The MHA Board of Trustees concluded the 2020-2021 program year by holding its first in-person meeting of the year at the MHA offices in Okemos for fully vaccinated attendees. As with every meeting since the onset of the COVID-19 crisis, the board reviewed the latest statewide COVID-19-related data and took a moment to reflect on the daunting toll the virus has taken in lives lost and strain placed on healthcare workers and all Michiganders. It was noted that, since the onset of the pandemic, Michigan hospitals have treated over 450,000 COVID-19 patients in emergency departments and admitted more than 120,000 for inpatient care, including 4,500 children. Despite these sobering statistics, the board celebrated the continued steep decline in COVID-19 hospitalizations and infections, as well as advancements in treatment since the onset of the pandemic; however, members expressed concern about slowing rates of vaccination as more infectious variants continue to spread nationally.
The board welcomed the staff of the Michigan Osteopathic Association (MOA), which represents osteopathic physicians statewide, as new tenants within the MHA headquarters building. MOA CEO and executive director, Kris Nicholoff, addressed the board and noted the longstanding and strong relationship between hospitals and the osteopathic community, which can be further strengthened through the new space-sharing arrangement.
The board also received a report on the status of healthcare funding priorities in the fiscal year 2022 state budget, which continue to be deliberated in the Legislature, as well as recent activities related to the statewide roll-out and provider concerns related to recent reforms to Michigan’s auto no-fault insurance law. Current Health PAC Chair and incoming MHA Board of Trustees Chair Tina Freese Decker provided an update on the status of the 2021 MHA Health PAC campaign, which has been extended through July 31. Freese Decker encouraged eligible individuals and organizations to meet their contribution goals. Information about the MHA Health PAC can be found online. The board also approved type 3 membership and Endorsed Business Partnership for NextJob, a nationwide reemployment solutions company.
The board concluded the meeting by acknowledging outgoing board members Edward Bruff, president & CEO, Covenant Healthcare, Saginaw; James (Chip) Falahee, senior vice president, Legal & Legislative Affairs, Bronson Healthcare Group, Kalamazoo; and David Jahn, president & CEO, War Memorial Hospital, Sault Ste. Marie. The board also recognized outgoing chair Ed Ness, president & CEO, Munson Healthcare, Traverse City, for his leadership during such a challenging program year and extended its best wishes to incoming chair Tina Freese Decker, president & CEO, Spectrum Health, Grand Rapids, for a successful year ahead. For more information about actions of the MHA Board of Trustees, contact Amy Barkholz at the MHA.
A somber milestone was reached April 17 when, according to Johns Hopkins University data, the global number of deaths caused by COVID-19 surpassed 3 million. 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.
MHA Board of Trustees Focuses on COVID-19 Data, Vaccines
The MHA Board of Trustees held a virtual meeting April 14, where much of the agenda focused on COVID-19 as the spring surge continues to challenge Michigan communities and health system resources (see related article). Board members heard presentations on hospitalization and other surge-related COVID-19 data, which may be starting to show signs of improvement as growth rates and emergency department visit rates begin to slow and plateau. Despite these encouraging signs, healthcare providers must continue to urge their communities to stay vigilant in preventive actions.
Board members also discussed vaccine-related issues, including the Johnson & Johnson pause and how it may impact conversations around equity, hesitancy, safety/effectiveness and more. They also discussed efforts health systems can pursue to encourage as many employees as possible to be voluntarily vaccinated. For more information on the board meeting, contact Amy Barkholz at the MHA.
Board members also met April 12 via Zoom with U.S. Sen. Gary Peters (D-West Bloomfield), who expressed interest in the experience of hospitals and health systems during the current surge of infection. Members shared the damage the pandemic has done to staffing capacity by causing exhaustion and early retirements; the need for post-COVID-19 care for brain health including seizures, anxiety and depression; and the younger average age of hospitalized patients. Peters announced his Committee on Homeland Security and Governmental Affairs is doing a complete after-action study of the COVID-19 pandemic to improve preparedness and communications for future long-term crises. For more information about federal advocacy and policy, members may contact Laura Appel at the MHA.
