What’s Next Address Focuses on Healthcare Access

Brian Peters

The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association following Gov. Whitmer’s What’s Next address.

Brian PetersOn behalf of Michigan hospitals and health systems, the MHA is very pleased to see Gov. Whitmer prioritize healthcare and improving access to care for Michiganders. Prescription drug costs continue to grow at alarming rates. Addressing prescription drug affordability will help improve access to important medication for residents throughout Michigan, leading to improved health outcomes.

Our association looks forward to working with the administration and lawmakers to support efforts to reduce costs for lifesaving drugs, remove barriers to prescription drug access and protect existing solutions such as the 340B drug pricing program to increase affordable prescription drug access for Michigan residents.

MHA Monday Report July 17, 2023

MHA Monday Report

MHA Service Corporation Board Highlights Solutions and Successes

The MHA Service Corporation board held its final meeting of the 2022-2023 program year focused on supporting the MHA Strategic Action Plan priorities of workforce sustainability, financial viability, achieving health equity and improving access …

capitol buildingGovernor Creates New Department to Support Workforce and Talent Development

The Michigan Legislature may be on summer recess but work in the state capitol continues. The governor made headlines the week of July 10 with the creation of a new state department, the Michigan Department of Lifelong Education, Advancement …

CMS Releases Proposed Rule to Update Home Health PPS

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule to update the home health prospective payment system (PPS) for calendar year 2024. The proposed rule includes updates to the …

Webinar Series Explores AI, Resilience and Other Topics

The MHA and other state hospital associations are hosting a webinar series in partnership with the Huron Consulting Group Aug. 10 through Nov. 9 from 1 – 2 p.m. EST. The content will help registrants …

HHS Releases 340B Proposed Remedy

The Department of Health and Human Services (HHS) recently released its proposed remedy for the unlawful payments cuts for certain hospitals that participate in the 340B drug discount program following the June 2022 unanimous Supreme …

Understanding Value-Based Payment Models Can Enhance Patient Care, Lower Costs

Over the last few decades, the healthcare industry has experienced a significant shift from fee-for-service  payments to value-based payments. Value-based care delivery models, which base payment on outcomes versus the number of services

MI care mattersMHA Podcast Explores Harmful Nurse Staffing Legislation

The MHA released another episode of the MiCare Champion Cast, which features interviews with healthcare policy experts in Michigan on key issues that impact healthcare and the health of communities. On episode 31, MHA CEO …

The Keckley Report

Paul KeckleyThe Five Most Important Questions Hospitals Must Answer in Planning for the Future

“As hospital leaders convene in Seattle this weekend for the American Hospital Association Leadership Summit, their future is uncertain.

Last week’s court decision in favor of hospitals shortchanged by the 340B drug program and 1st half 2023 improvement in operating margins notwithstanding, the deck is stacked against hospitals—some more than others. …

Most hospitals soldier on: they’re aware of these and responding as best they can. But most are necessarily focused only on the near-term: bed needs, workforce recruitment and staffing, procurement costs for drugs and supplies and so on. Some operate in markets less problematic than others, but the trends hold true directionally in every one of America’s 290 HRR markets. …“

Paul Keckley, July 10, 2023

Adam CarlsonMHA in the News

Michigan Advance published a story July 9 on the healthcare priorities included in the fiscal year 2024 state budget. Adam Carlson, senior vice president, advocacy, MHA, is quoted multiple times in the story regarding funding …

HHS Releases 340B Proposed Remedy

The Department of Health and Human Services (HHS) recently released its proposed remedy for the unlawful payments cuts for certain hospitals that participate in the 340B drug discount program following the June 2022 unanimous Supreme Court decision.

The HHS proposes to:

  1. Repay 340B hospitals that were underpaid from 2018 to 2022 via a single lump sum payment.
  2. Maintain budget neutrality by recouping funds from hospitals that received higher rates for non-drug services from 2018 to 2022. The Centers for Medicare and Medicaid Services (CMS) proposes to apply a negative 0.5% adjustment to the outpatient prospective payment system conversion factor starting in calendar year 2025, with this adjustment continuing until the full repayment amount is offset, which the CMS estimates to be 16 years.

The HHS will accept comments on the proposed remedy through Sept. 5, 2023. The MHA, along with the American Hospital Association and others, will continue to advocate that the CMS repay 340B hospitals as proposed but do so in a non-budget neutral manner. The MHA will submit comments by Sept. 5 and encourages hospitals to submit comments. The MHA will provide hospitals with an estimated impact analysis within the next few weeks.

