“We do not have government by the majority. We have government by the majority who participate.”―Thomas Jefferson
At the MHA, we often say that politics is not a spectator sport. It requires continual engagement and relationship building so that when you are in a crisis and need assistance, you have trusted friends you can turn to. Look no further than the pandemic and the numerous bills and policies considered and enacted that helped hospitals and health systems during extremely challenging times. As an association, we are very appreciative and value the help we received from both the administration and legislature – at both the state and federal level – during that time.
This Election Day is a vital component to our healthcare priorities, as it includes the state’s gubernatorial race, followed by attorney general, secretary of state, all 13 U.S. House of Representatives seats, all seats in both the Michigan Senate and House of Representatives, two Supreme Court seats, three ballot proposals and local races.
As you can see, this year’s ballot is packed with important races that will determine the outlook of our state and nation’s political landscape for the next two years or more. In addition, several factors, including redistricting, have made for a number of highly competitive races. As a result, many observers believe that control of each chamber may be at stake.
Through our concerted efforts, the MHA HealthPAC has grown to become one of the largest political action committees in the state and is one of the important tools in our advocacy toolbox. And whether it is through HealthPAC, or through our many other activities, the MHA has a long history of remaining nonpartisan while highly encouraging all Michigan residents, particularly those in the healthcare community, to participate fully in the political process – and at no time is this more important than election season. Elections have consequences and the best way to ensure that our needs are addressed in the future is to use your constitutional right to vote for the candidates that best represent your values.
Healthcare is influenced by all three legs of the public policy stool – the executive branch, legislative branch and judicial branch. The Michigan medical community needs people in office at every level who understand their role in policy decisions that affect healthcare. The challenges facing hospitals are numerous and significant, such as financial viability, healthcare workforce restoration and wellness, behavioral health and health equity. Our elected officials are critical partners for identifying and implementing solutions to these issues.
Before completing your ballot, make sure to do your research. As always, we are pleased to share a series of useful resources on the MHA website. In addition, the Citizens Research Council of Michigan has over 100 years of experience providing non-partisan, independent analysis on governmental policy and are another valuable resource when evaluating this year’s ballot proposals.
And while this election may change the political landscape of Lansing and Washington, D.C., it will not change the intensity or commitment of the MHA and our team at the MHA Capitol Advocacy Center towards our advocacy and policy work. Following the election will be a lame-duck session that could see a lot of activity prior to the end of the calendar year. In addition, once this year’s elected candidates are sworn into office, we will continue to meet with and identify healthcare champions that will be important partners towards improving the health and wellness of all Michiganders. And because of term limits, there will be a lot of them. One example: there will be over 50 new members of the Michigan House, all of whom will need to be educated and informed of the many complex issues in the healthcare domain.
Whether you’re planning to vote by absentee or in person on Nov. 8, you’re making a critical contribution to our democratic process. Every vote matters, particularly for the future landscape of healthcare.
Fiscal year 2020 data (the most recently available) is shared in each report and it reinforces the position that hospitals are both economic drivers and community leaders. Healthcare remains the largest private sector employer in Michigan with nearly 572,000 total individuals directly employed, 224,000 of which are in hospitals. These direct healthcare workers earned $44.2 billion in wages, salaries and benefits and when combined with indirect, healthcare-supported jobs, contributed almost $15.2 billion in local, state and federal taxes. Hospitals provide mission-oriented work aimed at the health and wellness of their patients and communities, but the data is clear that hospitals clearly have a role in the economic health of our state as well.
We take our work towards improving community wellness seriously, which is demonstrated by the nearly $4.2 billion investment in community-based partnerships and programming. Hospitals invested more than $869 million in community and voluntary-based activities while providing $3.4 billion in uncompensated care. Hospitals are committed to not only caring for anyone who walks through their doors, but towards preventative care programs that can help reduce the need of inpatient hospital services. The costs of these efforts come directly out of a hospital’s bottom line but are vital towards ensuring vulnerable patients have the ability to receive needed care.
These reports are based on data from the first year of the pandemic. I do not have to tell you how trying and difficult those times were for hospitals. Despite the uncertainty and demand on hospitals and health systems during that time, they continued to support our communities in these important ways. Our healthcare system was stretched to new lengths, but we had over half a million individuals directly involved in providing care to patients. With a statewide population of 10 million, 40% of which are either under the age of 18 or aged 65 and older, healthcare either directly or indirectly employs over 18% of our workforce.
Yet the 2020 numbers also begin to provide evidence of the loss of healthcare workers that we anecdotally have shared for the last several years. For the first time in the history of the economic impact report, total direct jobs in Michigan from healthcare declined, including the loss of 7,000 jobs in hospitals. Despite those losses, total compensation for hospital workers remained the same, as contracted labor (e.g. those working for nurse staffing agencies) became a necessity for hospitals to maintain appropriate staffing levels.
