Gov. Whitmer signed House Bill 4016 today, appropriating $75 million for the recruitment, retention and training of hospitals workers. This funding will directly benefit hospital workers and play an important role in helping to support hospitals experiencing a generational workforce shortage.
According to a recent survey of hospitals conducted by the MHA, there are more than 27,000 job openings in hospitals throughout Michigan, including nearly 8,500 nursing job opportunities. Other areas with a high need include technicians with more than 4,500 job openings, clinical assistants with 3,000 openings and 1,700 openings for operational support in areas such as environmental services and food service.
Hospital staffing levels determine patient capacity within facilities. Michigan has lost a high of about 1,700 staffed hospital beds since 2020 because of workforce shortages. Filling these job openings would increase statewide inpatient hospital capacity, expand service availability and assist in the transition of care outside of a hospital.
“Maintaining the sustainability of our healthcare workforce is a universal priority for all Michigan hospitals and health systems,” said MHA CEO Brian Peters. “We appreciate the work from the Michigan Legislature and Gov. Whitmer in passing this funding that will support hospital workers and help solve staffing shortages that persist throughout healthcare.”
House Bill 4016 was introduced by Rep. Angela Witwer (D-Delta Township) and passed the Michigan Senate Feb. 28 and the Michigan House of Representatives March 1 with bipartisan support.
Those interested in a healthcare career should visit the careers webpage of their local hospital or health system.
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.
Michiganders deserve local access to care from their hospitals, but that access has been threatened by a generational workforce shortage. On behalf of our member hospitals and health systems, we are very thankful our partners in the Michigan Legislature recognized this need and continue to be involved in developing solutions to retain and expand healthcare talent in Michigan. This supplemental appropriation will continue to assist in recruiting a talented and skilled workforce to Michigan hospitals, in addition to keeping and training existing staff.
There are currently more than 27,000 jobs available in Michigan hospitals. While our members continue to work closely with the education community to expand opportunities in the talent pipeline, this funding plays a crucial role in ensuring the viability of hospital service lines and capacity. We plan to work with the administration to ensure this funding is available as quickly as possible to make sure hospitals are staffed and ready for the health needs of all members of the community.
“The country is lyric, the town dramatic. When mingled, they make the perfect musical drama” — Henry Wadsworth Longfellow
Having 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.
The MHA received media coverage the week of Feb. 13 regarding challenges impacting hospital viability in Michigan and on a statement released by MHA CEO Brian Peters following the shooting Feb. 13 on the campus of Michigan State University (MSU).
MHA Board Chair T. Anthony Denton.
Bridge published an op-ed Feb. 13 from MHA Board Chair T. Anthony Denton, J.D., MHSA, expressing the need to consider short- and long-term policy solutions to the problems facing healthcare in Michigan. Denton is also senior vice-president and chief environmental, social and governance officer of University of Michigan Health-Michigan Medicine.
“I believe in the power of quality healthcare — care that treats the whole person, with attention and dignity and is close to where people live,” said Denton. “We can only continue to provide that care with high levels of commitment to health with proper resources. Please join me in my call to our policy leaders: healthcare is a team sport, and we all have a vital role to fulfill, on behalf of patients, healthcare teams, families and communities.”
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.
Words can’t express the sadness and concern we feel this morning for the victims from the shooting last night on the Michigan State University campus. Our hearts break for the families of the victims and we have in our thoughts those we lost last night and those fighting for their life in the hospital.
The MHA and our member hospitals have extremely close relationships with our higher education partners. We have particularly close ties with Michigan State University due to the many connections the MHA has with the university here in the Greater Lansing area. However, much more than our close proximity, healthcare employs countless Spartans who graduate from East Lansing every year. Our hearts ache for our fellow Spartans and we mourn together.
Lastly, we want to applaud the first responders, including police, EMS and healthcare workers who selflessly responded to this senseless act of violence.
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 Health subcommittee and the need for hospitals to make infrastructure updates.
Below is a collection of headlines from around the state that includes interviews or statements from MHA representatives. Included is coverage from a media statement from MHA CEO Brian Peters released a statement published in support of the executive budget recommendation, thanking Gov. Whitmer for her continued commitment to protecting hospitals and supporting healthcare workers.
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 new investments in workforce training and development. None of the line items important to MHA members were recommended for reductions in the recommendation.
The MHA will share additional information on the new initiatives in the coming weeks, but below are a few key pieces for MHA members.
New or expanded funding items:
Healthy Moms and Healthy Babies – $62 million.
Implementing recommendations from the Racial Disparities Task Force – $58 million.
Increased rates for laboratory services, traumatic brain injury services and other related professional services – $120 million.
Expanding eligibility for the Michigan Reconnect scholarship program – $140 million.
Building capacity for insulin production in Michigan – $150 million.
Discretionary mental health supports for K-12 students – $300 million.
Items receiving continued, full funding:
The Healthy Michigan Plan (Medicaid expansion).
Hospital Quality Assurance Assessment Program.
Rural and obstetrical stabilization pools.
Hospital outpatient rate increase.
Critical access hospital rate increase.
MHA CEO Brian Peters released a statement in support of the executive budget recommendation, thanking Gov. Whitmer for her continued commitment to protecting hospitals and supporting healthcare workers.
Members with questions about the budget or any other state legislation impacting hospitals should contact the MHA advocacy team.
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.
