MHA Monday Report Nov. 7, 2022

MHA Monday Report

MHA Board of Trustees Advances Strategic Action Plan, Affirms Policy Panel Legislative Recommendations

The MHA Board of Trustees began their Nov. 2 meeting with a review of key communication strategies to assist hospitals and health systems to “tell their stories” about the unprecedented financial and workforce challenges they currently face and how they are adapting to meet the critical healthcare and economic development needs of their communities …


Logo for MI Vote Matters, Tuesday Nov. 8Healthcare Community Urged to Vote in Nov. 8 General Election

The MHA encourages its staff, members and other stakeholders in the healthcare community to vote in the state’s general election Nov. 8.- Polls will be open from 7 a.m. to 8 p.m. …


Parents Urged to Take Preventive Measures as Pediatric Beds Fill Up

Michigan children’s hospitals and pediatric healthcare leaders are raising awareness about a pediatric hospital bed shortage and urging the public to help prevent respiratory illnesses, which are rapidly spreading in the form of respiratory syncytial virus (RSV) and influenza …


CMS Releases Final Rule to Update OPPS

The Centers for Medicare and Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service (FFS) outpatient prospective payment system (OPPS) effective Jan. 1, 2023 …


Provider Enrollment Requirements Reinstated Effective Dec. 1, 2022

The Michigan Department of Health and Human Services (MDHHS) issued MMP 22-38 COVID-19 Response: Termination of Bulletin MSA 20-28, which reinstates provider enrollment requirements …


CMS Releases Final to Update Medicare PPS Effective 2023

The Centers for Medicare and Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service home health (HH) prospective payment system (PPS) effective Jan. 1, 2023 …


MHA Supports Increased Access to Affordable Post-Secondary Education

The MHA, along with stakeholders across diverse fields, supported record state investment in Michigan’s future workforce. On October 11th, the Governor signed Public Act 212 of 2022 establishing the Michigan Achievement Scholarship, and applications starting with students in the high school class of 2023 will now be eligible for increased state financial aid …


CE Credits Available for Unionization and Legal Guidelines Webinar

The webinar Dispelling Misinformation About Unionization and Legal Guidelines 8:30 – 10 a.m. ET Nov. 11 has been approved by HR Certification Institute® (HRCI®) for 1.5 hours …


MHA Rounds Report - Brian Peters, MHA CEOMHA CEO Report — Your Vote Matters

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 …


The Keckley ReportPaul Keckley

The Three Blind Spots in Hospital Strategic Plans

“For 40 years, I have facilitated Board Retreats for hospitals, health systems, insurance plans and medical groups. At no time has the level of uncertainty about the future for hospitals been as intense nor the importance of a forward-looking strategic vision and planning been as necessary as now. The issues are complicated: lag indicators about demand, clinical innovations, reimbursement, costs et al are a foreboding backdrop for these discussions. And three issues have surfaced as blind spots in the environmental assessments and deliberations preceding the plan …”

Paul Keckley, Oct 31, 2022


Michigan Harvest GatheringsNews to Know

Many Michigan hospitals are underway with their Michigan Harvest Gathering campaign which runs through Nov. 18. Online donations by hospital employees and community members to the Michigan Harvest Gathering program can be made through the Food Bank Council of Michigan’s website …


MHA in the News

The MHA received media coverage on the surge of RSV cases across Michigan’s pediatric hospitals during the week of Oct. 31. The coverage included several comments provided to news outlets and the distribution of a press release Nov. 4 to statewide media …

MHA Board of Trustees Holds Final Meeting of Program Year

Tina Freese Decker at the MHA Annual Meeting
Tina Freese Decker at the MHA Annual Meeting
2021-2022 MHA Board Chair Tina Freese Decker.