But I do not want to lose sight of what the headline should be, and that is healthcare remains an economic engine and the largest private-sector employer in Michigan. At a time where every industry is struggling with having enough staff, healthcare remains a very significant employer. And the industry holds a tremendous amount of opportunity for new job growth moving forward: Michigan’s recent list of the top career fields with the highest projected growth is dominated by healthcare professions. Hospitals not only offer well-compensated careers with strong benefits, but in a rewarding field that truly makes a difference in the lives of our neighbors. Hospital careers also exist in communities large and small, helping to keep college graduates and young professionals in our state. Lastly, the skills of a healthcare professional are transferrable, regardless of region, and long-lasting. The training and education for a healthcare professional today will remain relevant over the next several decades.
Every year that goes by, hospitals seek to be more involved with individuals outside the walls of their facilities. They are helping to address the social determinants of health, including access to transportation and food insecurity. And they are intertwined in not only the individual health of community members, but in the success of local business and municipalities. Access to healthcare is at the top of any organization’s checklist wishing to expand their footprint into new markets. Our success depends on the success of community leaders and vice versa.
When we advocate for much-needed Medicaid and Medicare funding, for the 340B drug pricing program and for good health policy at the state and federal level, we do so because we know these are essential to maintaining access to quality healthcare in communities throughout Michigan. With the facts presented by our new reports on economic impact and community benefit, we believe there is more reason than ever for our elected officials – and all of us – to support our Michigan hospitals.
“The world-altering powers that technology has delivered into our hands now require a degree of consideration and foresight that has never before been asked of us.” ― Carl Sagan
A long-held practice utilized by businesses of all stripes is the ubiquitous SWOT (strengths, weaknesses, opportunities and threats) analysis. For a hospital or health system in 2022, there is no shortage of candidates to fully stock the “threat” category. In this column, I want to draw attention to one that deserves increased attention because of its potential to cripple an organization in an instant: cybersecurity.
The wonders of technology have dramatically improved healthcare in Michigan and beyond. Advancements include imaging technology that identifies serious disease at a much earlier stage, robotic devices that permit surgical interventions that were previously considered too risky to attempt, remote patient monitoring and telehealth, and electronic medical records that facilitate better tracking and coordination for patients across various sites of care — the list is impressively long. And amid our current workforce shortage crisis, we often describe technology in healthcare as a “force multiplier” that can supplement and extend our limited staffing resources to help ensure adequate access to care.
Make no mistake, healthcare still has one foot on the proverbial dock and one foot in the proverbial boat. That is, many of our communications and services remain in the “analog” world, while a growing share have become electronic, digitized and inter-connected. This phenomenon — coupled with the fact that the personal health information we collect and store has more value on the black market than any other data — has painted a neon target on our back for a growing cadre of cybercriminals and adversarial nation states. It is no accident the FBI has identified healthcare as the number one target of these bad actors. And simply put, a cyberattack on a hospital is a “threat to life” crime. We must act accordingly.
The statistics on healthcare attacks are enough to keep any executive up at night. An attack on a midsize hospital creates an average shutdown time of 10 hours and costs on average $45,700 per hour, according to an Ipsos report. In the same report, 49% of the respondents said their annual compliance budget for cybersecurity wasn’t enough. According to IBM, a data breach at a healthcare organization costs more than any other sector at $10.1 million. And the threat continues to grow, as healthcare cyberattacks have increased by 84% from 2018 to 2021, according to Critical Insight. Michigan hospitals, health insurance companies, physician offices and others have been the victims of ransomware attacks and related cybercrime in recent years.
If this wasn’t bad enough, a spotlight was shone on cybersecurity this past spring during Russia’s invasion of Ukraine, when cyberattacks on the Ukrainian government and critical infrastructure organizations had the potential to ripple across multi-national organizations and infect U.S.-based operations, including healthcare. Experts believe this scenario will be part of every future global conflict. And unfortunately, for many hospitals and health systems who welcome patients from multiple foreign countries, and who have business partners outside the United States, the practice of “geo-fencing,” or blocking all incoming email traffic from outside the country, is not always a viable approach.
So where can hospitals and health systems turn for help? At the national level, the American Hospital Association anticipated this trend several years ago and employs John Riggi as the national advisor for cybersecurity and risk. John has been a resource for the MHA in the past and as a former leader within the FBI’s cybercrime division, he maintains close ties with all the relevant government agencies.