J&J Vaccine Paused While Investigation Continues on Six Blood Clot Events
The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), out of an abundance of caution, issued a statement April 13 that providers should halt administration of Johnson & Johnson (J&J) COVID-19 vaccines while they investigate six instances of blood clots in previously vaccinated individuals. More than 6.8 million J&J vaccines have been administered to date nationally, meaning these instances are extremely rare. All those affected were women between the ages of 18 and 48, and their symptoms developed six to 13 days after vaccination.
The CDC Advisory Committee on Immunization Practices (ACIP) met April 14 to discuss and review these incidents and, after several hours of debate, concluded that it would take additional time to review the cases and make a final recommendation for continued use of the vaccine. A decision is expected by the end of April.
Because the ACIP is an advisory committee, it is permissible, but highly unlikely, that the CDC and FDA would advise providers to resume use of the vaccine without a new recommendation from the ACIP. In the meantime, providers should continue to only use Pfizer and Moderna vaccines, and store/label J&J vaccines as instructed by recent alerts from the Michigan Department of Health and Human Services (MDHHS). The department stated, in part, “Clinics that are scheduled to administer J and J vaccine should be rescheduled to use a different vaccine. If you have inventory of this vaccine, please separate in your storage unit, mark do not use and store appropriately until further notice.”
The MHA will keep members apprised of recommendations as they become available. Members with questions on vaccines may contact Ruthanne Sudderth at the MHA.
Pfizer Requests Emergency Use Authorization for Younger Children
Pfizer recently asked the FDA to grant expanded emergency use authorization (EUA) of its COVID-19 vaccine for use in adolescents between the ages of 12 and 15. The request is based on data from Pfizer’s late-stage trial of the vaccine in children in this age group with or without prior evidence of COVID-19 infection, which demonstrated 100% efficacy and robust antibody response after vaccination.
The participants tolerated the vaccine with the incidence of side effects similar to adults, and Pfizer continues to monitor these adolescents. The company is also confident the vaccine will deliver long-term protection for as long as two years after the completion of dosage, although currently available data supports at least six months of protection. Since the vaccine is currently allowed to be used for anyone ages 16 and older, young Michiganders are urged to get vaccinated with the Pfizer vaccine as quickly as possible to prevent further spread among this age group, as well as illness, hospitalization and death.
Given the speed at which the expanded EUA could take effect, making 12- to 15-year-olds eligible for vaccination, health systems are encouraged to educate their family practice/pediatric care settings on administration of the Pfizer vaccine. The MHA will work with the Michigan Association of Family Physicians and the Michigan Chapter of the American Association of Pediatrics to coordinate messaging and resources. Members with vaccine questions may contact Ruthanne Sudderth at the MHA.
FDA Recommends Moving Away from Decontaminated N95 Respirators
The FDA recently issued guidance recommending that healthcare personnel and facilities transition away from crisis capacity conservation strategies for N95 respirators. Due to an increased supply of respirators approved by the National Institute for Occupational Safety and Health, the FDA believes there is a sufficient domestic supply to allow organizations to transition away from decontamination or bioburden reduction and reuse of respirators intended as single-use items. The guidance does not specify a “days on hand” calculation for when the recommendations should be implemented; it simply references moving away from the crisis capacity strategy.
To date, the Michigan Occupational Safety and Health Administration (MIOSHA) has not issued guidance or statements on how it will interpret this FDA letter in Michigan. The MHA will continue to advocate with state leaders for organizational flexibility in determining their supply needs and crisis capacity strategies.
Organizations that have concerns about their supply of personal protective equipment (PPE) should contact the appropriate Regional Health Care Coalition. Members with questions or concerns on PPE may also contact Adam Carlson at the MHA.
MIOSHA Issues Permanent COVID-19 Workplace Rules
The MIOSHA released draft rules that would make permanent workplace regulations governing the use of PPE, physical distancing, contact tracing and other pandemic-related modifications. The MHA participated in a work group on the development of the permanent rules, but its suggestions to allow the rules to be flexible for updated CDC guidelines and to set an end date to the rules were not adopted in the draft rule set. The association followed up by submitting its recommendations to the MIOSHA in writing.
