quarter compared to pre-COVID times in the second quarter of 2019. This pent-up demand is increasing the pressure on our hospitals and staff as people use the ED as a point of entry to the healthcare system.

A contributing factor to the staffing shortage prior to the pandemic was the rate of stress and burnout in the healthcare setting. It is apparent that there are certain jobs, especially those dealing with direct patient care, where the burnout factor is especially pronounced. In response, the MHA has assisted our members in recent years in adopting the Quadruple Aim, a framework that focuses on achieving better healthcare outcomes and has the added goal of improving the mental wellness and work/life balance of healthcare providers to address the issue of burnout. The pandemic has added new urgency to this work.  

In addition, our member hospitals and health systems throughout the state have been active in identifying solutions for our healthcare heroes. Some have offered bonuses and hazard pay to staff to show their appreciation for their hard work. Hospitals are also deploying more resources toward behavioral health support to help staff cope with the traumatic stress that they have experienced over the past 17 months. During Michigan’s three COVID-19 surges, many hospitals also brought in contract workers and traveling nurses to supplement their existing workforce due to staffing shortages, the cost of which came well above standard rates due to the demand. Hospitals have also gone to great lengths to procure record amounts of personal protective equipment for their staff — yet another unplanned and unbudgeted expense.   

For years, the MHA has advocated strenuously to support graduate medical education (GME) in the state budget process, and we have hosted in-person GME Advocacy Day in Lansing events in the past with our partners at the Michigan Osteopathic Association and the Michigan State Medical Society to connect medical residents with their elected officials. GME is critical to attracting medical students and residents from around the globe to Michigan.   

In addition, we advocated for passage of House Bill 4359, which modernized the scope of practice for Certified Registered Nurse Anesthetists (CRNAs). Rural providers have a difficult time hiring anesthesiologists, and this new law will allow 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. We appreciate all the stakeholders that made this bill possible, as it eliminates a costly regulation while maintaining patient safety.

The MHA has also been active in bringing together stakeholders to identify solutions to healthcare staffing. The MHA Service Corporation (MHASC) Human Resources (HR) Committee was created as a collaborative body for HR leaders to come together and address issues specific to healthcare workforce issues. Led by Peter Schonfeld, senior vice president, policy & chief operating officer, MHASC, the committee has met to discuss current HR leadership priorities and review its role in guiding the purpose and direction for the MHASC efforts to address workforce resources, education, data staff development and more. The committee has also addressed priorities including vaccination policies, staffing shortages, and diversity, equity and inclusion.

We also recently formed the MHA Human Resources Council as a resource for healthcare professionals to provide input on legislative and regulatory issues relevant to healthcare employers. Staffed by MHA COO Nancy McKeague, the council will provide networking and educational opportunities for HR professionals, dissemination of best practices, and data collection and reporting relating to hospital and health system workforce metrics.

The MHASC has also been providing staffing solutions to our members through both the Unemployment Compensation Program and our Endorsed Business Partner (EBP) Program. The Unemployment Compensation Program has seen a dramatic increase in the number of cases filed since the pandemic began, processing over 70,000 unemployment claims in the last year alone, from clients in Michigan and across the country. Their decades of expertise have saved our client organizations tens of millions of dollars while addressing unemployment fraud that has become rampant recently.

We currently have six EBPs that focus on workforce solutions, including Merritt Hawkins, which provides permanent physician recruiting and consulting services. These EBPs have been carefully vetted to ensure they provide high-value services for our members in need of workforce assistance. In fact, we recently added NextJob as our newest EBP to help hospitals better support healthcare workers with re-employment services, which enhances the work of our unemployment program. I’m extremely happy that we have these services available, with other EBPs in this space focusing on compensation, workplace violence training, consulting and performance coaching.

Finally, as we look to the future, we know that telehealth and virtual care, which has seen an acceleration during the pandemic, has the potential to be real game changers for the delivery of healthcare. We will need to do all we can to help ensure that new technologies are adopted in such a way as to maximize access and affordability for all populations, while also doing right by our healthcare staff.

As you can see, the staffing challenges hospitals face are complex; yet across Michigan we are pursuing every tool in our toolbox to create solutions that both bring in top-notch caregivers and retain our healthcare heroes who have treated over 125,000 COVID-19 patients during the pandemic. Michigan hospitals remain committed to protecting our staff and doing everything we can to ensure they feel safe and protected while caring for their patients. From physicians and nurses to environmental service workers and support staff, our hospitals need all levels of team members to efficiently and effectively operate 24/7/365.