And here at the MHA, we are also very committed to strengthening our own cyber defenses, while doing the same for our members. We have appointed Mike Nowak to serve as our own Chief Information Security Officer. Several years ago, Mike and his team helped to launch, and have subsequently helped to operate, the Michigan Health Security Operations Center (Mi|HSOC) for hospitals and health systems. Created for healthcare providers by healthcare providers, this first of its kind entity has the proven ability to prevent, detect, analyze and respond to cybersecurity events. Operating 24/7/365, the Mi|HSOC has developed strong relationships and communication with law enforcement at various levels, including the Michigan State Police Cyber Division, FBI and Secret Service.
An organization that helped form the Mi|HSOC is CyberForce|Q, which is now an MHA Service Corporation Endorsed Business Partner. In addition to sharing tactical information on emerging threats with the members of the security operations center, CyberForce|Q offers a variety of additional cybersecurity services to our members and other healthcare clients.
The bottom line — the MHA and our partners have helped Michigan become a leader in this space. By mitigating potential risk, physicians, nurses and staff of our member hospitals have the best opportunity to provide exceptional patient care without any external interruptions. While the advocacy, policy and safety and quality areas of the association often receive public attention, our cybersecurity efforts are constantly at work, often without much notice, to protect healthcare in Michigan.
But we need your help. I am the farthest thing from an expert in this field, but one thing I have learned is that the “human factor” is the most critical element of our defenses — and therefore the most vulnerable. Think twice before opening a suspicious email or text message, safeguard your electronic devices and passwords and take the time to educate yourself on all of the best practices to follow in the midst of this new, online world. The health of your patients and communities may depend on it.
“We must find time to stop and thank the people who make a difference in our lives.” ― John F. Kennedy
We have rightfully spent a lot of time in the past two years thanking the heroes who work in our hospitals and other healthcare settings for the incredible work they have done in the face of extreme challenge.
I want to take a moment now to thank another group of people who have recently helped our cause through their bipartisan actions; our elected officials in Lansing were extremely busy the last week of June passing the fiscal year 2023 state budget, which has since been signed by Gov. Whitmer. Our MHA mission is to advance the health of individuals and communities — and this budget absolutely provides significant help in that regard. While some elements of the new budget represent long-standing MHA priorities, others are new funding items that have the potential to reshape access to care and help our members and the patients and communities they serve.
Our MHA team does a tremendous job advocating for the importance of items such as the Healthy Michigan Plan, graduate medical education of physician residents, disproportionate share hospital funding, maximization of our robust provider tax program and Medicaid payment rates, the rural access pool and obstetrical stabilization fund, and critical access hospital reimbursement rates. Every election cycle, new legislators are welcomed to Lansing and the MHA’s efforts never stop to ensure these decisionmakers are aware of the impact these budget items play in their communities. The bottom line is the financial viability of hospitals is increasingly reliant on these important programs, and the MHA is dedicated to protecting them.
Hospital closures continue to happen across the country. However, they have occurred at a much higher rate in states that have not participated in Medicaid expansion through the Affordable Care Act. Maintaining funding for our expansion program — the Healthy Michigan Plan — has been one of our top priorities, and the pandemic has made the importance of insurance coverage more important than ever. In short, when the pandemic hit and thousands of Michiganders lost their jobs, the Healthy Michigan Plan was there to ensure access to good healthcare.
Our hospitals that treat the highest numbers of uninsured and underinsured patients also qualify for disproportionate share hospital funding, which provides enhanced reimbursement to account for the higher costs of care. This pool is funded through hospital provider taxes that reduce the state’s general fund contribution to the overall Medicaid program.
Small, rural and independent hospitals can often experience financial challenges in a particularly acute way, thus items such as the rural access pool, obstetrical stabilization fund and critical access hospital reimbursement rates also support access to healthcare services in rural areas. Labor and delivery units typically do not contribute to positive margins, but they are extremely important for families and communities. The obstetrical stabilization fund provides additional means for hospitals in rural areas to maintain these services so expectant mothers can avoid driving exorbitant distances for these services. Lastly, the state also included $56 million in new funding to increase Medicaid reimbursement rates for primary care services, which will help individuals on Medicaid receive the necessary primary and preventative care that can help prevent hospitalizations and reduce overall healthcare costs.
Lastly, behavioral health investments have been at the forefront of our advocacy efforts for some time and we were very pleased to see new funding to improve and enhance state behavioral health facility capacity. Michigan lacks adequate capacity to treat patients with behavioral and mental illness and this new funding is an important and necessary step to address the shortage. Included is $50 million to expand pediatric inpatient behavioral health capacity, $30 million to establish crisis stabilization units and $10 million to fund the essential health provider loan repayment program to cover behavioral health professionals.
In total, the budget includes $625 million in new investments for behavioral health funding and investments in workforce. While this will not solve all the issues impacting hospitals, it provides needed resources and demonstrates the commitment of lawmakers to a healthy Michigan. This budget also signifies that our work must continue to advocate for the resources necessary for hospitals and health systems to care for all Michiganders. Once again, on behalf of the entire MHA family, I want to acknowledge and thank both Governor Whitmer, as well as lawmakers in the state House and Senate, for their support of this latest state budget. And I would also encourage anyone who cares about access to quality, affordable healthcare to engage in the process, share your stories and input with those who can make a difference going forward. But also remember to say thank you when they support our cause.