After a two-year pause due to the COVID-19 pandemic, the MHA Board of Trustees held its final meeting of the 2021-2022 program year on Mackinac Island in conjunction with the MHA Annual Membership Meeting. As part of a standing agenda item focused on safety and quality lessons learned, board member Ed Ness, president and CEO, Munson Healthcare, shared examples of community and workforce resiliency exhibited by the Gaylord community and Otsego Memorial Hospital team members in the wake of the destruction caused by the recent EF3 tornado that carved a path through that community and within a block of the hospital, resulting in injury and loss of life. The board also had a strategic conversation about the most effective association engagement on matters of social and public health, health equity, financial sustainability and improving the patient experience. In all of these areas, the board stressed the importance of focusing on the mission of healthcare organizations to advance the health of patients and communities and explaining the challenges healthcare providers face in achieving this mission with specific examples. Other business included final program year reports from the committees on Behavioral Health and Public Health, with the recommendation to continue the work of these standing committees.

Current Health PAC Chair and incoming MHA Board of Trustees Chair T. Anthony Denton provided an update on the status of the 2022 MHA Health PAC campaign and encouraged eligible individuals and organizations to meet their contribution goals. Information about the MHA Health PAC is available online. The board also approved type 3 membership for BMG Money Inc., Fifth Third Bank, Vituity, and new Endorsed Business Partners AMN Language Services, B.E. Smith, HealthRise and WeLearn.

Board chair Tina Freese Decker, president and CEO, BHSH Health System, acknowledged outgoing board members Tim Johnson, president and CEO, Eaton Rapids Medical Center, and Dan Babcock, CEO, Marlette Regional Hospital and Deckerville Community Hospital. Freese Decker also recognized past chair Ed Ness for his leadership during the pandemic and wished incoming chair T. Anthony Denton, senior vice president and chief operating officer, University of Michigan Health System, well in his leadership role. For more information about actions of the MHA Board of Trustees, contact Amy Barkholz at the MHA.

Final Procedural Step for CRNA Legislation Completed

Legislation enhancing hospital flexibility for anesthesia care went into full effect May 10 following official confirmation from the Centers for Medicare & Medicaid Services (CMS) that it had received the letter of attestation sent by the governor. This was the final step needed for the provisions in House Bill (HB) 4359 to go into full effect in Michigan.

The MHA-supported HB 4359 was signed into law by Gov. Gretchen Whitmer and took effect Oct. 11, 2021. Sponsored by Rep. Mary Whiteford (R-Casco Township), the bill modernizes the scope of practice for certified registered nurse anesthetists (CRNAs) 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 by eliminating the state requirement that a CRNA must work under direct physician supervision.

Federal provisions have allowed states to request exemption from physician supervision of CRNAs under 42 CFR 482.852 upon passage of applicable laws and a letter of attestation from the governor to the CMS.

Members with questions on the new law may contact Adam Carlson at the MHA, while questions regarding amending their facility policies should contact Amy Barkholz at the MHA.

Board of Trustees Meets at MHA Capitol Advocacy Center

The MHA Board of Trustees met at the MHA’s downtown Lansing offices April 13 and were joined by Michigan House of Representatives Appropriations Committee Chair Thomas Albert (R-Lowell). Albert provided an update on the progress of the fiscal year 2023 state budget, which includes funding for the state’s Medicaid and other health-related programs, indicating he expected the budgets to progress in a timely manner and be presented to the governor by the statutory July 1 deadline. The board also heard from State Attorney General Dana Nessel via a recorded video in which she described how the state would be allocating a $776 million legal settlement from opioid drug manufacturers. Nessel indicated the funds would be divided evenly between the state and local county and municipal units of government. The board called on members to share best practices to help hospitals reach out to their local community health departments and seek collaborative ways to use the funds most effectively.