As always, I welcome your thoughts. 

CEO Report — Incorporating a Federal Advocacy Strategy

MHA Rounds Report - Brian Peters, MHA CEO

“You want a friend in Washington? Get a dog.” – Harry S. Truman

MHA CEO, Brian PetersI have a dog — a beautiful German Shepherd that joined our family in the midst of the pandemic.  I know that many of you have a family dog too, and they are indeed wonderful friends. But as it turns out, the MHA family is also fortunate to have friends in Washington, DC, and never before has that been more important. 

Hospitals and health systems play a key role in their local communities, both as healthcare providers and economic engines. While much of the funding, regulatory, and other public policy decision-making occurs at the local or state level, the truth is that federal politics has become increasingly important, as decisions made at the federal level can have profound impacts on the healthcare delivered in Michigan. The dramatic increase in enrollment for both Medicaid (a shared state/federal program) and Medicare (a strictly federal program) is just one of many reasons why. 

Over the years, the MHA’s engagement at the federal level has increased dramatically, to the point where we have now established meaningful relationships with the entire Michigan congressional delegation and their staffers. These relationships were on display early in the pandemic when we were able to convene conference calls with our delegation — both Republicans and Democrats together on the line at the same time — to listen to our insights and requests and target much-needed assistance to our members who were dealing with a true crisis. We have done all the blocking and tackling that is instrumental to federal advocacy, including routine in-person visits to our delegation members’ DC offices, developing congressional district-specific data and talking points on key issues, coordinating closely with the government relations officers of our member health systems (including those with multistate operations), organizing fundraising events and much more.   

We are fortunate to have a very close partner in this regard: the American Hospital Association.  I’m happy to share that more than 100 of our Michigan community hospitals are also AHA members, a penetration rate that puts Michigan in the very top tier nationally. As a result, our voice is heard clearly as many Michigan healthcare executives are actively involved in the policymaking process of the AHA, serving on various committee and task forces, including the AHA’s Regional Policy Boards. In this manner, we are able to identify needs unique to our region and provide direct input on public policy — and political strategy — to the AHA.  On that note, we are fortunate that Michigan’s own Wright Lassiter, president and CEO of Henry Ford Health System, is now the chair-elect of the AHA Board. 

In addition, the MHA’s political action committee, Health PAC, also has a formal working partnership with the AHAPAC, allowing us to support our members of Congress in this important way.

Recent examples of this partnership in action include our advocacy to protect the Affordable Care Act (ACA), as well as the 340B Drug Pricing Program, and our efforts to combat the COVID-19 pandemic. Several weeks ago, the United States Supreme Court released its opinion in the California v. Texas case that challenged the constitutionality of the ACA. The opinion reversed the Fifth Circuit’s judgement in the matter and upheld the constitutionality of the ACA. The MHA was formally involved in the case, as we joined a number of other state hospital associations in filing an amicus brief with the Supreme Court. We are very pleased with this outcome, which will help to preserve coverage for as many Michiganders as possible — a key MHA priority.

The MHA has also been involved in the federal legal strategy to support the 340B Drug Pricing Program, which is a federal program created by Congress to help provide relief from escalating drug prices to safety-net hospitals and other healthcare providers serving vulnerable patient populations. Over the past year, six drugmakers have stopped providing discount drug prices for pharmacies that contract with 340B providers. The MHA is working with the American Hospital Association Advocacy Alliance for the 340B Drug Program and the 340B Health coalition to protect this vital program. Last fall, the MHA organized a letter to the Michigan congressional delegation that was signed by representatives from 68 of the more than 80 Michigan 340B hospitals to share hospitals’ concern regarding drug manufacturers’ attempts to limit payment to contract pharmacies and other actions that are a significant detriment to 340B hospitals and the services they can provide to eligible patients because of the program. The MHA also joined other state hospital associations earlier this spring in submitting an amicus brief in support of the AHA’s petition to the U.S. Supreme Court for certiorari (a formal request to the court to take up the case) in its appeal of an appellate court decision unfavorable to hospitals on 340B.