Members with questions may contact Elizabeth Kutter at the MHA.

MHA CEO Report — The Challenges for Rural Hospitals

MHA Rounds Report - Brian Peters, MHA CEO

“The country is lyric, the town dramatic. When mingled, they make the perfect musical drama” Henry Wadsworth Longfellow

MHA Rounds Report - Brian Peters, MHA CEOHaving just returned from the annual American Hospital Association (AHA) Rural Health Care Leadership Conference, where I was joined by a strong contingent of MHA members and staff, the future of our rural hospitals has been top of mind.

When I was in graduate school at the University of Michigan many years ago, I recall clearly our discussions related to rural health. In short, we were taught that rural America was statistically older, poorer and sicker than the rest of the country – and this demographic and socioeconomic reality led to all kinds of challenges for those responsible for the health of rural populations and the viability of rural hospitals.

Fast forward to the most recent (2020) census and this dynamic remains true. In addition, we discovered that between 2010 and 2020, rural America actually lost population for the first time in history. Here in Michigan, the latest projections indicate that while the total state population will grow moderately over the next 20 years, the population in rural Michigan will remain flat or even decrease.

The operating environment has never been more difficult for healthcare organizations, for reasons we have documented at length in prior CEO Reports. This statement is particularly true for rural hospitals – 100 of which from across the country have actually closed since 2005. Many more have had to make the difficult decision to terminate service lines or otherwise scale back their operations to keep their doors open. What is driving these challenges?  A few items come immediately to mind:

  • An older and poorer population translates into a higher percentage of government payors (Medicare and Medicaid), which traditionally do not fully cover the true cost of care.
  • The traditional volume-based reimbursement model that has been one of the cornerstones of American healthcare does not serve rural providers – which often lack sufficient volume – particularly well. The pitfalls of the volume-based model were on full display during the worst days of the COVID-19 pandemic, particularly when non-emergent procedures were suspended.
  • Recruiting physicians today most often involves recruiting a spouse as well; in other words, there must be a good job match for both parties to spur a relocation. Physician recruitment is more difficult in rural communities for the simple fact that there are fewer potential jobs for that spouse. In addition, the on-call coverage demands can be particularly significant in rural areas, because the number of available rotating on-call clinicians is simply fewer. I would be remiss if I didn’t mention the Merritt Hawkins firm, which is one of our original MHA Service Corporation Endorsed Business Partners, and is dedicated to working with our members to create solutions to some of the most vexing challenges of the day.
  • Lastly, it is no secret the country is in the middle of a behavioral health crisis, with a lack of available placements leading to behavioral health patients boarding in emergency departments throughout the state, awaiting placement in a more appropriate setting. Hospitals are experiencing higher costs caring for these patients, increasing security to protect other patients and staff, while receiving little to no reimbursement since these patients have yet to be admitted to an inpatient psychiatric unit. This lack of access is even worse in rural areas. For example, the Upper Peninsula only has one licensed child psychiatrist for the entire region.

The reality is that when we think about rural Michigan and the more densely populated areas of the state, we are all inextricably linked. There is no “us and them.” People from the big city travel every day to rural communities for conferences and events, meetings, sales calls, deliveries, vacations and visits with friends and family (and people from rural communities come to the big city for the same reasons). While we want to ensure the vibrancy of a hospital in a rural community so that the residents have access to quality healthcare, we should all want the same thing, because we never know when we might be on one of those sales calls or vacations and need that same access. This is not just theoretical, as I have countless stories about this phenomenon playing out in real life, and I suspect you do as well.

Moreover, hospitals are one of the largest – if not the largest – employers in many rural Michigan communities, playing a crucial role in the economic vibrancy of the state. Healthcare careers provide stable, good paying jobs and positively impact lives every day. Not only are hospitals important for access to care, but also as economic drivers. 121,000 total workers are associated with the healthcare sector in rural Michigan, including 81,000 direct jobs. These direct healthcare workers received $7.6 billion in total wages, salaries and benefits and contributed $1.4 billion in local, state and federal taxes. In addition, the existence of a hospital nearby is one very important item for businesses of all kinds when considering investment in a new factory, office or headquarters.

