MHA Monday Report March 20, 2023

MHA Monday Report

State Medicaid Office Addresses Legislative Policy Panel

The MHA Legislative Policy Panel convened March 15 to develop recommendations for the MHA Board of Trustees on legislative initiatives impacting Michigan hospitals. The meeting was highlighted by a presentation on Medicaid redetermination from Brian …


MHA Provides Testimony Supporting State Psychiatric Care and Healthy Michigan Plan

During the week of March 13, the MHA provided testimony to both the Michigan House Appropriations Subcommittee on Health and Human Services and the House Health Policy Committee. Laura Appel, executive vice president of Government …


RFP Available for Pediatric Inpatient Behavioral Health Grant

The MHA is issuing a request for proposal for a $50 million competitive grant program for Michigan healthcare entities to expand access to pediatric inpatient behavioral health services. The funding was appropriated by the …


MHA Keystone Center PSO Annual Meeting May 3

The healthcare workforce is at higher risk of harm due to violence than other professional fields.  Recent increases in workplace violence represent a major barrier to both staff and patient safety, prompting the need for …


Registration Open for MHA Human Resources Member Forum

The MHA will host an in-person Human Resources Member Forum at the MHA headquarters in Okemos from 8:30 a.m. to noon April 26, with a virtual option available as well. The forum is structured as …


Changes to Medicaid Dental Coverage Effective April 1

The Michigan Department of Health and Human Services will implement a new service delivery model for adult dental benefits effective April 1, 2023. The following groups will be eligible: Medicaid beneficiaries ages 21 years and …


Changes to Telemedicine Policy Post-COVID-19 Public Health Emergency

The Michigan Department of Health and Human Services will rescind certain COVID-19 telemedicine flexibilities beginning May 12, 2023, with the conclusion of the federal health public health emergency. Policy MMP 23-10 outlines flexibilities that …


Michigan Dispensing Law Changes

Michigan state law will be updated beginning March 29, 2023, to allow pharmacists to dispense a non-controlled prescription written by a prescriber licensed in another state or province of Canada. Public Act 80 of 2022 …


Latest AHA Trustee Insights Covers Board Development and Behavioral Health

One of the strongest predictors of health system performance is the quality of governance that shapes its response in an unstable environment. The March edition of Trustee Insights, the monthly digital package from the American …


The Keckley Report

Paul KeckleyThe Biden Budget: Key Signals to Voters and an Important Implications for the Health Industry

“Last Thursday, the Biden administration released its proposed FY24 federal budget which is certain to spark political posturing by partisans on all sides and long-term speculation by political pundits and economists. At a high level, it includes… …

In total, healthcare spending represents 30% of the total outflow of federal funds in this budget compared to 29% in ’22 (Medicare 12%, Veteran’s Health 2% and Other Line Items 15%)—almost 50% more than Social Security and more than 100% above defense spending. …”

Paul Keckley, March 12, 2023


News to Know


MHA CEO Brian PetersMHA in the News

The MHA received media coverage the week of March 13 regarding conversations around workforce funding and current challenges amid the third anniversary of the COVID-19 pandemic.

Latest AHA Trustee Insights Covers Board Development and Behavioral Health

One of the strongest predictors of health system performance is the quality of governance that shapes its response in an unstable environment. The March edition of Trustee Insights, the monthly digital package from the American Hospital Association (AHA), includes an article outlining steps to move from a “yes” board to a “best” board by carefully considering whether the hospital has the appropriate structure and composition to press back on the strategies that may not be the best solution.

Additionally, the AHA released a new trustee resource, Boardroom Brief: How Boards Can Support Workforce Behavioral Health. This resource intends to educate and raise awareness for trustees about suicide prevention and the role that hospital and health system boards can play in this important public health issue. It also provides resources for boards to initiate a conversation about reducing the risks of and preventing suicides in the healthcare workforce.

For information about MHA trustee resources or webinars, contact Erin Steward at the MHA.