Lastly, the MHA has been involved with various aspects of the COVID-19 response at the federal level, from advocating for provider relief funds to providing data and insights on the impact of the pandemic. In May, the MHA worked quickly to get a majority of Michigan’s U.S. House delegation to sign onto a letter urging Department of Health and Human Services (HHS) Secretary Xavier Becerra to extend the deadline for hospitals to use provider relief funds. This joint effort with the AHA and other groups ultimately led to the HHS announcing extended deadlines by which hospitals and other providers that received Provider Relief Fund (PRF) money may use their COVID-19 PRF payments. We also had several MHA members directly involved in submitting statements to Sen. Gary Peters on the impact of healthcare supply chain shortages during the pandemic, which were utilized by the Senate Homeland Security and Governmental Affairs Committee that Sen. Peters chairs.

The MHA is currently working on a comment letter for the recently released federal Occupational Safety and Health Administration (OSHA) Emergency Temporary Standards (ETS). Although the AHA achieved several improvements in the final proposed ETS, a number of issues remain. Because Michigan uses a state plan for OSHA regulation, MIOSHA adopted these rules June 22. The MHA is aware that the federal ETS is under regular review and amendments are possible. Filing comments brings attention to those parts of the rule that require further action.

Laura Appel, MHA senior vice president of health policy and innovation, has done an outstanding job as our point person on federal advocacy for many years now. I can tell you from firsthand experience that she knows her way around the federal policymaking process as well as she knows her way around the maze of offices on Capitol Hill. In addition, MHA Executive Vice President Chris Mitchell is serving as the chairman of the SAGRO (State Association Government Relations Officers) group, representing all the state hospital association advocacy leaders. MHA Chief Medical Officer Gary Roth, DO, is also serving as chairman of the SHAPE (State Hospital Association Physician Executives) group, leading his peers across the country. And for the past year I have had the privilege of serving as the chairman of the AHA State Issues Forum, which is the group of state hospital association CEOs focused on the strategic issues that we all share. Collectively, these engagements are just another indication of the stature and leadership of our association on the national level.

As you can see, our dedication to advocating for our members — and the pursuit of our mission to advance the health of individuals and communities — extends from Lansing to Capitol Hill. I am proud of the strong foundation that we have established in this regard and, given the increased focus on hospitals and healthcare in the national conscience as a result of the pandemic, I am convinced that our work at the federal level will continue to be critical. 

As always, I welcome your thoughts

CEO Report — Emerging from a Pandemic Program Year

MHA Rounds Report - Brian Peters, MHA CEO

"Keep your face to the sunshine and you cannot see a shadow."Helen Keller

MHA CEO Brian PetersFor many years, the turning of the calendar to June has created an air of excitement as we make final preparations for our incomparable Annual Membership Meeting on Mackinac Island. While I am disappointed that the pandemic has necessitated a virtual annual meeting for the second consecutive year, new guidance from the Centers for Disease Control and Prevention and subsequent revised state guidelines have many optimistic that we have emerged from the darkest days of the COVID-19 pandemic. We know it will still be a long time before our hospitals cease caring for patients infected by COVID-19, but the increasing vaccination rates and mounting evidence documenting the reduced risk of vaccinated individuals contracting, transmitting or falling ill with COVID-19 is a sure sign that better days are ahead.

Now that we are in the home stretch of the current MHA program year (and in light of declining COVID-19 case rates, hospitalizations and test positivity rates in Michigan), I’d like to highlight several very recent non-COVID MHA accomplishments that show the strength and value of our association.

Our advocacy work never stops, and I am very pleased to share that the Michigan Legislature recently advanced budget proposals for both the current and upcoming fiscal year that fully fund our MHA priorities for hospitals and health systems. They include the Healthy Michigan Plan, which now has record enrollment levels in excess of 900,000 Michiganders; recent Medicaid outpatient rate increases; graduate medical education; the rural access pool and obstetrical stabilization fund; and disproportionate share hospital payments. In addition, the budget now includes potentially transformational behavioral health funding.

We are all too familiar with the worsening behavioral health crisis in Michigan and its significant impact on patients and families (as well as hospitals themselves). This issue has been elevated as a priority by the MHA Board of Trustees this year and, with their encouragement and support, we are pleased that the MHA team has secured inclusion in the House budget proposal for $125 million in new funding to add access to pediatric psychiatric treatment at hospitals, improve care of behavioral health patients in the emergency departments and add additional settings of care for behavioral health cases. By adding these resources, we should be able to reduce the time it takes for children to find placement, while also providing infrastructure funding for hospitals to find innovative solutions for emergency departments to improve existing facilities to accommodate patients with psychiatric needs. This may include distinct entrances for patients in crisis and separate spaces with safe furnishings and restrooms. As demand and the acuity of these patients increases, we are hopeful these funds can help address the main challenges so Michiganders can receive the treatment they need.

