The MHA published a letter today on behalf of all Michigan hospitals and health systems signifying their unified opposition to proposed House Bills 4550-4552, which threaten to put patient care at risk across Michigan. MHA CEO Brian Peters announced the letter during his testimony in the House Health Policy Committee, which contains the names of leaders from all Michigan hospitals and health systems.
“Our hospitals are prepared to serve you and your loved ones on your worst day with high-quality, safe care,” said Peters. “We can’t risk losing experienced clinical judgment and local access to care. It is for these reasons that our membership is publishing a letter today signed by every hospital leader indicating our complete unified opposition to these bills.”
The proposed bills would mandate one-size-fits-all nurse staffing ratios for all Michigan hospitals, which do not create more nurses nor solve staffing shortages, as evidenced in other states that have tried this policy. California has a shortage of 40,000 registered nurses, despite the presence of mandated staffing ratios for 25 years. Michigan hospitals are currently trying to hire more than 8,400 nurses for vacant positions despite a national staffing shortage. Data from the Michigan Public Health Institute and the Bureau of Labor Statistics show that 85% of all licensed Michigan registered nurses currently living in the state below the age of 65 continue to work as nurses from a pool of 119,714 RNs.
Peters was joined for testimony by Beth Charlton, president and CEO, Covenant HealthCare; Doug Dascenzo, DNP, RN, chief nursing officer, Trinity Health Michigan; and Bonnie Kruszka, DNP, FNP-C, ENP-BC, RN, VP & chief nursing officer ambulatory services, Munson Healthcare.
A representative from American Nurses Association – Michigan also testified in opposition. The committee hearing included approximately 60 hospital representatives in attendance.
The testimony opposition follows the announcement earlier this week of a comprehensive coalition of healthcare, business and advocacy organizations opposing the bills.
A diverse coalition of healthcare, business and advocacy organizations published a letter to members of the Michigan Legislature today opposing the proposed House Bills 4550-4552 and Senate Bills 334-336, which threaten to put patient care at risk across Michigan.
“These partners from a broad collection of industries all agree imposing a one-size-fits-all legislative mandate to hospital nurse staffing will harm patients and severely restrict access to care in Michigan communities,” said Brian Peters, CEO of the Michigan Health & Hospital Association. “Our nurses, patients and communities deserve more than political posturing that puts healthcare access at risk.”
The proposed bills would mandate one-size-fits-all nurse staffing ratios for all Michigan hospitals, which would not solve existing staffing shortages, as evidenced in other states that have tried this policy. In California, which has had legislatively mandated staffing ratios for over two decades, the state still faces a shortage of 40,000 RNs. Additionally, Michigan outperforms California in hospital quality, as Michigan has both a higher percentage of 4- and 5-star hospitals than California (49% to 35.3%) and a lower percentage of 1- and 2-star hospitals (18.4% to 38.7%), according to CMS Care Compare Hospital Overall Star Ratings.
The United States is facing a national nurse shortage issue, exacerbated by the aging nursing workforce, as many experienced nurses approach retirement. Currently, 32.3% of licensed RNs in Michigan are 55 years of age or older and nearly 8,500 open nursing positions exist statewide. A survey of 109 Michigan hospitals conducted in July 2023 shows Michigan is at risk of losing up to 5,100 hospital beds across the state if this legislation is implemented. This total represents 23% of Michigan’s overall statewide hospital bed capacity and is equivalent to closing all hospitals north of Grand Rapids and Flint.
The coalition emphasizes that mandatory nurse staffing ratios have a broader impact beyond hospitals alone, affecting all healthcare providers’ ability to hire nurses. With a finite pool of available RNs, nursing homes, rehabilitation facilities, physician practices and other healthcare settings will experience increased difficulty in recruiting and hiring nurses, especially as hospitals compete for the same talent pool.
“The entire healthcare sector is facing historic workforce shortages,” said Melissa Samuel, Health Care Association of Michigan President/CEO. “We all need more nurses. Unfortunately, these bills exacerbate the problem and fail to offer meaningful solutions.”
The potential impact to the business community is significant. Data collected from hospitals indicates the proposed ratios could increase healthcare costs by over $1 billion, impacting economic development and employers.
Recent EPIC-MRA polling of Michigan voters indicates that 82% do not believe the government should mandate one-size-fits-all nurse-to-patient staffing ratios in every hospital, and if the bills were to become law, 83% of Michigan voters would be concerned about their ability to receive care, or the wait times, in a Michigan hospital emergency room.
The coalition supports the following alternative solutions to address the nurse staffing shortages:
Join the Nurse Licensure Compact: Bring Michigan into the national Nurse Licensure Compact to reduce barriers for out-of-state nurses to practice in Michigan immediately, joining 41 other jurisdictions across the country.