“Alone we can do so little. Together we can do so much.” ― Helen Keller
The arrival of summer signifies the completion of the MHA’s program year. During this time, the association reviews our many accomplishments related to the core issues reflected in our strategic action plan. These accomplishments directly benefit not only our members, but the patients and communities that we collectively serve as well. As we went through the process this year — a year that was still heavily influenced by the COVID-19 pandemic — a key theme resonated throughout: the MHA, and the health of our communities, is strengthened by collaboration and stakeholders working together.
“Stronger together” is the theme of the MHA’s 2021-2022 Annual Report. It encapsulates how integrated healthcare truly is, whether reflected by partnerships between health systems throughout the state, with our partners at other associations, or through external stakeholders in public health and government. As I have said many times in the past year, our work in this challenging environment is truly an all-hands-on-deck affair. With that in mind, stronger together also addresses the value of the amazing staff at the MHA and how we collectively could not achieve our goals without the expertise, talent and teamwork of our various divisions. Lastly, I must thank Tina Freese Decker, president and CEO of BHSH System and the 2021-2022 MHA Board of Trustees chair, for her exceptional leadership during this program year. Tina provided direction and influence in both the crafting of the strategic action plan, as well as the tactics that we used to meet our goals.
During the year in review, our members had to navigate multiple COVID-19 surges and the most significant workforce crisis I’ve experienced throughout my professional career. However, vaccine access was available to most of our population and new therapeutics became available that have truly improved health outcomes for those infected by COVID-19. In addition, as the focus and attention of our society and lawmakers slowly pivoted away from the pandemic, we devoted significant energy and resources to a host of other important issues including workforce sustainability, health equity, data strategy, behavioral health and more. Collectively, these efforts have supported our association mission and helped to advance the health of individuals and communities.
It is my pleasure to share the completed MHA 2021-2022 Annual Report that goes into greater detail on the strategic objectives and how the MHA met and addressed each task head-on. This summary makes me extremely proud to work with an incredible organization that unquestionably has provided value to our members and made a real difference in our state.
As COVID-19 moves closer to an endemic stage, we have entered a “new normal” phase in the healthcare landscape, which brings unique opportunities to significantly improve how care is designed, delivered and reimbursed. In the coming months, the MHA will establish our specific priorities and strategies for the new program year — and I can promise that we will address all of those priorities with the same intense focus, professionalism and commitment that the MHA has always displayed. And we will do it together.
“We will make electricity so cheap that only the rich will burn candles.”― Thomas A. Edison
Recently the RAND Corp. released its latest hospital pricing study that uses Medicare as a benchmark for hospital pricing. For many years, pricing and affordability has been top of mind for our patients, and our hospitals and health systems go to great lengths to ensure anyone who walks through our doors at any date or time will receive high-quality care regardless of their level of coverage. Efforts have been made to increase healthcare transparency, including the development of the MHA’s verifymicare.org website, recent federal legislation to establish a dispute resolution process for balanced billing that removes patients from payer and provider disputes, and federal requirements that hospitals post price information online.
Unfortunately, the recent study from RAND does not provide an accurate picture on the relationship between fixed government reimbursement rates, negotiated private insurer rates and financial sustainability for hospitals. We know Medicare does not cover the true cost of care. Hospitals do everything they can to break even, and most operate on razor-thin margins. Just consider that 52 hospitals in the US closed between 2018 and 2020. Nearly all hospitals still lose money on Medicare. In addition, unlike public goods that respond quickly to inflationary pressures, the ability of a hospital to pass cost on to consumers is extremely limited. The drivers of increased cost in the economy are felt by all hospitals, such as through the increased cost of labor and supply chain increases.
The RAND study makes a very broad claim from a cherry-picked data set that looks at claims for just 2.2% of overall hospital spending and inappropriately uses Medicare reimbursement rates as a benchmark. It fails to acknowledge that hospitals are the only healthcare entities in our communities and modern society that are open 24/7/365 to everyone, regardless of their ability to pay. This remains a commitment of ours well into the future.
Hospitals not only have to consider the actual and projected cost of care but plan capital improvements that will be necessary in terms of new technologies or facility renovations. For example, the cost of the workforce is built into negotiations with insurers. The reason we see price increases is that underlying costs for hospitals are on the rise. When contrasting the price of hospital care with the price of many goods and services in this inflationary economy, we do not look out of line. Looking at 2020, the unbudgeted expenses for hospitals exploded due to personal protective equipment and staffing expenses that totally changed the cost of hospital operations. Remember, hospitals are extraordinarily labor dependent, and hospitals must meet workforce sustainability challenges to maintain appropriate staff throughout their facilities and ensure the quality of care is never impacted.