From an operations perspective, there has been a great deal of recent activity at the association. We recently welcomed Molly Dwyer-White, MPH, as the MHA’s new vice president of safety and quality and the MHA Keystone Center’s new executive director. Molly brings over 18 years of experience in healthcare and comes to us from Michigan Medicine, where she led multiple efforts to establish and integrate structures to assess and improve patient experience while serving as the director of the Office of Patient Experience. Molly is working closely with the MHA and MHA Keystone Center staff and governing boards as she transitions into her role, and I am confident she will continue the MHA’s strong work in improving health outcomes and addressing health inequities.

We just announced our newest MHA Service Corporation Endorsed Business Partner, CyberForce|Q, which is a leading provider of cybersecurity services, advancing the safety of information systems by utilizing a tactical, collective defense model with a focus on continuous improvement. CyberForce|Q has worked directly with the MHA for a number of years and helped us to launch our Mi|HSOC cybersecurity operations center for hospitals and health systems. With healthcare now the top target for cybercriminals globally, we are pleased to offer this new collaboration.

The MHA has also reconfigured our headquarters in Okemos, the Spencer C. Johnson Building, to allow for a new tenant in the Michigan Osteopathic Association (MOA), effective May 1. We are delighted to welcome the MOA and its members to our facility, and we are confident that this arrangement will lead to even greater opportunities for synergy well into the future. Both of our organizations, along with the Michigan State Medical Society, comprise The Partnership for Michigan’s Health, which routinely produces the Economic Impact of Healthcare in Michigan report, and collaborates on efforts that improve Michigan healthcare.

As for those MHA employees housed in the MHA headquarters and our Capitol Advocacy Center in downtown Lansing, their contributions and insights have helped the MHA make Modern Healthcare’s list of Best Places to Work in Healthcare for 2021 — the only state hospital association to be recognized. I am incredibly proud of this prestigious distinction because it validates our constant efforts to support our employees — who are the strength of our association. To earn this distinction in the midst of a pandemic is especially gratifying.

I also want to recognize our outgoing Board Chair Edwin A. Ness, president & CEO of Munson Healthcare, whose term will end later this month. Taking the gavel amid a once-in-a-century pandemic, Ed provided tremendous leadership to help guide us through multiple statewide COVID-19 surges and the challenges associated with the delivery of safe and effective COVID-19 vaccines. We spent many early mornings and late nights on phone calls, and the MHA could not have accomplished what we did without Ed’s unwavering commitment to the role.

During Annual Meeting, we will formally transition from Ed to incoming Board Chair Tina Freese Decker, president & CEO of Spectrum Health, who I could not be more excited to lead us through our next program year. In addition to guiding West Michigan’s largest health system, Tina has played an active role as a co-chair with the Protect Michigan Commission in addressing vaccine hesitancy and increasing education and awareness efforts on the safety and effectiveness of the COVID-19 vaccines.

If you have not done so already, I encourage you to register and join us at Annual Meeting. In addition to hearing Tina’s formal remarks, I’m particularly happy to have my friend Rick Pollack, president and CEO of the American Hospital Association, scheduled to join us to discuss key healthcare advocacy items at the federal level. We will also be joined by Kevin Ahmaad Jenkins, a leader in health equity who serves as a fellow within the Veterans Health Administration’s Office of Minority Health and will explore racism and its effect on public health, as well as breaking social stigmas relating to racial injustice in healthcare.

While the 2020-2021 program year has been one of the most difficult in recent memory, I am proud of the strength and resiliency displayed by the MHA, our employees, our member organizations and the front-line caregivers who have gone to war against the COVID-19 virus every day. We are not out of the woods yet by any means, as we must be mindful of potential emerging variants and other complicating factors that could lead to yet another future surge. Rest assured that the MHA will continue our daily efforts in support of our members until COVID-19 is defeated once and for all. In the meantime, we should collectively celebrate the fact that, at least for now, new infections and hospitalizations have been dramatically reduced.

Through it all, the MHA has continued to serve our members and live our mission to advance the health of individuals and communities, to innovate and to keep an eye to the future. I am pleased to share just a few tangible examples in this column, and I am optimistic about our ability to create even more successful outcomes in the future. In short, we have kept our collective faces to the sunshine and, as a result, our association is as strong as ever.