Expand Michigan Reconnect Eligibility: Lower the age requirement to 18 and older, encouraging more individuals to pursue nursing careers.
Funding Innovative Approaches to Workplace Violence Prevention in Healthcare Settings: This complements the passage of House Bills 4520 and 4521 that increase penalties for violence committed against healthcare workers and would make the nursing profession more attractive by addressing safety concerns.
To date, Michigan hospitals, health systems and other healthcare providers have focused on addressing staffing shortages by implementing various measures, including increased compensation, partnerships with post-secondary education institutions, emotional well-being support, modernizing scope of practice rules and recruitment awareness campaigns such as MI Hospital Careers.
“Thought Of equality- as if it harm’d me, giving others the same chances and rights as myself- as if it were not indispensable to my own rights that others possess the same.” ― Walt Whitman, Leaves of Grass
As we have discussed in these monthly reports in the past, I am incredibly proud that the MHA is committed to the health equity journey, which once again has been identified by the MHA Board of Trustees as one of our association’s strategic pillars for this program year. We have made progress, with much more work on the docket.
It is clear that to achieve health equity, there are multiple complex factors that must be addressed, and by now most of us in the healthcare field recognize how issues like food insecurity, transportation and housing all play a significant role. But there is another important consideration: the ability to participate in elections is one of the foundational elements of our American democracy, and just as our member hospitals are very engaged in removing barriers to healthcare access, Secure Automatic Voter Registration (AVR) removes a barrier for low-income Michiganders in the voter registration process.
In our health equity journey, we have learned that we can’t take certain things for granted. A small but illustrative example: when my physician prescribes for me an important medication that must be refrigerated, neither one of us has traditionally thought twice about it….but what if the patient in question can’t afford their utilities bill, or can’t afford a refrigerator to begin with? In the same manner, most of us don’t think twice about registering to vote, either by driving to the Secretary of State office or logging on to our computer. But what if we don’t have a car and can’t afford a computer or internet access?
At the end of the day, the MHA is an advocacy organization, so we know all too well that elections at both the state and federal levels have major consequences on healthcare funding, and a wide range of public policies that affect health insurance, pharmaceutical access and so much more. It is only logical that the very people who are directly impacted by these healthcare funding and policy decisions should have a voice in the process.
House Bill 4983 currently introduced in the Michigan Legislature would help expand representation in Michigan by using existing government data to register eligible voters. Referred to as Secure Automatic Voter Registration, those receiving Medicaid benefits would be automatically registered to vote, increasing the number of eligible voters by approximately 400,000 to 600,000. Medicaid was picked for several specific reasons. First, the agency already verifies citizenship, which is a requirement for voter registration. Only limited non-health data would be securely and electronically shared with election officials, who would use this information to either register nonregistered Michiganders or update existing registration. New or updated voters would receive a mailer providing an opportunity to decline the registration or correct the information.
Second, registering Medicaid enrollees would address election inequities. People of color, new U.S. citizens, young adults, people with disabilities and low-income individuals are disproportionately excluded from voting in the U.S. and overrepresented among Medicaid enrollees. We know Medicaid beneficiaries, in aggregate, tend to have additional challenges that impede their ability to register to vote, such as working multiple jobs, transportation access, available childcare and other needs.
Lastly, Medicaid provides a secure avenue to update voter registration rolls, as Medicaid offices routinely work with public health information and have experience securely sharing data. The agency routinely shares data securely with other agencies to determine access to additional benefits and with outside organizations that provide healthcare and other services. Such a system streamlines the voter registration process because the state already has the required information on file needed to register to vote. It also allows information to be updated more regularly, improving the accuracy of the voter rolls.
The MHA supports efforts to increase voter participation and we believe that Medicaid Automatic Voter Registration helps to achieve that goal while improving the efficiency of voter registration. The country still only has 69.1% of the voting-age population registered to vote and we can do better. We also see communities with higher voter turnout have better health outcomes, in part due to increased attention and resources from elected officials. In our quest to address inequities across the board, Medicaid AVR is a step in the right direction of improving access to resources within Michigan’s minority and underrepresented populations.
New report outlines hospital community health efforts in FY 2021
The Michigan Health & Hospital Association (MHA) released today the Making a Difference in Our Communitiesreport that highlights how hospitals invested more than $784 million in community and voluntary-based activities in fiscal year (FY) 2021, from education and prevention services to community outreach, research and workforce development.
Data in the report shows investments made throughout the second year of the COVID-19 pandemic, demonstrating that despite the workforce challenges and financial burdens Michigan hospitals and health systems face, they continue to offer a wide range of services and resources to their communities beyond the traditional healthcare setting that improve the overall health, wellness and quality of life of residents.