The board also engaged in a strategic discussion on workforce sustainability and behavioral health funding and delivery, noting that both are key priorities in the association’s multiyear action plan. A discussion surrounding the recent Tennessee case involving a criminal conviction of a nurse reinforced the board’s priorities surrounding building a culture of safety and supporting the ongoing work of the MHA Keystone Center. Other action included approval of an amendment to the MHA bylaws to extend Type 2-B membership to Michigan-based ambulatory care organizations. The amendment will also go to the MHA House of Delegates for approval at the association’s annual meeting in June. Finally, the board approved the recommendations of the Task Force on Dues and Governance to provide a 2% annual dues increase over the next three years based on a value-driven performance assessment and approved Type 3 association memberships for Enviah, PC; Joint Venture Hospital Laboratories, LLC; and Lilly USA. For more information, contact Amy Barkholz at the MHA.

Combating the Novel Coronavirus (COVID-19): Week of March 14

MHA Covid-19 update

MHA Covid-19 updateAs Michigan begins the third year of living with COVID-19, new cases, hospitalizations and deaths are trending downward and hopes are high that a new variant will not emerge to cause another surge of disease. The state reported there were 2,770 cases recorded for March 17 and 18 (including about 825 cases attributable to older lab results), 648 adults and children were hospitalized with confirmed and suspected cases, and 50 deaths caused by the disease were recorded over the two-day period. These numbers are fractions of what was seen in December and January, when Michigan hospitals were at or near inpatient capacity.

The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

MIOSHA Will Not Increase COVID-19 Inspections of Healthcare Facilities

Barton Pickelman, director of the Michigan Occupational Safety and Health Administration (MIOSHA) within the Department of Labor and Economic Opportunity, has confirmed that MIOSHA will not be conducting additional, focused, COVID-19 compliance inspections of healthcare facilities in Michigan. Although a March 2 memo issued by the federal Occupational Safety and Health Administration (OSHA) announced a 90-day COVID-19-focused inspection initiative for hospitals and skilled nursing care facilities, Pickelman noted that MIOSHA and other state plans are not required to adopt the federal OSHA initiative. Because MIOSHA has already conducted state emphasis programs for healthcare over the past two years, it is not adopting the federal inspection initiative.

Separate from the OSHA inspections, surveyors from the Michigan Department of Licensing and Regulatory Affairs (LARA) will continue to check for compliance with requirements of the Centers for Medicare & Medicaid Services and state licensing agencies during regular survey visits or in response to specific complaints. LARA will confirm that facilities have written policies and protocols in place surrounding COVID-19 screening processes, are following their policies as written, and that these policies and protocols can allow either active or passive screening procedures, consistent with guidance from the Centers for Disease Control and Prevention (CDC).

For more information, contact Laura Appel or Amy Barkholz at the MHA.

MHA Creates State/Federal COVID-19 Guidelines Tracker for Providers

To help hospitals and health systems keep track of COVID-19 guidelines, the MHA has developed a document outlining state and federal COVID-19 protocols for healthcare personnel, including vaccination, masking and COVID-19 testing guidelines from both the CDC and the Michigan Department of Health & Human Services (MDHHS). The downloadable tool can be found on the MHA’s website on the COVID-19 webpage under Resources for Healthcare Professionals. Those with questions may contact Lucy Ciaramitaro at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

MHA Board Meeting Focused on Workforce, Other Healthcare Challenges

At its Feb. 9 meeting, the MHA Board of Trustees had robust conversations about key priorities for healthcare and the MHA. Among them were the MHA’s role as healthcare and public policy continue to evolve; workforce development and shortages (including $300 million appropriated by the Michigan Legislature; see related article); auto no-fault insurance; staffing agency challenges; COVID-19 data trends; Medicaid payment and policy; and much more. The MHA will use much of the board’s discussion to address strategic priorities this program year and beyond.

Members with questions about the MHA Board of Trustees may contact Amy Barkholz at the MHA.

Combating the Novel Coronavirus (COVID-19): Week of Dec. 13

MHA Covid-19 update

MHA Covid-19 updateA full year after COVID-19 vaccines were made available in the U.S., the coronavirus continues to sicken and kill people, with nationwide deaths from the illness surpassing 800,000. As demonstrated in a collection of headlines, Michigan’s hospitals are being stretched to treat COVID-19 patients across the state.