As always, I welcome your thoughts. 

CEO Report — Michigan’s Next COVID-19 Obstacle: Overcoming Vaccine Hesitancy

MHA Rounds Report - Brian Peters, MHA CEO

"Leadership is not about titles, positions, or flow charts. It is about one life influencing another."  John C. Maxwell

MHA CEO Brian PetersAs Michigan seeks to recover from an unexpectedly challenging third surge of COVID-19, the focus of the MHA, our member hospitals, and our partners in the public and private sectors remains squarely on vaccinating enough Michiganders to prevent any such spread from occurring again. We have made great progress in this regard, and I am especially proud of our member hospitals that have played a major role in administering the nearly 7 million vaccine doses to Michiganders, leading to a statewide vaccination rate of 38% as of this writing. A prioritization process that began with healthcare workers, first responders and the highest-risk population cohorts has now expanded to include all Michiganders age 16 and older.

It was natural that when the long-awaited vaccine finally became available late last year, demand would exceed supply. Broad swaths of the American population were eager and highly motivated to receive their vaccination as soon as possible, and the supply chain simply couldn’t keep up. For months, the MHA was fielding daily calls from our hospital and health system leaders, pleading for help in securing more vaccine. They had invested time, energy and financial resources to establish the infrastructure necessary to store and administer the vaccine, to schedule appointments and secure adequate staffing, and a host of other components. With community members lining up to get vaccinated, the lack of adequate vaccine supplies became the real bottleneck in the process.

But just as we anticipated, the supply/demand curve has begun to flip. For the very first time, we are beginning to field calls from members who are concerned that vaccination appointment slots are now going unfilled in large numbers, and — combined with a significant increase in the flow of vaccine to Michigan — in some locations supply has begun to exceed demand. According to a new Yahoo News/YouGov poll, just 6% of American adults now say they have not yet been vaccinated but plan to get a shot “as soon as it is available to me.” With Gov. Gretchen Whitmer last week announcing the MI Vacc to Normal plan, which directly links our vaccination rate progress to the gradual re-opening and full return to normalcy for the state, this challenge takes on even more urgency. 

“Vaccine hesitancy” is not a new term, as the MHA has been deeply engaged in the I Vaccinate effort to encourage childhood vaccinations to protect against pertussis, flu, measles, mumps and more. We partner annually with the Michigan Department of Health and Human Services (MDHHS) to promote flu vaccine for hospital staff and all Michiganders. From these experiences, we know that there are multiple drivers of vaccine hesitancy, and some of those can be confounding.

When it comes to COVID-19 vaccine hesitancy, many of the issues have been well covered in the media, and U.S. census estimates provide an up-to-date tracking mechanism. Rather than diving into those issues, I want to lift up this reality: for clear evidence that vaccines work, look no further than our Michigan hospitalization data during this most recent surge — hospitalizations for the oldest age groups increased at the lowest rates because they had the highest vaccination rates. Said another way, this latest hospitalization surge was driven mainly by relatively younger, unvaccinated Michiganders.

COVID-19 vaccines are proving to be approximately 99% effective at preventing severe illness, hospitalization and death. This is the data point that should prevail against any discussion of “breakthrough” cases or serious, unanticipated side effects — both of which have occurred in extraordinarily small numbers and pale in comparison to the risk presented to individuals and communities by the ongoing pandemic if we allow it to continue. On a personal note, I recently received the Pfizer vaccine, delivered by Sparrow Health System right here in Lansing. The entire process was very efficient and painless, and the psychological boost that I have heard others describe is very real: I feel protected for my family, friends and colleagues, and I have done my part to help the broader community.

So, what is the right strategy to move us forward? Already, there are discussions around vaccine mandates, “passports” and incentives — and the social and political angst that accompanies these discussions was easily predictable. For now, I will simply state our belief that this is truly an all-hands-on-deck challenge, and no one person, organization or institution can win this battle alone. 

The health of communities depends on vaccinating enough of the population to stop the spread of the disease and limit the chance of more contagious variants developing. If you understand this and have been vaccinated yourself, thank you. Now, please share your encouragement with the people in your life who are still on the sidelines — because we know that the most influential thing that a hesitant person can experience is hearing from someone they know and trust who chose to be vaccinated. If you work in healthcare, this is especially important. After all, true leadership is “one life influencing another.” Both the American Hospital Association and the MDHHS have created their own communications tools and television ads modeled on sharing personal reasons for vaccination to assist in this effort.