“This report uplifts the profound impact Michigan hospitals, health systems and healthcare teams have on their communities,” said MHA CEO Brian Peters. “In addition to outlining the latest community benefit data, it provides specific examples showing how these investments are improving health outcomes, building community and supporting efforts around workforce restoration.”
The report features examples and testimonials from patients who benefit from the programs implemented by hospitals throughout Michigan, as well as providers. Many of these programs expand access to care, address healthcare workforce needs and improve the health of vulnerable populations.
“Our care teams at Trinity Health are driven by a mission of service and improving access to resources that help individuals and communities thrive,” said Shannon Striebich, MHA Board Chair and President and CEO of the Trinity Health Michigan Market. “Investing in behavioral health programming is just one example of what we do; I’m proud to see the work of our Western Wayne Suicide Prevention Coalition featured in the report among many other impactful community benefit stories.”
The full report and stories from hospitals across the state that exhibiting community benefit can be accessed online here.
MHA EVP Laura Appel discusses auto no-fault legislation with the Michigan Business Network.
The MHA received media coverage the week of Oct. 16 regarding auto no-fault legislation passed in the Michigan Senate and nurse staffing ratio legislation.
The coverage is based on interviews conducted with MHA CEO Brian Peters and MHA Executive Vice President Laura Appel.
Below is a collection of headlines from around the state.
The MHA received media coverage the week of Oct. 9 on rural healthcare challenges and legislation proposing state mandated nurse-to-patient staffing ratios.
The Detroit Free Press published an article Oct. 12 on the closure of Kelsey Hospital. Included is a quote from MHA CEO Brian Peters and MHA data regarding critical access hospitals and rural emergency hospitals. The story describes the close relationship and important impact hospitals have within their communities.
“We have to provide new options … new opportunities,” said Peters. “I think all of us — as residents of this state — want to have access to care, whether we’re in the big city or whether we’re on vacation in northern Michigan, or we’re commuting from point A to point B. You never know when you’re going to need health care and we need to have that infrastructure protected into the future.”
Two op-eds opposing one-size-fits-all nurse staffing ratios were also published. The first appeared in Bridge Michigan from MHA CEO Brian Peters, explaining the MHA’s opposition and the dramatic impact the legislation would have on a patient’s ability to access healthcare services.
Then Sen. Curt VanderWall presents to the MHA Legislative Policy Panel in 2019.
Rep. Curt VanderWall (R-Ludington) also published op-eds in the Ludington Daily News and Cleburne Times-Review explaining his opposition and the need for nurse staffing solutions that grow the talent pipeline while maintaining the ability to make staffing decisions at the local level.
Members with any questions regarding media requests should contact John Karasinski at the MHA.
MHA CEO Brian Peters speaks with the Michigan Business Network.
The MHA received media coverage the week of Oct. 2 regarding auto no-fault legislation introduced in the Michigan Legislature and nurse staffing ratio legislation.
The coverage is based on interviews conducted with MHA CEO Brian Peters and MHA Executive Vice President Laura Appel.
Below is a collection of headlines from around the state.
“Do the right thing. It will gratify some people and astonish the rest.”–Mark Twain
Last month’s CEO Report focused on our grave concerns with legislative proposals to mandate nurse staffing ratios, and the negative impact they would have on patient access to care. And we spent the entire month of September laser-focused on telling our story to elected officials, the media, business and healthcare trade groups and many others who care about the Michigan healthcare ecosystem. This advocacy work will continue, without question.
But the hallmark of the MHA and our members is to not simply advocate against bad public policy, but rather, to voluntarily do the right thing when it comes to the best interests of the patients and communities we serve. And when it comes to the safety and quality of the care we provide in Michigan hospitals, we indeed have a very special story to tell.
This year marks the 20th anniversary of the inception of the MHA Keystone Center, which was originally created in 2003 as a first-of-its-kind collaboration among hospitals to identify and implement practices that improve healthcare safety and quality and reduce cost. Acting as our safety and quality organization today, the MHA Keystone Center voluntarily identifies safety and quality improvement opportunities and develops solutions among Michigan hospitals to improve experiences for both patients and healthcare workers alike. The extraordinary partnerships among MHA Keystone Center hospitals have saved many lives as well as healthcare dollars.
It needs to be stressed that there is no mandate requiring participation; all Michigan hospitals and thousands of their team members voluntarily participate in MHA programs to improve the safety and quality of healthcare because of their missions to care for the sick and vulnerable. Because of our long history of success, a growing number of hospitals in other states are now part of MHA-led safety and quality initiatives. In addition, the hospital-based collaborative efforts first pioneered by the MHA Keystone Center have now been replicated in 48 of the 50 U.S. states and various other countries.