Emergency rules already in place on this topic were slated to expire April 14 and are expected to be extended to Oct. 14, 2021. The MHA hosted a webinar in December on that rule set for members, and the association will review the renewed emergency rules when they are available. The MHA will compile additional recommended changes to the permanent rule set prior to a public hearing being scheduled. Members with questions on the emergency or permanent MIOSHA rules may contact Adam Carlson at the MHA.
COVID-19 patients continued to fill Michigan hospitals throughout the Thanksgiving holiday and into December, while drug companies Pfizer and Moderna applied for emergency authorization of their respective COVID-19 vaccines from the Food and Drug Administration (see related article). The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
Nursing Home Application Deadline Extended; CRC Bulletin Issued
The state announced Nov. 30 that it is extending the deadline from Dec. 1 to Dec. 15 for long-term care (LTC) facilities to become care and recovery centers (CRCs) and COVID relief (CR) facilities. The MHA has advocated for this extension to ensure LTCs do not transfer residents to hospitals without medical indication simply to avoid being out of compliance with new law requirements. While this is a positive step, the MHA will continue to advocate for more permanent solutions to transfer issues and the number of LTCs approved as CRCs and CR facilities.
The MDHHS also issued a bulletin for hospital-based CRCs. Bulletin Number MSA 20-78 supplements Bulletin Number MSA 20-73, which established operational requirements for nursing facilities to operate as CRCs during times of a public health emergency and provides a pathway for Michigan hospitals to establish hospital-based CRCs to support the safe care and isolation of COVID-19-positive individuals. Details about requirements for hospitals seeking designation as a CRC, how to apply and more are available in the bulletin.
Quarantine Duration Requirements Addressed
The MHA hosted its weekly call of hospital/health system chief medical officers Dec. 4, which was joined by representatives of the MDHHS. Among the topics discussed was quarantine requirements and the new guidance from the Centers for Disease Control and Prevention (CDC) advising the public that shorter quarantine periods of 7-10 days may be acceptable, depending on their access to testing and their symptoms or lack thereof.
According to Public Act 238 of 2020, healthcare workers who are exposed to COVID-19 but test negative and are not symptomatic are still able to report to work. Employees’ quarantine needs apply to how they spend time outside of work. There remains in state statute a 14-day quarantine provision for employees who test positive for COVID-19. The MHA is working with state officials and legislators to amend Public Act 238 of 2020 to bring quarantine times for employees who test positive in line with the CDC guidance. Additional information on the statute and administration rules is available from the Michigan Occupational Safety and Health Administration (MIOSHA), as discussed below.
Healthcare facilities and professionals may get questions from patients/community members on this change in quarantine guidance. The state announced its recommendation that the public continue to use the 14-day quarantine as a best practice, but if that is not feasible, the 10-day recommendation should be followed. The state did not endorse a seven-day quarantine with a negative test as a safe alternative.
MIOSHA Emergency Rules Clarified
The MHA hosted a call Dec. 1 with representatives from MIOSHA regarding its emergency rules that, among other items, emphasize the use of a remote workforce and proper use of personal protective equipment.
MIOSHA provided an overview of the rule set and answered questions, emphasizing the agency’s reliance on CDC guidelines in developing the rules and the availability of the free MI Symptoms app to assist employers. Questions or requests for the meeting materials should be directed to Adam Carlson at the MHA.
New Uses of Surge Capacity Beds May Require Certificate of Need Approval
Temporarily licensed surge capacity beds that have already been approved by the Bureau of Community and Health Systems (BCHS) may continue to be used if the following criteria are met:
An originally required emergency certificate of need (CON) approved by the MDHHS remains in effect.
The facility has maintained the BCHS-approved surge capacity so that it can be used within 48 hours if needed.
The facility has not notified the BCHS since the original approval that it has voluntarily surrendered the surge capacity.