We have the finish line in our sights, but we cannot waiver in our commitment to end this pandemic. We owe it to ourselves, to our healthcare heroes and to those who have lost their lives to COVID-19 to do what it takes to end it now. The most powerful tool is in our toolbox, and we must redouble our commitment to using it. 

As always, I welcome your thoughts. 

CEO Report – Protecting the Financial Health of Hospitals

MHA Rounds Report - Brian Peters, MHA CEO

"Annual income twenty pounds, annual expenditure nineteen six, result happiness. Annual income twenty pounds, annual expenditure twenty pound ought and six, result misery."Charles Dickens

MHA CEO Brian PetersThe past year has been extremely challenging for everyone across the globe. At the very top of that list: those who have lost loved ones to the pandemic, and those who have suffered from the often severe health consequences associated with COVID-19. At the same time, the financial blow to hotels, restaurants, bars, entertainment venues, and countless other businesses large and small has been well documented. And we all know about the mental health concerns brought about by income and job loss, the need for remote learning for students and the resulting lack of socialization, plus a host of other consequences that have accompanied this pandemic and negatively impacted people for many, many months now.

As a Michigander and a father, I care deeply about all of this. And as the CEO of the Michigan Health & Hospital Association, I have the great privilege of getting to do something about it every single day. After all, our very mission is to “advance the health of individuals and communities.” It is from this perspective that I can tell you how proud I am of our member hospitals and health systems throughout the state — and how concerned I am for the wellbeing of our caregivers and staff, and for the financial viability of the organizations themselves as the dark cloud of the pandemic continues to hover over all of us. Am I biased? Perhaps. But I truly believe that hospitals must be supported and protected at this time more than ever, for the betterment of our entire society.

Our members have now been serving on the front lines for over a year and have experienced significant physical and mental trauma. For those institutions that serve our local communities and employ our healthcare heroes, the last year has also been filled with financial uncertainty at best, and devastation at worst. Early in the pandemic, when elective procedures came to an abrupt halt, the double-edged sword of new, unbudgeted expenses related to ramping up to deal with COVID-19 combined with lost volume and revenue on an order of magnitude that we have never seen in modern times, pummeled our hospitals and health systems financially. For even our largest members, furloughs and layoffs became necessary.  And for our smaller, independent or rural hospitals, there were legitimate concerns about keeping the doors open in the face of severe cash flow disruptions.

Just one example of new costs: personal protective equipment (PPE) is a term Americans became all too familiar with last year. Our hospital supply chain leaders can verify that increasing the number of gloves, gowns, respirators, masks and face shields, both for immediate use and for the “new normal” stockpile requirements, is not only more expensive due to sheer quantity, but the prices have soared due to increased demand. To avoid dependence on the global supply chain, many organizations are now diversifying their network of suppliers and contracting with domestic companies. However, doing so comes at a cost, as domestic production is typically more expensive. This is just one of many factors that have driven hospital total expense per adjusted discharge higher by 19.6% over the past year, according to a recent analysis of national data from Kaufman Hall. Our own data and anecdotal evidence show that Michigan closely mirrors this trend.

Coupled with increased expenses is decreased revenue, as total patient volume has yet to recover to pre-pandemic levels. The same analysis from Kaufman Hall found that overall revenue (not including federal aid from the Provider Relief Fund) fell 4.6%, with emergency department visits decreasing 26.8%. As part of surge planning, hospitals have been forced to delay many nonemergency medical procedures.  Unfortunately, images of hospitals admitting COVID-19 patients and constructing temporary outdoor facilities also created a misplaced fear among a subset of the public that hospitals were no longer safe places of care. Much work, at both the state and federal level, has gone into correcting this misconception, but there remains a significant number of people who have legitimate healthcare needs who are still delaying care — to their own detriment. The resulting drop in patient volume and procedures has created a gap in hospital revenue that will take a long time to recover.

Lastly, the insurance coverage mix is also continuing to change for the patients utilizing our hospitals, specifically moving toward government programs or no coverage at all. According to the National Center for Coverage Innovation, Michigan had the sixth highest increase in newly uninsured adults, with 222,000 individuals becoming uninsured due to job losses, representing a 46% increase from 2018 levels. We’ve seen the growth borne out in the Healthy Michigan Plan (HMP), our state’s Medicaid expansion program, which has seen enrollment increase from a pre-pandemic level of approximately 650,000 beneficiaries to nearly 900,000 today. While continued coverage for all Michiganders is a top MHA priority, and we are incredibly thankful for the existence of the HMP, this transition from employer-sponsored health plans to government healthcare programs means more patient care is being reimbursed at a lower rate in contrast to the full cost of care.