So, the vibrancy of our rural hospitals should be a priority. What is the MHA doing about it? As it turns out, we have done a lot. Beyond our advocacy on the traditional Medicaid and Medicare budgets, certificate of need, medical liability, workforce funding and many, many other public policy issues that affect all our members, here are just a few of our rural advocacy highlights:

  • We fought hard to secure passage of the Healthy Michigan Plan (our Medicaid expansion program) and have advocated for full funding in every budget cycle since. For the reasons cited above, this is particularly impactful for our rural hospitals.
  • We worked to pass, implement and protect the Critical Access Hospital program, which has created an important lifeline for 37 Michigan hospitals. And the MHA was successful in changing existing statue at the end of 2022 to make adoption of the new Rural Emergency Hospital designation possible for our members.
  • We have worked very hard to protect the 340B drug pricing program, which is vital to many rural hospitals and their ability to provide access to care to all in their communities. Our work includes advocacy with both the state legislature and Congress, and even in the federal courts, where the MHA has filed amicus curiae briefs related to recent 340B cases.
  • The MHA successfully advocated for two new supplemental Medicaid payment pools that specifically benefit our rural members with implementation of the rural access pool in fiscal year (FY) 2012 and the obstetrical stabilization fund in FY 2015. Our advocacy efforts were also successful in securing Medicaid outpatient rate increases in FY 2020, the first increase in two decades, followed by an additional increase in FY 2021. These increases resulted in a 63% increase for critical access hospitals and a 21% increase for all other hospitals compared to Jan. 1, 2020, rates.
  • We successfully advocated for an extension of both the Medicare-dependent Hospital and Low-volume Adjustment programs during the 2022 Congressional lame-duck session, which provide critical support to many rural hospitals.
  • Finally, we have successfully advocated for passage and implementation of state legislation that modernizes the scope of practice for certified registered nurse anesthetists and allows flexibility for each hospital to choose the anesthesia care model that best fits its location, staffing and resources to offer safe and effective patient care.

Our advocacy is also focused on ensuring our members can tell their story and connect with lawmakers, both at the state and federal levels. The MHA hosted its first ever Rural Advocacy Day last September in Lansing to facilitate conversation between rural hospital leaders and members of the Michigan Legislature. The MHA also accompanied members in February for the National Rural Health Association’s Rural Health Policy Institute event. MHA members met with Michigan’s congressional delegation and staff during the trip to discuss rural health issues facing Michigan hospitals. And if you haven’t yet had the opportunity to listen to the Rural Health Rising podcasts, I encourage you to tune in to our friend JJ Hodshire, the CEO of Hillsdale Hospital and an MHA Board member, as he does a fantastic job shining a light on a wide range of rural health issues – with an impressive set of special guests – in real time.

Successful advocacy and storytelling require teamwork. As mentioned above, for years we have partnered closely with the AHA and the National Rural Health Association. We have also enjoyed a close partnership with the Michigan Center for Rural Health (MCRH), and I am pleased to share Hunter Nostrant, CEO of Helen Newberry Joy Hospital, is a member of both the MHA Board of Trustees as well as the MCRH Board.

The mission of the MHA is to advance the health of individuals and communities, and in that context, we have always strived to represent all our members and communities. Each hospital is vital to the health of our great state. While the path forward may be difficult, I’m encouraged by the many rural hospital leaders – some of the nicest, and most talented people that I have met – that have developed innovative and strategic ways to address these challenges and position themselves to be able to care for their communities for years to come.

As always, I welcome your thoughts.

MHA Monday Report Feb. 13, 2023

MHA Monday Report

MHA Board of Trustees Reviews State and Federal Advocacy Options to Further Strategic Priorities

The MHA Board of Trustees began its Feb. 8 meeting with a federal advocacy briefing from federal lobbyist Carlos Jackson with Cornerstone Government Affairs. Jackson highlighted the policy and funding threats and opportunities healthcare providers …

capitol buildingFiscal Year 2024 Executive Budget Recommendation Released

Gov. Whitmer released her executive budget recommendation Feb. 8 for fiscal year 2024. The proposed budget fully protects traditional hospital line items for Medicaid and the Healthy Michigan program, continues targeted rate increases from recent budget cycles and includes …

MHA and Rural Members Advocate on Capitol Hill

The MHA and rural hospital leaders visited Capitol Hill in Washington D.C. Feb. 7-9 to advocate for specific rural healthcare policies as part of the National Rural Health Association’s Rural Health Policy Institute event. …