The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Legislation Signed to Delay Sequestration Cuts

President Joe Biden signed legislation Dec. 10 to stop Medicare cuts to hospitals, physicians and other providers from going into effect early next year. As urged by the MHA and the AHA, both the U.S. Senate and House recently voted to pass the legislation.

Specifically, the bill would extend the moratorium on the 2% Medicare sequester cuts until March 31, 2022, and reduce the cuts from 2% to 1% from April 1 through June 30, 2022. The package also would stop the 4% statutory Pay-As-You-Go sequester from taking effect early next year. Other provisions in the package would mitigate a separate Medicare payment cut to physicians; delay payment cuts and private payer data reporting requirements for certain hospital laboratories; and more (see related article). Members with questions may contact Laura Appel at the MHA.

Licensing Flexibility Passes Legislature, Awaits Governor’s Signature

The state Legislature completed work Dec. 14 on Senate Bill 759, which allows healthcare workers licensed in another state to work in Michigan during times of great need (see related article). The MHA issued a media statement both thanking legislators for their support of licensing flexibility and encouraging Gov. Gretchen Whitmer to sign the bill into law as soon as it’s enrolled.

Members with questions may contact Adam Carlson at the MHA.

State Approves Additional Tier-2 COVID Relief Facilities

Fifteen additional Tier-2 COVID Relief Facilities (CRFs) were recently approved by the state at a time when post-acute placements are critically needed.

Tier-2 CRFs can keep their own COVID-19-positive residents and are able to admit new residents who test positive only if additional capacity is needed and the nearest COVID Recovery Center (CRC) is more than 25 miles away or at maximum capacity with patients positive for the disease.

With the additional facilities, there are currently 27 CRFs in the state. While this is a positive development, the number is significantly lower than the more than 100 CRFs the state had approved before starting its annual renewal process in October. That process took nearly a month to approve the additional facilities. The MHA continues to advocate that the state not use an annual application process for approving CRFs due to the time involved and the delays it causes for hospital transfer.

In addition, Michigan currently has no Tier-2 CRFs north of Grayling. Therefore, the MHA is urging the state to work with facilities in the northern Lower Peninsula and Upper Peninsula to quickly approve them as CRFs. Members with questions may contact Paige Fults at the MHA.

Changes Continue with Legal Action on Vaccine Mandates

The U.S. Court of Appeals for the Fifth Circuit issued a ruling Dec. 15 ordering the Centers for Medicare & Medicaid Services (CMS) vaccine mandate rule to resume in about half of the country while saying 24 states are not subject to the mandate. This means that the mandate is back in place for Michigan, requiring healthcare workers to be fully vaccinated. However, the suspension of enforcement of the mandate continues.

The Fifth Circuit upheld the Louisiana district court’s preliminary injunction as applied to facilities in the 14 states that are plaintiffs in the case. An additional 10 states that are plaintiffs in a Missouri case do not need to comply with the mandate while the injunction stands. Michigan is not a plaintiff in either lawsuit.

The American Hospital Association (AHA) provides a blog with the latest details of the CMS vaccine mandate cases, as well as an update on an appeals court ruling challenging the Occupational Safety and Health Administration vaccine mandate.

The recent court actions are additional steps toward the suits eventually being appealed to the U.S. Supreme Court. These legal actions do not impact individual organizations’ vaccine policies. Members with questions should contact Amy Barkholz at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpageQuestions on COVID-19 and infectious disease response strategies may be directed to the Michigan Department of Health and Human Services Community Health Emergency Coordination Center (CHECC)

Combating the Novel Coronavirus (COVID-19): Week of Dec. 6

MHA Covid-19 update

MHA Covid-19 updateAs MHA CEO Brian Peters outlines in his December CEO Report, the situation confronting Michigan hospitals is dire, with hospitalizations due to COVID-19 exceeding record highs and intensive care units full of patients — most of whom are unvaccinated. The MHA joins healthcare experts around the country in urging the public to get one of the available COVID-19 vaccines.