Recent analysis from Kaufman Hall clearly indicates profiteering is not occurring by hospitals. Hospitals have been losing money during the pandemic and, while federal relief funds have made a significant impact, many have still lost money because of the exorbitant staffing and supply expenses they have been forced to absorb. Median operating margins for hospitals fell from 5.6% to -1.4% between December 2021 and March 2022, which includes funding from the Coronavirus Aid, Relief, and Economic Security Act. Hospital labor expenses have increased by more than one-third from pre-pandemic levels while contract labor as a percentage of total labor expenses increased more than five times the rate from pre-pandemic levels. In addition, drug costs have seen the largest increase in expenses for hospitals, up 24% compared to before the pandemic.
We empathize with our patients: no one wants to pay more money for healthcare than is necessary. This is true whether it’s healthcare or gas or milk. Hospitals’ shared goal is providing access to high-quality care in this challenging environment in a cost-effective way. It is a costly enterprise to ensure everyone in the community has high-quality healthcare every minute of every day, but hospitals do their best to keep costs as low as possible for every patient, every time.
“Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.” ― Rudolf Virchow
As we enter the final two months of the MHA program year, our “all-hands-on-deck” prioritization of the healthcare workforce continues, and I am pleased to share that we have made significant strides in this regard. Included in that progress is work with our partners in higher education, other Michigan healthcare associations, hospital clinical leaders and the Michigan Legislature.
One aspect of our workforce efforts is not new. For many years, the MHA has led a special Graduate Medical Education (GME) Advocacy Day, hosted at our MHA Capitol Advocacy Center (CAC) in downtown Lansing. At this event, medical students, residents from teaching hospitals and academic medical centers, and other key leaders converge on the Capitol and meet with legislators to discuss the vital importance of GME funding in the state budget process.
After a brief hiatus due to the pandemic, we are excited to play host once again for this important in-person event, as we will welcome our colleagues to the CAC on May 5.
When this event began, the primary focus was to express the importance of GME and the national prominence that Michigan has earned in medical education. We have more than 7,200 physician residents currently working in the state, which ranks fourth in the nation. In addition, Michigan is third in the country for student enrollment in public medical schools. The investment Michigan makes in GME is very valuable, as every $1 in GME generates $2.53 in federal funding in fiscal year 2022. While the current rate is enhanced due to the existing public health emergency, there is no question that GME funding for Michigan’s beginning physicians is a wise investment for the future healthcare workforce in our state. GME also improves access to care, as it allows physicians to further their medical education while delivering much-needed care to patients throughout Michigan in teaching hospitals, community clinics and laboratories.
The vital role of GME in filling the talent pipeline is more important today than ever, as Michigan hospitals (and the healthcare delivery system in general) struggle with workforce shortages that have been exacerbated by the COVID-19 pandemic. Those shortages across the state have caused Michigan to lose approximately 1,300 staffed hospital beds over the past 18 months. Nationally, the physician shortage is estimated to be between 37,800 and 124,000 by 2034, including primary care and nonprimary care specialties, as the Association of American Medical Colleges estimates two out of every five active physicians will be 65 or older within the next 10 years.
The participants in our GME Advocacy Day have experienced many of the challenges that we’ve shared with elected officials: stress, burnout, workplace violence, vaccine hesitancy and significant loss of life due to COVID-19 and a host of other medical issues. Their perspective is extremely valuable as we make the case for funding and public policy that ensures the viability of our healthcare infrastructure for years to come. In addition to full funding of the traditional GME pool, there are several related items on the radar screen here in Lansing, including:
Included in the state’s Higher Education budget proposal is House Bill 5785, which would provide funding to create a healthcare workforce collaborative between the MHA and Michigan’s public and private post-secondary educational institutions. This partnership would not only provide employers with a better understanding of statewide graduates in health professions, but further improve the knowledge of employment opportunities in healthcare for post-secondary education institutions throughout the state. Included in the collaborative would be the creation of a searchable and accessible repository that allows healthcare employers to understand current educational trends and provides prospective employees easy access to healthcare positions throughout the state.
The MHA also supports legislation designed to incentivize more medical school and advanced practice nursing program preceptors by providing new tax credits. Senate Bills 998 and 999 would create a new tax credit for individuals who agree to work as a preceptor for required clinical rotations. We believe this legislation could help increase the capacity for clinical rotations at hospitals across the state, which would also improve the talent pipeline.