MHA Monday Report Dec. 19, 2022

MHA Monday Report

Michigan legislation modernized the scope of practice for certified registered nurse anesthetists (CRNAs) in 2022, eliminating the state requirement that a CRNA must work under direct physician supervision. CRNAs enhance the ability to deliver care in a multitude of scenarios, particularly in rural areas where anesthesia services may be limited. …


Webinar Series Reviews Critical Access Hospitals CMS CoPs Requirements

Critical access hospitals (CAHs) that accept Medicare and Medicaid payments must follow the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (CoPs). The CMS Critical Access Hospital Manual has seen multiple changes to regulations and interpretive guidelines. …


Latest AHA Trustee Insights Outlines Multitiered Governance Structures

The latest edition of Trustee Insights, the monthly digital package from the American Hospital Association (AHA), is now available. The Dec. issue includes an article noting the uptick in hospital and health system mergers and affiliations and defining expectations for board members in a multitiered governance system. …


The Keckley Report

Paul KeckleyMedPAC Needs to Revisit its Analysis

“At its December 8-9 meeting, MedPAC considered future funding for hospitals and physicians along with other sectors in healthcare. The 17-member commission will vote on its recommendations at its meeting January 12-13 after staff makes some changes based on commissioner feedback and then submit its official recommendations to Congress in March for FY2024…

The lag indicators used by MedPAC to evaluate Medicare utilization and payments for physician and hospital services are accurate. However, they’re of decreasing relevance to the future of Medicare’s formula for paying providers.”

Paul Keckley, Dec. 12, 2022


News to Know

Due to the holidays, Monday Report will not be published Dec. 26 and Jan. 3. Monday Report will resume its normal schedule Jan. 9. Member alerts and MHA newsroom articles will continue to be published during that time to provide relevant updates to the MHA membership, as necessary.


MHA EVP Laura Appel speaks with WOOD TV8.MHA in the News

WOOD TV8 published a story Dec. 12 on the passage of Senate Bill (SB) 183, which includes language allowing rural emergency hospital (REH) licensure in Michigan. The bill passed Dec. 6 with overwhelming support in both the State House and Senate following collaboration between the MHA, the Michigan Department of Health and Human Services, the Michigan Department of Licensing and Regulatory Affairs and the Whitmer administration on making the necessary changes in state statute to allow for the new federal designation. …

Latest AHA Trustee Insights Outlines Multitiered Governance Structures

The latest edition of Trustee Insights, the monthly digital package from the American Hospital Association (AHA), is now available. The December issue includes an article noting the uptick in hospital and health system mergers and affiliations and defining expectations for board members in a multitiered governance system. The article addresses roles of executives and trustees, using an authority matrix to outline key governance functions and the implications to governance as the system grows and becomes more complex. The issue also includes a whitepaper containing key strategies and practical tools for orienting new board members.

This resource is available free for AHA members and at a cost for nonmembers.

For information about MHA trustee resources or webinars, contact Erin Steward at the MHA.

MHA Monday Report Dec. 12, 2022

MHA Monday Report

capitol building2022 Legislative Session Adjourns

The Legislature took their final votes for the 2021-2022 legislative session during the week of Dec. 5. Given the results of the election, very few bills passed during the legislative lame-duck session compared to a typical year. …


Media Join Hospital Viability Press Conference

The MHA conducted a virtual press conference Dec. 6 to discuss the economic and staffing challenges impacting hospitals across the state to generate awareness with lawmakers of these issues and the potential impact on access to timely, high-quality healthcare for Michiganders. …


MHA and Michigan hospital representatives pictured with Rep. John Moolenaar (R-Midland).

MHA Visits Capitol Hill with Member Hospitals for AHA Advocacy Day

The MHA visited Capitol Hill in Washington DC last week to emphasize year-end priorities to Michigan’s congressional delegation. The MHA and several hospital representatives met with House members and with U.S. Senator Debbie Stabenow to deliver the message that pending Medicare cuts are unsustainable and unacceptable. …


Rural Emergency Hospital Legislation Passed in Michigan

On Dec. 6th, the legislation needed for hospitals to begin converting to Rural Emergency Hospitals (REH) in Michigan was sent to the Governor’s desk for final approval. Due to the limited session days left, the language to allow for REH licensure in Michigan were officially included in Senate Bill (SB) 183. …


CMS Issues Proposal to Modify the Prior Authorization Process

The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule to modify the prior authorization process for certain payers. The proposal would require payers to: Include a specific reason when denying a request. Publicly report certain prior authorization metrics. …


MHA Workforce Webinar to Discuss Diverse Workforce Solutions

Understanding the workforce’s values, preferences, triggers and character traits is essential to developing relationships that create a healthy organization. This may sound basic, but many organizations continue to miss the mark. …


Keckley Report 

Paul KeckleyThe Transitioning of US Healthcare from A Virtuous to Vicious Cycle

“U.S. healthcare has moved into a vicious cycle marked by intensified competition and noticeable acrimony between major players. Growing tension between major health insurers and health systems is illustrative.