The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Legislature Considers Bills to Assist in Treating COVID-19

The Michigan House Appropriations Committee voted Dec. 8 in support of House Bill 5523, a bill that would provide critical staffing resources to hospitals and other providers. The MHA urges hospitals and others to contact their legislators, urging them to support the bill (see related article).

In addition, the Michigan Senate unanimously voted Dec. 8 in support of Senate Bill (SB) 759, a bill that would allow healthcare workers licensed by another state to continue to practice in Michigan during COVID-19 (see related article).

Court Issues Temporary Stay of Vaccine Mandate Enforcement for Federal Contractors

A federal district judge in Georgia issued an injunction Dec. 7 that is applicable to all states and temporarily pauses enforcement of the Centers for Medicare & Medicaid Services (CMS) COVID-19 vaccine mandate for federal contractors.

This is a preliminary injunction; until there is a final decision from the highest appellate court on these challenges to the CMS rule, federal contractors should be prepared to comply if the requirement is upheld. Like previous injunctions, this does not impact a contractor’s ability to implement and enforce its own organization-based vaccine policy.

The MHA will apprise members of updates on legal challenges to President Joe Biden’s vaccine mandates as they become available. Those with questions may contact Amy Barkholz at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpageQuestions on COVID-19 and infectious disease response strategies may be directed to the Michigan Department of Health and Human Services Community Health Emergency Coordination Center (CHECC).

Combating the Novel Coronavirus (COVID-19): Weeks of Nov. 22 and 29

MHA Covid-19 update

MHA Covid-19 updateThe state’s coronavirus webpage indicates there were an average of 9,222 new COVID-19 cases per day Dec. 2 and 3, bleakly demonstrating the current surge of the disease in Michigan. However, 55.6% of Michiganders ages 5 and older were fully vaccinated as of Dec. 3, and more than 1.6 million residents had received booster shots as of that date.

The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Collaborative Efforts Urge Public to Take Precautions, Get Vaccinated

As the omicron variant, the latest version of the evolving coronavirus, begins to appear in the United States, the MHA, its members and public health agencies are urging the public to be particularly mindful of precautions they can take to guard against infection. At this time, there is no evidence to indicate omicron is present in Michigan. However, the MHA will remain in close contact with the State Department of Laboratories as it sequences samples and will keep members apprised of any developments.

The Michigan Department of Health and Human Services (MDHHS) and the MHA issued a joint press release Dec. 2 using a new set of infographics developed by the association. These images show the percentages of vaccinated versus unvaccinated COVID-19 hospitalizations, those in ICUs and those on ventilators. The release urged the public to get vaccinated to not only protect their own health, but the health of healthcare workers and to avoid additional strain on the state’s healthcare systems.

MHA-member health systems provided the data for this effort. The release included the following messages:

  • Three out of four COVID-19 patients are unvaccinated (76%).
  • 87% of COVID-19 ICU patients are unvaccinated.
  • 88% of COVID-19 ventilator patients are unvaccinated.

Members are encouraged to share these figures along with their organizations’ local data to maintain the public’s awareness. Members with questions may contact Ruthanne Sudderth at the MHA.

In addition, the MHA published a consensus statement Nov. 22 to statewide media on behalf of the chief medical officers of its member hospitals urging the public to take action to help slow COVID-19 growth throughout the state and educate them about the serious nature of the current surge and hospital capacity issues. MHA members are encouraged to use this statement locally or use it as a template for an organization-specific update to their communities. This message has been widely broadcast throughout the state (see related article).

Members with questions about vaccines and COVID-19 precautions may contact Ruthanne Sudderth at the MHA.