Gov. Whitmer and her administration demonstrated their commitment to protecting hospitals and supporting healthcare workers with the release today of the 2024 executive budget recommendation. Not only does it continue to protect vital funding pools in the state budget, but also provides health equity resources and includes significant workforce investments that should help grow the healthcare talent pipeline.
Important items included in the state budget include support for rural and critical access hospitals, obstetrical services, graduate medical education, the Healthy Michigan Plan and Michigan’s Medicaid population. The investments to expand the Healthy Moms, Healthy Babies program and to implement recommendations from the Racial Disparities Task Force should help improve health outcomes and reduce disparities in care. The announced workforce development investments such as lowering the eligibility age for Michigan Reconnect are long-term strategies that should help fill the incoming talent pipeline as staffing challenges continue to impact hospitals and their overall patient capacity.
Actions like today show Gov. Whitmer is a healthcare champion and on behalf of Michigan’s hospitals, we thank her for helping Michigan advance the health and wellness of individuals and communities. The MHA is committed to working with lawmakers throughout the budget process to identify funding solutions that expand access to care, protect the viability of hospitals and assist healthcare workers.
“I have gained this by philosophy; I do without being ordered what some are constrained to do by their fear of the law.” ― Aristotle
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 new leaders in key roles. The playing field has changed in a palpable way.
As healthcare leaders, the list of emerging challenges may seem endless today, ranging from unprecedented labor shortages, inflation, cybersecurity and much more. But as the new legislative session ramps up, we also can’t turn a blind eye toward issues from years past which have the potential to rear their ugly head once again. Medical liability is at the top of that list and merits our close attention.
One of the MHA’s signature achievements over the past thirty years was the passage of sweeping medical liability reforms in the early 1990s. Our leadership and collaboration with our friends in organized medicine and other partners helped to directly address a situation that had become untenable for Michigan: runaway verdicts in medical liability cases were threatening the financial viability of hospital-based service lines (and even entire hospitals). Doctors, particularly those in high-risk specialties, were leaving the state in droves and our recruitment efforts faced an extraordinarily high hurdle.
Since the passage of our reforms, which brought reason and predictability to the system, medical liability has been relatively stable for nearly three decades, even as the caps on noneconomic damages continued to grow with inflation. And over the years, the MHA has been extremely vigilant, advocating to preserve these reforms both in the legislative arena and in the courts, where we have filed countless amicus curiae briefs on behalf of our members and the healthcare field. However, a recent decision by the Michigan Supreme Court is bringing these concerns back to the forefront of our minds.
The case of Estate of Langell v McLaren Port Huron, heard by the Michigan Supreme Court in 2022, ultimately affirmed a Court of Appeals decision that a plaintiff’s estate can recover all earning potential that a decedent would have been able to earn and provide if a person who died due to medical malpractice had lived. This is now the law, even if that person was not responsible for the support of anyone else. The Court of Appeals cited the precedent established in Denney v Kent Road Commission. Since that decision, what a decedent’s estate can recover is referred to as “Denney damages.” Cases that once settled for $250,000 are now expected to be resolved for $700,000.
With “Denney damages,” the liability for healthcare organizations increase as earnings can be counted for any victim of medical malpractice, even those who have yet to establish any known talents, educational attainments or trainings typically used to calculate such earnings.
It is important to note that while we engage on this topic in the public policy arena, our ultimate priority is the safety and wellbeing of patients. Our hospitals and providers take the life of each patient in their care extremely seriously and there is nothing a hospital wants to avoid more than a medical error. To that end, we have “put our money where our mouth is” by establishing the MHA Keystone Center, which has become a true leader in this space, both in Michigan and nationally. The Keystone Center, which also operates a federally certified Patient Safety Organization, collects and analyzes data on medical errors and “near-misses,” serving as a North Star in our collective efforts to improve patient safety and quality. Our successes have been well-documented in peer-reviewed medical journals. Blue Cross Blue Shield of Michigan has provided significant funding to the MHA Keystone Center over the years, and so has the federal government through a series of contracts, as they have seen and valued the tangible improvements we have made and will continue to make.
Back to the issue at hand: our hospitals and providers are committed to doing right by patients, through the provision of the highest quality care possible. And for nearly three decades, Michigan’s medical liability laws have proven our system can fairly handle cases of medical malpractice that compensate patients and families fairly while maintaining hospital liability at sustainable levels that do not threaten the viability of an organization due to a single error. The system works and it is our intention to keep it that way.
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 how the 340B drug pricing program benefits hospitals. The placement of the op-ed follows recent criticism of the program in the media on how the program generates savings for hospitals and health systems.
“Michigan has some of the best state-level 340B protections in our country that prioritize access to care for vulnerable patients,” said Peters. “The program is funded through drug company discounts and not taxpayer dollars. Reducing the availability of 340B simply means even higher profits for drug companies. As the Michigan Legislature begins a new session, it is important to remember that for three decades, the 340B drug pricing program has received bipartisan support and helped hospitals from Detroit to the Upper Peninsula.”
In a separate story, Laura Appel, executive vice president of government relations and public policy, MHA, appeared in a story that looks at the shortage of child psychiatrists in rural and northern Michigan and the challenges it presents to children and families accessing care. The story originally written by Capital News Service was picked up by publications such as the Midland Daily News, Cadillac News, Ludington Daily News and City Pulse.
Members with any questions regarding media requests should contact John Karasinski at the MHA.
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 new investments in workforce training and development. None of the line items important to MHA members were recommended for reductions in the recommendation.