Virtuosity to insurers is predicated on the core belief that keeping providers honest and care affordable and their domain; its vicious pursuit is to attribute unsustainable health costs to hospital inefficiency and price gauging.

The virtuous cycle for hospitals is premised on community health and provision of services to those unable to pay; the vicious cycle is the unwelcome intrusion of insurers and private investors who put profit above all else by paying them less so they can keep more. …”

Paul Keckley, Dec. 5, 2022


News to Know

Medtel was approved for associate membership in Nov. 2022. Medtel was founded in 2016 with a mission to improve surgical care experiences and outcomes for patients and providers by developing and delivering technology solutions. …


Brian PetersMHA in the News

The MHA received media coverage the week of Dec. 5 following a virtual press conference Dec. 6 on the financial and staffing challenges impacting hospital viability, as well as topics including hospital capital improvements, mergers and acquisitions and respiratory illness hospital admissions driven by RSV and COVID-19. …

MHA Visits Capitol Hill with Member Hospitals for AHA Advocacy Day

MHA and Michigan hospital representatives pictured with Rep. John Moolenaar (R-Midland).
MHA and Michigan hospital representatives pictured with Rep. John Moolenaar (R-Midland).
MHA and Michigan hospital representatives pictured with Rep. John Moolenaar (R-Midland).

The MHA visited Capitol Hill in Washington DC last week to emphasize year-end priorities to Michigan’s congressional delegation.

The MHA and several hospital representatives met with House members and with U.S. Senator Debbie Stabenow to deliver the message that pending Medicare cuts are unsustainable and unacceptable. Memorial Healthcare CEO Brian Long joined the group to request prompt action to prevent the forthcoming 4% Statutory Pay-As-You-Go (PAYGO) sequester and extend or make permanent the low-volume adjustment and the Medicare-dependent hospital programs. Without an extension, these critical rural programs expire Dec. 16 and will reduce reimbursement to Michigan hospitals by more than $12 million annually. The MHA also pushed for making permanent the expansion of telehealth services and extending the hospital-at-home program. The members of the Michigan congressional delegation were receptive to these requests and generally expressed optimism that the pending Medicare reductions would be paused or even repealed.

The MHA also took part in both the American Hospital Association and Children’s Hospital Association advocacy briefings, which concurrently took place in DC. Both associations discussed their central priorities as the lame duck session nears its end and a new Congress prepares to enter Capitol Hill.

Members with questions about end of year priorities or future advocacy days on Capitol Hill may contact Laura Appel at the MHA.

Michiganders Need Continued Access to High-quality, Timely Healthcare

Michigan’s hospitals are facing a funding crisis, putting communities and families across the state at risk of losing access to high-quality, timely healthcare. Health systems, business and university leaders are urging policymakers to address the crisis to avoid further reduction of available beds and access to care and healthcare services.

Michigan has lost a high of 1,700 staffed hospital beds since 2020 due to lack of staffing. This creates a cascade of problems, from longer wait times in the emergency department, reduced services, particularly in rural areas, and more difficulty transferring patients to the appropriate care setting. Respiratory illnesses are also surging, making problems worse.

T. Anthony Denton

“Recently, we have seen a surge in cases of respiratory syncytial virus (RSV), flu and COVID. This puts an additional pressure on emergency departments and our already-strained inpatient bed capacity across Michigan, impacting care statewide. Without funding to address staffing shortages, we run the risk of compromising our ability to provide the same level of exceptional care that we’re accustomed to across the state,” said T. Anthony Denton, senior vice president and chief operating officer, University of Michigan Health System and Michigan Health & Hospital Association board chair.

A 2021 Washington Post-Kaiser Family Foundation survey found that nearly 30% of healthcare workers are considering leaving their profession altogether. The U.S. Bureau of Labor Statistics projects the need for 1.1 million new registered nurses nationwide by 2030, the Association of American Medical Colleges estimates two out of every five active physicians nationwide will be 65 or older within the next 10 years, and the nation faces a projected shortage of more than 3.2 million lower-wage healthcare workers such as medical assistants, home health aides and nursing assistants, according to a Mercer report.