CMS Delays Enforcement of Healthcare Worker Vaccine Mandate as Courts Issue Injunctions

Although Michigan was not impacted by the Nov. 29 preliminary injunction against enforcement of the Centers for Medicare & Medicaid Services (CMS) healthcare worker vaccine mandate in 10 states, a separate preliminary injunction issued Nov. 30 does affect Michigan by placing a hold on the mandate in all other states. The federal government has appealed each order to the U.S. Court of Appeals in their respective circuits and asked the appellate courts to set aside the district courts’ preliminary injunction pending appeal.

Subsequently, the CMS issued a memorandum Dec. 2 confirming that it will not enforce its vaccine mandate while the court orders are in effect. The memo states that the CMS has “suspended activities related to the implementation and enforcement of this rule pending future developments in the litigation.” It also states that “while these preliminary injunctions are in effect, surveyors must not survey providers for compliance with the requirements of the” mandate.

The document does not state what the CMS would do when and if the preliminary injunctions are removed, such as setting new compliance dates.

The federal mandates do not impact hospitals’ ability to implement their own organization-based staff vaccine requirements if they choose to adopt such a policy.

MHA members are encouraged to follow the American Hospital Association (AHA) blog authored by Sean Marotta, a partner at Hogan Lovells and outside counsel for the AHA. The blog will be updated regularly as new developments occur. The MHA will also keep members apprised of developments. Members with questions may contact Amy Barkholz at the MHA.

Medicaid Coverage Expands to Cover Authorized In-home COVID Test Kits

The MDHHS recently released concurrent proposed and final policies to expand Medicaid coverage of COVID-19 testing to include home testing kits authorized by the U.S. Food and Drug Administration when administered consistent with recommendations by the Centers for Disease Control and Prevention. The expanded coverage for dates of service on and after Aug. 30, 2021, is contingent upon approval by the CMS. Approved testing kits must be prescribed or ordered by a Medicaid-enrolled participating pharmacy. Coverage will continue through 15 months following the end of the federal public health emergency. Comments should be submitted by Jan. 4. Questions may be directed to Vickie Kunz at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpageQuestions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

MHA Board Discusses COVID-19 Surge, Behavioral Health, Sustainability Goals

Amid a third surge of cases and hospitalizations in the state, the MHA Board of Trustees began its April 14 meeting with a review of the COVID-19 data dashboard. While Michigan’s positivity rate, emergency department visits and hospitalizations have approached levels seen last fall, there is some indication that these numbers may be leveling off. In addition, the data show that the current surge has been less lethal than previous waves due to the state’s success in vaccinating older citizens. Despite this good news, the current wave of COVID-19 infections has sickened younger adults and children more severely than earlier surges. Board members universally expressed concern about staffing fatigue as hospitals continue to care for patients while also managing staffing challenges associated with workforce illness, quarantine, and administering and operating vital community vaccine clinics. Board members urged the MHA to continue its public messaging on the importance of vaccination, as well as continued mask usage, social distancing and hand washing. The board further stressed the importance of encouraging higher vaccination rates within the healthcare community through voluntary measures, including having management lead by example and sharing best practices.

The board also engaged in a significant discussion about the ongoing challenges of funding and access for behavioral health patients, especially adolescents. The MHA estimates a need for an additional 120 inpatient pediatric beds in Michigan to treat patients for four- to12-week lengths of stay. The board endorsed proposals of the MHA Behavioral Health Council to seek grants to improve treatment in the emergency room, establish crisis stabilization units and identify incentives for recruiting child behavioral health providers.

The meeting also included a presentation from the chair of the MHA Green Healthcare Committee on its work to support healthcare efforts to advance sustainability goals related to energy, water, waste reduction, environmentally preferred purchasing, healthy sustainable food and community mobility. Finally, the board kicked off the association’s 2021 campaign for the Health Political Action Committee (PAC). More information about the campaign is available online.

Members with questions on the vaccine rollout or COVID-19 data issues should contact Ruthanne Sudderth and questions about the MHA Board of Trustees should be directed to Amy Barkholz at the MHA.