To directly address all these challenges, the MHA has advocated strenuously for financial relief at the state and federal levels, and our members have been incredibly grateful for it. Federal funds such as the CARES Act helped to alleviate the immediate crisis, while providing a measure of financial stability to all hospitals (and serving as a real lifesaver for some). We have successfully delivered accelerated payments, targeted loans and grants, and more. One item of important relief that was implemented at the beginning of the pandemic was a moratorium on Medicare sequestration, the scheduled 2% cut to all Medicare payments that would have been a significant financial hit to hospitals and health systems at the worst possible time. Recently, legislation that delays these cuts through the end of the year passed the Senate with a bipartisan vote (thank you to our U.S. Sens. Debbie Stabenow and Gary Peters, for their support) and is expected to pass the House of Representatives once Congress returns from Easter recess. All of this is helpful — but none of this is a long-term solution to guarantee the financial viability of hospitals. Our members (even pre-pandemic) are doing their part to be innovative and increasingly focused on cost-effectiveness. But they need our continued support.

There is cause for optimism as we head down the road to recovery. Today, all adults 16 years and older are eligible to receive the COVID-19 vaccine in Michigan. Vaccine supply, which has increased dramatically in recent weeks, is expected to expand in the weeks ahead. In fact, we are very close to the day where the supply and demand curve flips and our efforts will need to focus on reaching vaccine-hesitant populations. The reasons to receive the safe and effective vaccines are many, as most importantly they prevent hospitalization and death and protect loved ones and those around you from contracting the disease. There is no better evidence than recent data the MHA released that shows hospitalizations are increasing the slowest among the age cohorts that have a higher percentage of vaccination.

Collectively, achieving our state’s goal of vaccinating 70% of the population allows our financial recovery to truly begin. To return to some sense of normal, everyone must do their part to mitigate the chance of future outbreaks. That tool is in our toolbox and it starts by scheduling a vaccine appointment. From there, restrictions and protocols placed on in-person office work, education instruction, and entertainment and leisure activities can be lifted. But we cannot trick ourselves into thinking that we can do all these things without reaching our vaccine goals first.

As Michigan hospitals deal with a legitimate third surge of COVID-19 patients, it takes everyone to do their part to put our state and communities on a path to recovery. By doing the right things, practicing preventive measures such as wearing a mask, social distancing, washing your hands and receiving a vaccine, we can protect both our physical health and the financial health of our hospitals that operate 24/7/365 to provide care when we need it. After all, the same hospitals that are needed to fight COVID-19 today are the hospitals that will be needed to treat auto accident victims, cancer patients and countless other loved ones in the future. They deserve our full support.

As always, I welcome your thoughts.

CEO Report – Adding Value to Your Membership

MHA Rounds Report - Brian Peters, MHA CEO

“If people like you, they’ll listen to you.  But if they trust you, they’ll do business with you.”
― Zig Ziglar

MHA CEO Brian PetersSeveral months ago, I celebrated my 30th anniversary with the MHA. As you can imagine, the operating environment for our association has changed dramatically from the day I first walked in the door as an intern working for legendary MHA President Spencer Johnson. I shared an office with another intern by the name of Amy Barkholz, who of course is now our MHA General Counsel. Amy and I used typewriters to compose memos, sharing a bottle of white-out to correct any mistakes (she didn’t make many, but I sure did). There was no email, no voicemail, no internet and no Zoom calls. Smoking was permitted just about everywhere, including inside the MHA offices. Different times for sure.

As I reflect on the last few decades, it is clear to me that one of the MHA’s strengths has been a diversified business model. And as I look to the future, there is no doubt that this diversified model will become even more important. Allow me to explain.

The MHA is widely known as an advocacy organization and, by any metric, we have consistently been among the very best in this regard. Whether it is the legislative, regulatory or legal domain — at both the state and federal levels — we have the connections, experience and clout to make good things happen for our members and the patients and communities they serve. 