Registration Available for MHA Keystone Center Safe Patient Handling Conference

Registration is now open for the MHA Keystone Center Safe Patient Handling Conference. The all-day event will take place April 13 at the Ann Arbor Marriott Ypsilanti at Eagle Crest. In partnership with the MHA Keystone Center, EarlyMobility.com …

January MA Enrollment Increases by 33,000 Beneficiaries

Medicare Advantage (MA) enrollment in Michigan totaled approximately 1.25 million in January, an increase of 33,000 beneficiaries since October. The January enrollment is spread across 48 MA plans that are currently operating in the state, …

The Keckley Report

Paul KeckleyWave Two Value-Based Care: The Five Market Shifts that Will Reset the Payment Environment for Providers

“Wave One of the Value Based Care environment was marginally effective: CMS’ alternative payment models showed promise but savings to Medicare fell short of expectations per MedPAC. Medicare Advantage enrollment grew but plan sponsors were overpaid by Medicare. Hospital avoidable readmissions and complications efforts have been successful but the pandemic economy decapitated hospital resources necessary to compete in the value-based environment. Wave One is a mixed bag. …

The Wave Two Value Agenda in U.S. healthcare will impact every player and be messy. The backdrop of the 2024 Campaign cycle and post-pandemic economy mean impetus will shift from resource-constrained Medicare to the private sector as both offer significant but distinct opportunities for lower spending. And the revolution of generative AI assures shortcomings of the system—diagnostic error, administrative waste, fraud—will be widely exposed. …”

Paul Keckley, Feb. 6, 2023

News to Know – Feb. 13, 2023

  • Prospective payment system hospitals are reminded that any requests for corrections to the January public use file data being used by the Centers for Medicare and Medicaid Services to develop the fiscal year 2024 Medicare wage index must be received, along with supporting documentation, by the Medicare Administrative Contractor by Feb. 15, 2023.
  • The MHA is offering its popular Healthcare Leadership Academy program on March 13-15 and May 15-16.
  • MHA Endorsed Business Partner Demand Workforce/Qodex will host a free 30-minute webinar on Mission Impossible: Let’s Talk About How to Heal Your Staffing Crisis at noon ET Feb. 22 to discuss healthcare trends in staffing including creative approaches to deliberately using your nursing workforce.

MHA in the NewsMHA CEO Brian Peters

The MHA received media coverage the week of Feb. 6 regarding a variety of topics, including the fiscal year 2024 executive budget recommendation, the role food insecurity has as a social determinant of health, the new state House Behavioral …

MHA and Rural Members Advocate on Capitol Hill

Rural hospital leaders at NRHA Rural Health Insitute event in Washington D.C.

The MHA and rural hospital leaders visited Capitol Hill in Washington D.C. Feb. 7-9 to advocate for specific rural healthcare policies as part of the National Rural Health Association’s (NRHA) Rural Health Policy Institute event.

During the trip, the MHA and members met with Michigan’s congressional delegation and staff to discuss rural health issues facing Michigan hospitals. Topics included protection of the 340B drug pricing program, the new Rural Emergency Hospital (REH) designation, rural workforce shortages and reimbursement issues. Also participating in the visit were representatives from the Michigan Center for Rural Health.

Members with questions should contact Lauren LaPine at the MHA.

MHA Monday Report Feb. 6, 2023

MHA Monday Report

MHA Testifies During First House Health Policy Committee Hearing

The first hearing of the new legislative session for the House Health Policy Committee was held Feb. 2. Led by Chair Julie Rogers (D-Kalamazoo), new committee members heard testimony from advocacy organizations about the state of public health in Michigan. …

Implicit Bias Trainings Available to Meet LARA Requirement

The Department of Licensing and Regulatory Affairs revised Public Health Code – General Rules to allow asynchronous teleconferences or webinars as acceptable modality of training as part of the implicit bias training standards for all professions licensed or registered under …

MHA Ludwig Community Benefit Award Accepting Nominations

Hospitals taking part in local efforts to enrich the overall welfare of their communities are encouraged to nominate those programs for the 2023 MHA Ludwig Community Benefit Award. First presented in 1990, the annual award honors MHA-member healthcare …

MHA Annual Meeting Sponsorship Opportunities Available

Just as hospitals and health systems have changed their strategies to adapt to the new environment, MHA education programming and sponsorships have changed to deliver more value. The MHA team are designing in-person events tied to the priorities of the …