As we advocate in support of GME and related issues, we of course greatly appreciate the collaboration of our friends from the Michigan State Medical Society (MSMS) and Michigan Osteopathic Association (MOA). Together, our three associations make up The Partnership for Michigan’s Health, which has a long history of working together on healthcare issues of common interest, including the achievement of major medical liability reforms in the early 1990s, which established the foundation for much of our advocacy work in the Legislature and the courts ever since.
Most recently, the collective voice of our three associations, along with associations representing various other areas of healthcare, led to successfully securing $300 million in state funding for the recruitment, retention and training of healthcare workers. Collectively, the Healthcare Workforce Sustainability Coalition was created to focus on workers already within the healthcare workforce. Gov. Whitmer also recently signed Senate Bill 247 that would decrease wait times for commercial insurance prior authorization requests, a priority for all three associations. We are also united in our opposition to Senate Bill 990 that would create a serious public health risk by licensing naturopathic practitioners and classifying them as physicians. As healthcare associations, the professional careers of our members are dedicated to serving their patients and protecting the health and safety of the public. This opposition is an example of our need to protect the public from a practice that lacks scientifically proven treatment methods and clinical training.
In addition, we have long collaborated with MSMS and MOA to produce The Economic Impact of Healthcare in Michigan Report, which provides a detailed look at the extensive roles hospitals and health systems play in their local economies. Work is underway on the next issue of the report. The MHA Keystone Center Board of Directors has also designated one seat each for the MSMS and the MOA since its inception to ensure physician representation as we strategize on safety and quality improvement issues. And finally, the MHA and the MOA literally got closer last year when the MOA relocated its offices to the MHA headquarters building in Okemos – an arrangement that is unique anywhere in the country.
I’d also be remiss if I didn’t mention the MHA’s new focus on engaging with our physician leaders. For the first time ever, the MHA will be hosting activities dedicated to our physician leaders during our MHA Annual Meeting, including several sessions that will include CME credits. MHA Chief Medical Officer Dr. Gary Roth is leading these efforts, which complement his work throughout the pandemic engaging with our health system chief medical officers to facilitate consistent and reliable dialogue that allowed the MHA to efficiently provide policy updates to our clinicians as well as real-time feedback to policymakers. We’re extremely fortunate to have Dr. Roth, as the MHA is one of just a few state hospital associations with a full-time CMO on its leadership team.
Lastly, in an effort to fully support our physician colleagues (and other caregivers), the MHA Keystone Center is offering the Well-being Essentials for Learning Life-Balance (WELL-B) webinar series to prevent healthcare burnout by delivering weekly webinars on evidence-based well-being topics, including prevalence and severity of burnout, relationship resilience and being present. It is encouraging to see that over 4,000 individuals have already signed up for this innovative program.
As you can see, there is no magic pill that can solve the healthcare staffing crisis overnight. It will take many years and a multitude of public and private solutions to protect access for all of Michigan’s communities. GME is one of those key solutions, and we call on our elected officials – and all Michiganders – to give it the support it deserves.
“Not until we are lost do we begin to understand ourselves.” ― Henry David Thoreau
I don’t suspect that many of our Michigan colleagues are Ohio State football fans, but regardless, if you have not heard the recent NBC Today Show story of offensive lineman Harry Miller, it is a great reminder that behavioral health challenges can significantly affect individuals of all ages, races, socio-economic status and athletic prowess — even those who seemingly have it all. Miller was not only a star football player and prized recruit, but also a high school valedictorian who was carrying a 4.0 GPA as a mechanical engineering major in college and made multiple mission trips to Nicaragua to help those in need. It was a shock to those who passionately follow the team, and even to family and friends who knew him well, that after multiple suicide attempts, he finally quit football.
His parents have been effusive in their praise of the support provided by Ohio State head coach Ryan Day since this revelation — and this is no accident. Coach Day lost his own father to suicide when he was only 9 years old, which led him to become deeply engaged in behavioral health advocacy efforts that have included the formation of his own charitable foundation dedicated to pediatric and adolescent mental wellness.
Suicide represents the extreme tip of a proverbial iceberg of massive proportions, with a wide range of issues affecting more people than we likely realize. Unfortunately that iceberg is growing; while COVID-19 has occupied headlines and healthcare resources for more than two years, this global pandemic has also exacerbated the crisis of limited behavioral health access that has existed for decades in our state and beyond. While some small strides have been made to improve behavioral health coverage parity and in reducing the stigma around mental health challenges, there are nowhere near the necessary number of professionals, facilities and resources to build a system that is not only adequate, but excellent, for our residents in need. Quite simply, it is unacceptable for a state with our talent, industrious history and legacy of caring to be in this situation in 2022.
Since 1949, May has been recognized as Mental Health Awareness month. While we will join many other voices in shining a light on this issue during that month, the fact is we can’t wait another month — or another day — to address what has become a true crisis. In 2018, suicide was the leading cause of death in 10- to 14-year-olds and the second most common cause of death in 15- to 24-year-olds in Michigan. This was well before the stressors brought on by the pandemic.