If facilities with existing BCHS-approved surge capacity beds want to operate these beds in a different location, manner or use than originally requested, they must contact the MDHHS CON program, as applicable, and the Michigan Department of Licensing and Regulatory Affairs (LARA) State Licensing Section to determine whether new approval is required. Such requests must include a detailed narrative description of the proposed new use, space and floor plans of the area showing the new bed locations. If the proposed space deviates from current BCHS physical plant regulatory requirements, such as minimum square footage, hand sink locations or number of patients/residents to a room, the facility must include a narrative description of how those issues will be addressed to ensure patient/resident safety and care needs.
If the state has questions or concerns on a proposal as submitted, the Health Facilities Engineering Section engineer assigned to the facility will follow up as needed to address those concerns.
All applications not previously approved must apply to both the MDHHS and LARA as applicable and required. Both BCHS-HFD and Appendix E forms are required when applying. Members with questions may contact Paige Fults at the MHA.
BCBSM Provides Update on Coverage for COVID-19 Care and Testing
Blue Cross Blue Shield of Michigan (BCBSM) recently announced that it will continue to waive cost-sharing for its members diagnosed and treated for COVID-19 through March 31, 2021. This extension of a temporary benefit, originally set to expire Dec. 31, means members will not pay out-of-pocket costs — copays, deductibles or coinsurance — for the medical care and pharmacy costs associated with COVID-19. Members with feedback or questions are encouraged to contact Jason Jorkasky at the MHA.
Judge Denies Injunction for Bars, Restaurants Ordered Closed by MDHHS
A federal judge Dec. 2 denied a motion for preliminary injunction seeking to end the temporary MDHHS-ordered closure of bars and restaurants intended to prevent further spread of COVID-19. The MHA submitted an amicus or “friend of the court” brief in support of the temporary emergency measures enacted by the MDHHS. The MHA also issued a media statement supporting the order, which is effective from Nov. 18 through Dec. 8.
The ruling on Michigan Restaurant and Lodging Association v. Gordon was issued by Judge Paul Maloney of the U.S. District Court for the Western District of Michigan. It states that the motion was not granted to plaintiffs because it found the MDHHS’ reasoning for the order convincing and that groups tend to linger more in those settings than transitional environments like a food court or airport dining area.
Maloney further stated that, because the Michigan courts have not yet had an opportunity to evaluate the state issues and these challenges must be adjudicated before the federal claims can be considered, he scheduled a Dec. 17 certification hearing and will accept briefs from the parties to determine which legal questions to pass on to the state courts for further consideration. The MHA’s brief in support of the MDHHS provided medical evidence of the effectiveness of face covering and social distancing in curbing the spread of infection and reducing strain on the healthcare system. There are several other legal challenges in federal and state court against state and local public health orders requiring face coverings, social distancing measures and cooperation with contact tracing. Members with questions about the ruling may contact Amy Barkholz at the MHA.
The MHA continues to keep members apprised of developments affecting Michigan hospitals during the pandemic through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
Requirements Clarified on Quarantines for Ill Employees
Executive Order (EO) 2020-166, which mandated a 10-day home quarantine period for an individual who exhibited any COVID-19 symptoms, was recently rescinded and replaced with EO 2020-172.
The previous order had provided no exception for a subsequent negative COVID-19 test or an alternative medical explanation for the symptoms. EO 2020-172 clarifies the symptoms of COVID-19, stipulates that two or more symptoms must be present to require quarantine, and allows an employee to avoid quarantine if their symptoms can be explained by another medical or physical condition. In addition, healthcare professionals and workers at specifically defined healthcare facilities are exempted from a requirement to stay at home for 14 days following close contact with someone who is COVID-19 positive.
Although the new EO does not address all the MHA’s concerns, it provides beneficial clarity. Members with questions should contact Amy Barkholz at the MHA.