MHA Rounds Report - Brian Peters, MHA CEOMHA CEO Report — Medical Liability and Denney Damages

In last month’s CEO Report, we focused on the new political environment in Lansing, with a host of first-time lawmakers taking office, Democrats assuming majority control of both chambers of the legislature and a host of …

The Keckley Report

Paul KeckleyThe Big Tech Advantage in U.S. Healthcare

“This week, 100 of the Fortune 500 will report earnings for 2022 and heightened attention will be on four tech giants–Apple Inc., (AAPL); Amazon (AMZN) Meta Platforms Inc.(META) and Alphabet Inc.(GOOG). Comparatively, reports this week by Pfizer, Merck and Eli Lilly will get industry attention but news about these technology-giants will extend to a much wider audience. Why? …

2023 will be pivotal to U.S. healthcare’s future: it’s the transition year from pandemic adaptation buoyed by emergency-relief funds and opportunistic private equity plays in capital-starved sectors to a normalcy that’s unprecedented. … “

Paul Keckley, Jan. 30, 2023

Brian PetersMHA in The News

The MHA received media coverage the week of Jan. 30 regarding the 340B drug pricing program and the lack of child psychiatrists in northern Michigan. Crain’s Detroit Business published an op-ed Feb. 1 from MHA CEO Brian Peters on …

Legislative Policy Panel Convenes for Program Year

The MHA Legislative Policy Panel convened Oct. 12 to develop recommendations for the MHA Board of Trustees on legislative initiatives impacting Michigan hospitals.

The meeting was highlighted by a presentation from Ruthanne Sudderth, senior vice president, public affairs and communications, MHA, on a storytelling campaign advocating for funding solutions to the financial challenges facing MHA members. Sudderth described the objectives of the campaign, strategies that will be utilized and ways members can get involved. The campaign is a direct result of an MHA Board directive from the strategic action plan.

The panel also held a discussion on Certificate of Need in relation to pediatric psychiatric beds in Michigan and potential measures to improve access to care and patient experience. An additional portion of the meeting was dedicated towards reviewing challenges associated with placing patients in post-acute care settings and potential legislative options to assist hospitals.

Regarding an action item, the panel recommended the MHA support proposed state legislation to expand the swing bed program.

The panel received updates on other issues at the state level, including a preview of the upcoming lame-duck session, the November election and the 340B drug pricing program.

For more information on the MHA Legislative Policy Panel, contact Adam Carlson at the MHA.

MHA CEO Report — Michigan Hospitals: Benefitting Communities in Significant Ways

MHA Rounds Report - Brian Peters, MHA CEO

Life’s most persistent and urgent question is, ‘What are you doing for others?”  Martin Luther King, Jr.

MHA Rounds Report - Brian Peters, MHA CEOFall is officially upon us. At the MHA, that means a new program year is well underway, we have a new Strategic Action Plan in place and are preparing for the November election which is now just weeks away. This fall, we are also very proud to continue an annual tradition and publish two new reports documenting the critical role of our membership throughout the state: the 2022 Economic Impact of Healthcare in Michigan and the Healthy Futures, Health Communities community benefit report.

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.

As always, I welcome your thoughts.

Lt. Governor Gilchrist II Hosted at the Capitol Advocacy Center

The MHA hosted Lt. Gov. Garlin Gilchrist II Sept. 7 at the Capitol Advocacy Center to connect with hospital affiliated legislative officers and MHA staff on current priorities of the administration. The meeting provided an opportunity for MHA members to share priorities and concerns and allowed for an incredible exchange of information, ideas and solutions to the issues many hospitals and health systems are currently experiencing.

Lt. Gov. Gilchrist meets with MHA members.

Lt. Gov. Gilchrist touched on several topics, but the focus was largely on workforce and talent development, workplace violence, health disparities, access to care and rural health. Time was also spent discussing the importance of the 340B drug discount program and expanding behavioral healthcare access. The impact of having a statewide leader understand and discuss these top tier issues with MHA members is unparalleled and creates an opportunity for the MHA to carry strong momentum into the lame-duck state legislative session this fall.

The MHA and MHA members continue to advocate for important healthcare improvements to support the care of Michigan residents and communities. Partnerships with state executive officials also help to build on existing collaborations, create new spaces for improvement and protect MHA priorities.

The MHA will continue to foster opportunities to connect members with state and federal leaders, producing strong information exchanges and advocacy for healthcare priorities. Members with questions should contact Adam Carlson at the MHA.