Michigan’s behavioral health system is stressed to its limits. While we do have a small number of outstanding facilities dedicated entirely to mental healthcare services, as well as acute-care hospitals with special units dedicated to these services, it is simply not enough. According to data from the Citizens Research Council of Michigan published in 2020, Michigan has a total of 3,195 inpatient psychiatric hospital beds spread across dedicated inpatient psychiatric facilities and acute-care hospitals to serve adults and children. This number of beds is not adequate to serve Michigan’s population of nearly 10 million. In fact, since 1993, the number of psychiatric beds available in Michigan has decreased more than 30%. However, simply adding beds is not an adequate solution because we do not have enough of the right kind of professionals to staff these beds and serve more patients. The Research Council also reported that Michigan has “11.84 psychiatrists per 100,000 residents in the state overall and 33 of the 83 counties do not have a single psychiatrist. As of 2019, Michigan ranks third in the shortage of mental healthcare professionals, surpassed only by Texas and California.” This makes convenient access to behavioral health services in many rural communities nearly impossible.
Patients, particularly adolescents and children, have few places to turn for care after experiencing a mental health crisis. There are no child or adolescent psychiatrists in 55 of Michigan’s 83 counties. Kids and people with intellectual and developmental disabilities are at risk for long stays in the emergency department — a setting that is typically not equipped to handle complex behavioral health patients. Bed availability for children and adolescents with complex needs is limited, and providers are forced to hold patients in acute-care settings sometimes for weeks or months while seeking appropriate placement for treatment. It is unacceptable for those patients, their families and the caregivers trying to manage their treatment and keep them safe. Not only is it bad for patients, but it often leads to violence against healthcare workers that is escalating at alarming levels.
The MHA and our members have been intricately involved in identifying potential solutions to address this complex system. The MHA Behavioral Health Integration Committee has been instrumental in documenting the specific challenges confronted by our members and developing guiding principles as we consider emerging public policy proposals emanating from the Whitmer administration and the state Legislature. For example, the MHA is working with the Michigan Council for Maternal and Child Health and the University of Michigan to increase funding for telesupport services for primary care providers who treat children with mental illness.
Additional financial resources and cooperative planning dedicated to behavioral health could create transformational improvements to our broken and fragmented system. Based on feedback from our members, the MHA believes an appropriation to fund additional support for pediatric behavioral health, a grant pool to improve behavioral healthcare in emergency departments and recruitment support for behavioral health providers would have significant and lasting improvements in access to care and quality. This appropriation would help address a major barrier to improving access right now, which is the lack of appropriately trained and educated behavioral health providers available in Michigan. It would also help modify the way emergency departments are prepared to temporarily care for patients in behavioral health crises — especially Michigan’s children.
These resources would not fix everything. However, they would start the process and provide critically needed relief to some of the elements of our care delivery system that is crumbling before our eyes, leaving patients in the rubble. It is a good starting point in a process that will ultimately be an all-hands-on-deck affair, requiring the best efforts of multiple organizations both inside and outside of healthcare.
Change to our behavioral health system can’t wait. Let’s fix this system together, once and for all, for all Michigan patients.
“I pass my life in preventing the storm from blowing down the tent, and I drive in the pegs as fast as they are pulled up.”— Abraham Lincoln
You may have seen recent media coverage noting that the MHA is joining efforts to address and reform Michigan’s auto no-fault insurance law. The reality is our efforts to protect and preserve what we viewed as the best system in the nation for ensuring access to care for auto accident victims dates back decades. Despite those efforts, in 2019, we clearly understood that the political stars were aligning in such a way that substantial reforms were imminent and, hence, our work in the months and years since has pivoted.
I am proud that we led an effort to assist consumers in making educated purchasing decisions in light of those 2019 reforms, and we are pleased that most Michigan drivers to date have seen the wisdom in continuing to purchase unlimited coverage to protect themselves and their families in the event of a catastrophic accident. While this effort was intended to be very visible to the public, some of our other efforts have played out behind the scenes and relate to the regulatory aspects of the new law that impact how hospitals and other care providers are compensated for the important services rendered to accident victims.
The changes to reimbursement that went into effect last July created several significant difficulties for hospitals. In effect, the new law created price controls, something we argued is never a good idea because they inevitably create real inequities. Throughout the no-fault debate, we have argued hospitals and other providers need to be fairly compensated to ensure we have the physical space, the technologies, the staffing expertise, and everything else that is necessary to provide care in the hospital emergency department, intensive care units and in the venues that provide rehabilitative and attendant care. Every step of that process is very important for the physical, mental, and fiscal health and well-being of those auto accident victims and their families.