But not every challenge confronted by hospitals and health systems lends itself (at least not solely) to a solution in the public policy arena. In a military situation, sometimes you need the Army, sometimes the Navy, sometimes the Air Force (or the Marine Corps or Coast Guard)  — and sometimes you need all the above, working closely together in harmony. In our world, the equivalent “three-legged stool” is the traditional 501(c)6 trade association (or as Spence used to call it, the “junkyard dog” always advocating for our members), but also a 501(c)3 nonprofit arm — the MHA Health Foundation and MHA Keystone Center, and a for-profit arm known as the MHA Service Corporation (MHASC).   

Through the Foundation, we have been able to provide outstanding educational programming, including issue-specific webinars, major conferences and events, an Excellence in Governance Fellowship and a Healthcare Leadership Academy. Through the Keystone Center, we have been able to provide nationally and internationally renowned leadership in the field of safety and quality improvement. And through the Service Corporation, we have been able to meet the unemployment compensation needs of our members through our Unemployment Compensation Program (UCP) and their healthcare data needs through our Data Services division. More recently, our Endorsed Business Partner Program has created even more capacity to meet new challenges in the healthcare operating environment.

To be more specific, since the pandemic began and caused staffing upheaval, the UCP has seen a dramatic increase in the number of cases filed. Representing over 300 employers in Michigan and numerous other states, the UCP last year alone processed over 70,000 unemployment claims, and saved client organizations tens of millions of dollars, while directly addressing the unemployment fraud that has become rampant in Michigan and throughout the country.

Our Data Services division is home to four decades of hospital data with the Michigan Inpatient Database and Michigan Outpatient Database. Their flagship products — Data Koala and Community Benefits Tracker — are used by more than 500 healthcare entities nationwide to formulate market strategies, track community benefits and improve care quality. The Data Services team has also played an integral role in our state’s pandemic response, working directly with our members and the state to collect and compile key data metrics that are used to guide our state’s strategy and response to the spread of COVID-19.

The launch of the MHA Endorsed Business Partner Program in 2018 was an important step in identifying business partners for our member hospitals and health systems that provide the highest quality products and services in key strategic areas, including staffing, workplace safety, financial services, 340-B drug program management and more. We currently have 14 business partners that have been carefully and thoroughly evaluated, ready to work with our members to address some of the most pressing issues of the day.

Lastly, as an association we obviously create and disseminate a very large number of communications, ranging from advocacy reports to event invitations and much more. Years ago, we decided that, rather than contract for this work to be done off-site, we would not only keep this business in-house, but look to serve the needs of our members as well (after all, every hospital has numerous events and annual fundraising galas, and we have produced the materials for more than a few). Today, we offer our world-class Graphic Design & Print Services to both our association members and a very large and growing list of external clients that includes the University of Michigan and Michigan State University. We have even handled the governor’s holiday cards! I consistently receive positive feedback from clients related to the quality, pricing and customer service that our team provides in this space — and I am confident that they are the best in the business. 

Bringing all this together: think about the issue of workplace violence — a growing problem whereby nurses and other front-line caregivers are put in harm’s way. We attempted to address this problem through our advocacy arm, supporting legislation that would create new penalties for those who commit acts of violence in a healthcare setting. But we also addressed it through the Foundation, offering educational programming that featured expert speakers and case studies, and through the MHASC, as MHA Endorsed Business Partner HSS provides violence prevention consulting services tailored specifically to hospitals. Because we know that one-size-fits-all legislative mandates are usually not the optimal way to govern the delivery of healthcare, we have been able to lift up the extraordinary work of the Keystone Center as a more effective path forward to improve patient safety for Michiganders. The examples of the importance of the “three-legged stool” could fill far more space than this column will allow, but you get the point.

But wait — there’s more! Not only do our members benefit from our diversified business model in the ways described above, but because these other arms of the MHA continue to generate their own revenue streams, they have helped to ensure a strong, effective association while eliminating the need for sizeable dues increases. In fact, MHA dues today represent a significantly smaller portion of our member hospitals’ total expenses than they did back when Amy and I were wrestling with typewriters and white-out.

Across the entire MHA enterprise, we are committed to our shared mission to advance the health of individuals and communities. And we are also committed to a culture of trust. When you do business with us, you are doing business with an organization that has now been around for over a hundred years.  Now more than ever, I can assure you that our entire team understands that we must demonstrate value and earn the trust of our members and clients, every single day, in everything we do. 

And I have never been prouder of them for doing exactly that.

As always, I welcome your thoughts.