Dr. Birx Meets with Governor, Healthcare Leaders in Michigan
A small group of healthcare leaders were invited to meet Sept. 2 with Deborah Birx, MD, the response coordinator of the White House Coronavirus Task Force. Birx came to Michigan to meet with the governor in Lansing and with healthcare leaders at St. Mary Mercy Livonia about Michigan’s efforts to fight COVID-19 and the continuing challenges that could be aided by additional federal action.
Part of the conversation with the healthcare group focused on growing concerns over inadequate lab and testing supplies for diagnosing both COVID-19 and other conditions. The MHA expressed several concerns related to lab supplies and other issues that were also outlined in a letter to Birx.
Birx provided input on a range of issues, including urging hospitals to be “efficient” in their use of lab supplies for COVID-19 testing, offering praise for how Michigan and Detroit, specifically, have managed COVID-19 outbreaks and the public health response, and more.
The MHA will keep members apprised of any additional communication from the White House Coronavirus Task Force in follow-up to this meeting.
Visitor Restrictions for Residential Care Facilities Updated
The Michigan Department of Health and Human Services (MDHHS) issued an order Sept. 10 that will allow outdoor visits at residential facilities while continuing to require precautions to protect against COVID-19. Residential facilities are not required to allow visitors under this order, which takes effect Sept. 15; it simply allows the visits if they meet the requirements and wish to allow guests.
The order is based in part on recommendations from the governor’s Nursing Home Preparedness Task Force and creates exceptions to the governor’s order that temporarily restricts visits at healthcare, residential, congregate care and juvenile justice facilities. The MDHHS also considered the flattening of the COVID-19 curve and the impact of the visitor restrictions on residents of these care facilities in issuing the order. Residential facilities are required to ensure that outdoor visitation areas allow for at least 6 feet of separation between all people and provide adequate protection from weather elements. Someone trained in infection control must also be within sight range for compliance reasons.
Facilities must meet certain criteria, including having had no new COVID-19 cases originate at the facility within the previous 14 days. Additional requirements and a description of the facilities the order affects can be found in the emergency order.
Authorized Use of Remdesivir Expanded
The Food and Drug Administration recently expanded the authorized use of remdesivir for treating COVID-19 patients. Remdesivir can now be used for all hospitalized COVID-19 patients, confirmed or suspected, whether the patient is on oxygen, off oxygen or intubated. This is a departure from the previous policy that restricted such treatment to those who required oxygen. For additional details, members can review the complete authorization letter issued Aug. 28.
Webinar Recording to Focus on PPE Strategies and Trends
The Department of Health and Human Services (HHS) Assistant Secretary for Preparedness and Response will hold a webinar Sept. 24 on personal protective equipment (PPE) preservation strategies, trends and lessons learned. Although the HHS webinar appears to be at maximum capacity, recordings of the event will be available upon request. The COVID-19: Optimizing Healthcare Protective Equipment and Supplies webinar will include public and private sector presenters on optimizing supplies of respirators and PPE, including crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. An online flyer provides more information on the topics to be covered and how to receive the recording.
CMS Releases Guidance for Reporting Requirements for Labs and Long-term Care Facilities
The Centers for Medicare & Medicaid Services (CMS) released COVID-19 reporting requirements Sept. 8 for laboratories and long-term care facilities. The new guidance complements a Sept. 2 interim final rule. Laboratories are expected to comply with the new requirements by Sept. 23. Those not in compliance will be subject to civil monetary penalties. The CMS also released new enforcement information for long-term care facility reporting requirements.
The MHA continues to work with both the MDHHS and the HHS to streamline the reporting process. Members with questions on data reporting should contact Jim Lee at the MHA.
Recording COVID-19 Federal Payments on the Medicare Cost Report
A recently updated CMS COVID-19 FAQs clarifies that COVID-19 Provider Relief Fund payments and Paycheck Protection Program loan forgiveness funds from the Small Business Administration should not be recorded as offsets to expenses on the Medicare cost report. This information is particularly important for critical access hospitals’ and other hospitals’ cost-based Medicare reimbursements, which would have been reduced if COVID-19 funding were to offset costs. The answers specific to Cost Reporting begin on page 98 of the document. Members with questions should contact Laura Appel.