The impact on post-acute facilities has already been well publicized, as reimbursement inequities are leaving many to reduce their patient load or close their doors entirely. While most of these patients have no immediate needs that require hospitalization, the lack of available alternatives means they increasingly have nowhere else to go; some patients are now being transferred to hospitals at a time when we are short staffed and operating at high capacity. Emerging from yet another COVID-19 surge, hospitals need every available bed for patients requiring acute hospital care.
Also impacting hospitals has been a lack of consistency in payment rates and confusion on payment limitations. Claims processing from insurers has been significantly delayed, and there are serious inconsistencies in reimbursement rates across payers due to confusion over Medicare rates. The definitions from the law passed in 2019 are insufficient, and additional clarity is needed to ensure reimbursement rates are accurate and consistent with the intent of the law. The MHA has spent much time working with the Department of Insurance and Financial Services on the need for a proper definition of Medicare rates to address this problem. The payment inadequacy, discrepancies and delays are at odds with the negotiations that occurred in 2019 and the intent of the law. The law was designed to reduce the cost of auto insurance. Instead, it is creating an unfair and unstable system of reimbursement and threatening access to certain types of patient care.
Many hospitals across Michigan operate on razor thin patient care margins and have done so for many years. In fairness to all involved, when the auto no-fault reform legislation was signed into law back in 2019, no one could have foreseen an impending pandemic and the unprecedented financial stress it would impose on hospitals and the entire healthcare ecosystem. But we clearly see the reality of the situation now.
The MHA is fully supportive of reforms that will address our concerns. It is often said that “politics is the art of the possible.” We will continue to do all that we can to advocate for public policy that ensures access to much-needed care, in the context of a challenging political environment.
On that note, I would be remiss if I didn’t thank the governor, as well as Republicans and Democrats in the state Legislature, for their bipartisan support of House Bill 5523, which will deliver critically needed funding support to address our healthcare workforce crisis. Our elected officials came together and got it right. When it comes to our auto no-fault system, I am optimistic that we will ultimately make things right as well.
“Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.”— Rev. Martin Luther King, Jr.
The past two years have sharpened the focus on several aspects of healthcare, none more so than efforts to achieve health equity throughout our communities and to improve diversity, equity and inclusion (DEI) within our healthcare organizations and communities. February is Black History Month, which makes it a perfect time to reflect on the areas where we, as healthcare leaders, can do better to promote the elimination of unconscious bias and to address the social determinants of health such as access to transportation, housing and healthy food, while also expanding our DEI efforts.
There is no question that COVID-19 and the momentum behind social justice reform in 2020 served as a force multiplier for many in this arena. The data is clear that, throughout the pandemic, minorities have suffered worse health outcomes from COVID-19, and we need to fully understand the reasons why.
I’m proud to say that the MHA Keystone Center, our association’s safety and quality organization, has already become deeply engaged in this space. Our efforts to date have included the release of the Eliminating Disparities to Advance Health Equity and Improve Quality guide and the MHA Board of Trustees pledge to Address Racism and Health Inequities, which includes a commitment to listen, to act and to lead. This pledge has since been universally embraced by our member hospitals throughout the state, which sets us on a positive path forward. As I have pointed out many times in the past, because hospitals are often the largest employer in their respective communities, we have an extraordinary opportunity to lead by example in all that we do.
Moving forward into 2022, our member hospitals will soon need to ensure compliance with a new state law, fully supported by the MHA, that requires unconscious bias training for all clinicians. Many of our hospitals were providing this sort of training well before the passage of this legislation, and we are eager to continue this work.
As with so many other issues, we are also very fortunate to have strong partners in the American Hospital Association (AHA), in this case with its Institute for Diversity and Health Equity (IFDHE) that offers a wide range of resources and initiatives to pursue health equity from a variety of areas. Together, the AHA and the IFDHE are helping to increase leadership opportunities for ethnic minorities, as they have historically been underrepresented in healthcare management.
We have come a long way in recent years, as we now have an organized, orchestrated effort within our hospitals and health systems to address these important issues. Today, positions and departments have been created, including C-suite leadership roles, that have influence on the actions both inside the hospital and outside with community partners. Just as this is an all-hands-on-deck effort throughout the care continuum, the same holds true with community partners in addressing the many vexing issues that contribute to poor health outcomes. The fact that we have leadership in place to guide this process is a testament to the commitment of our member CEOs and is an encouraging development for further things to come.
We also have a strong culture of shared learning in our state, and the willingness of hospitals and health systems to collect and share data (including race, ethnicity and language, or REAL, data) and best practices is encouraging and impactful. Despite our progress, we still have a long way to go, and I encourage any leader or organization that has not done so already to join the MHA on this journey. For too long our hospitals have treated the end results of years of health disparities, and the time is now for us to be leaders in driving change.