These initiatives are driven by evidence-based best practices and strongly supported by data. One great example of how engaged hospitals have seen great improvements on safety and quality outcomes is through the MHA Keystone Center’s leadership of the Great Lakes Partners for Patients (GLPP) Hospital Improvement Innovation Network (HIIN). Michigan hospitals saved 3,350 lives and avoided 25,304 harm events within hospitalized patients over a three-and-a-half-year period from Sept. 2016 to March 2020. In addition, our track record of outcome improvements includes the following:
Reduced the rate of CAUTI (catheter-associated urinary tract infection) events by 49% between 2012 – 2018.
Decreased CLABSI (central line associated blood stream infection) rates within ICUs by 35% between 2015 – 2018.
Reduced early elective deliveries by 68% between 2010 – 2018.
Reduced C. Diff rates by 15% from 2014 to 2017.
Reduced postoperative pulmonary embolisms and/or deep vein thrombosis by 22% from 2014 to 2016.
Reduced colorectal surgical site infections by 27% from 2014 to 2016.
This successful work led to the subsequent creation of the Superior Health Quality Alliance (Superior Health), which includes the MHA Keystone Center, along with our counterparts at the Illinois, Wisconsin and Minnesota hospital associations, and several other related organizations in the Midwest. Superior Health is funded by the federal government, which has clearly valued the ROI that is created by this work, both for Medicare and Medicaid patients for which they have a direct responsibility, as well as all patients.
On top of this work, the MHA Keystone Center has led hospitals on a high reliability journey for almost ten years now. Striving towards implementing and maintaining a high reliability culture means hospitals are focused on attaining zero preventable harm to patients, families and caregivers, making Michigan a safe place to receive care. Factors such as the pandemic, workforce shortages and increased rates of violence against healthcare workers all have emerged as challenges to this work. However, MHA Keystone Center member hospitals remain steadfast in their quest to reduce unintended harm in their facilities. One great example of how hospitals implement a high reliability culture is by stressing the importance of speaking up to prevent potential harm to patients or other staff members. Dozens of healthcare workers from hospitals throughout Michigan have been recognized by the MHA Keystone Center Speak-up! Award since it was launched in 2016. It is heartening that hospitals across the state, both large and small, urban and rural, have embraced an organizational culture that promotes and even celebrates anyone within the organization who speaks up to prevent harm.
Our to-do list in this realm is long and is constantly evolving. Based on the current needs of our membership, we are now focusing on reducing health disparities as our state strives to achieve health equity; improving maternal health outcomes; establishing age-friendly health systems; implementing solutions to address the opioid epidemic; facilitating person- and family-centered care; improving workplace safety; and providing emotional well-being support to healthcare workers through a partnership with the Duke Center for Healthcare Safety and Quality that has so far assisted 5,000 healthcare workers from 144 organizations throughout Michigan.
We know each of these efforts impact the health and well-being of countless Michiganders today. Thankfully, we have diverse funding support for our work; in addition to the federal government’s role noted above, the MHA Keystone Center has been funded by the Michigan Health Endowment Fund, and from our own hospitals who pay an annual fee for the services provided by our MHA Keystone Center PSO, a federally-certified Patient Safety Organization which collects adverse event data. But special recognition needs to be given to Blue Cross Blue Shield of Michigan (BCBSM), and their CEO Dan Loepp. Their initial support was instrumental in getting the MHA Keystone Center off the ground all those years ago, and we are now operating under a third round of very significant financial support from BCBSM that has been critical to our success.
Finally, I would like to acknowledge the great leadership of Sam Watson, our senior vice president of field engagement, and Sarah Scranton, our vice president of safety & quality, as well as the entire MHA Keystone Center Board of Directors, and of course the incredibly talented and dedicated MHA Keystone Center staff. We are proud to work every day with so many hospital leaders and clinicians who are dedicated to doing the right thing for patients and healthcare workers. At the end of the day, this is mission-driven work that all Michiganders can be proud of.
The MHA received media coverage the week of Sept. 25 regarding new auto no-fault legislation introduced in the Michigan Legislature and hospital staffing issues.
The MHA issued a media statement Sept. 26 from MHA CEO Brian Peters in support of Senate Bills 530 and 531, which would reform specific aspects of Michigan’s current auto no-fault insurance law.
Below is a collection of headlines from around the state.
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.
“The auto no-fault insurance bills introduced today will improve access to care for auto accident survivors and patients. The reforms implemented several years ago created an environment of extreme uncertainty. This bill package is an important step towards providing better access to services and reimbursement clarity, bringing Michigan healthcare provider reimbursement in line with national averages and ensuring they all have the resources needed to care for auto accident survivors throughout their recovery.
The Michigan Health & Hospital Association is proud to join the many stakeholders supporting Senate Bills 530 and 531.”