“The overall health and prosperity of Michigan is inextricably tied to the state’s investment in its healthcare and higher education enterprises,” said Daniel Hurley, CEO of the Michigan Association of State Universities. “Michigan’s public universities, together with our hospital and other healthcare partners, look forward to working with state leaders to ensure a future healthcare workforce that is capable of providing the highest levels of quality care for all Michiganders.”

The healthcare workforce shortage — combined with an aging population, a rise in chronic diseases and behavioral health conditions and advancements in medical care delivery — all contribute to an immediate need for resources that will allow hospitals to continue to provide the care residents need and deserve.

Despite staffing losses attributed to the COVID-19 pandemic, healthcare directly employed nearly 572,000 Michigan residents in 2020, continuing to make it the largest private-sector employer in the state. The 2022 Economic Impact of Healthcare in Michigan report found that direct healthcare workers in Michigan earned $44.2 billion in wages, salaries and benefits, with indirect, healthcare-supported workers earning about $28 billion wages, salaries and benefits.

“With healthcare being the largest private-sector employer, a healthy Michigan economy is directly linked to a properly funded healthcare system,” said Susan Smith, executive director, Economic Development Partnership of Hillsdale County. “Without access to healthcare services to support our communities, ranging from obstetrical units to trauma centers, we cannot remain economically competitive, attract or retain talent, or support placemaking for young families and care for everyone at all stages of life.”

Michigan officials have made recent short-term investments to address the hospital staffing crisis, but additional funding remains unappropriated that if used as intended, can improve hospital capacity and service lines. Michigan also needs a long-term funding solution to address stagnant reimbursement that has yet to respond to inflationary pressures to improve the retention of existing healthcare workers and recruit future workers to ensure that residents continue to have access to healthcare services.

Learn how you can help your local hospital or health system by visiting MiCareMatters.org.

Additional quotes:

JJ Hodshire

“Hospitals have an immediate need for resources to continue to provide the services residents need and deserve – like ambulances available for lifesaving care,” said JJ Hodshire, president and chief executive officer, Hillsdale Hospital. “As a rural hospital, we excel at being innovative to make the best use of our resources, particularly staff. However, we can only stretch resources for so long. Everyone can agree that access to lifesaving emergency medical care is a basic need for Michiganders and residents should be able to receive specialized care no matter where they live.”

“My colleagues in pediatric units across the state have spent the past month responding to one of the worst respiratory illness surges I can remember as a physician and the biggest challenge to our ability to care for more children was our lack of available staff,” said Dr. Rudolph P. Valentini, chief medical officer, Children’s Hospital of Michigan and group chief medical offer at Detroit Medical Center. “We can’t afford to have another surge of sick, hospitalized children before something is done to improve the health of our hospitals and health systems.”

Brian Peters

“Michigan residents deserve quality, accessible healthcare services and without hospital resources to adequately provide that care, Michigan hospitals have and will continue to face difficult decisions about what services they can offer,” said Brian Peters, chief executive officer, Michigan Health & Hospital Association.

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

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

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

Lawmakers should be urged to:

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

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

Contact Laura Appel at the MHA for more details.

Latest AHA Trustee Insights Outlines Physician Alignment and Consumerism Strategies

The latest edition of Trustee Insights, the monthly digital package from the American Hospital Association (AHA), is now available. The October issue includes an article outlining the critical need for alignment of leadership between the physician organization and hospital on key priorities and initiatives that address clinician needs and challenges and why alignment is an essential retention strategy to the operating environment. The article poses questions the board should be answering to maintain physician relationships.

Another article outlines the importance of identifying what individuals want and value from their healthcare experience, empowering Patient and Family Engagement Advisory Councils (PFEAC) to manage this process and working with the PFEAC to set goals and track progress using consumer engagement and patient experience metrics.

This resource is available free for AHA members and at a cost for nonmembers. For information about MHA trustee resources or webinars, contact Erin Steward at the MHA.

Suicide Prevention Focus of AHA Trustee Insights

September is National Suicide Prevention Awareness Month and an opportunity to be reminded of the many resources available to support emotional well-being.

The September edition of Trustee Insights, the monthly digital package from the American Hospital Association (AHA), features article about ways governing boards can support suicide prevention initiatives, both through quality and safety practices and through behavioral health networks offering services across the spectrum. Another article outlines how to recognize the behaviors of employees who experience burnout, depression and other forms of anxiety, ways to decrease stigma and interventions and treatments that reduce suicide risk.

This resource is available free for AHA members and at a cost for nonmembers. For information about MHA trustee resources or webinars, contact Erin Steward at the MHA.