The MHA Board of Trustees met April 12 at the MHA Capitol Advocacy Center in downtown Lansing, joined by Michigan Senate Health Policy Chair Kevin Hertel (D-St. Clair Shores). Hertel acknowledged the state’s significant challenges in meeting behavioral healthcare and workforce needs and identified these areas as priorities for the Senate Health Policy Committee. Board members stressed the need for lawmakers to support policies that allow flexibility and foster innovation, such as continuing to expand telehealth options started during the pandemic and looking beyond staffing ratios toward more effective ways to meet patient care needs within a finite labor supply.
The board also heard from colleagues about a recent learning and technology exchange between Michigan health system leaders and their Israeli counterparts and had the opportunity to listen to the reflections of Shreya Desai, a neurobehavioral researcher and current government relations and health policy fellow with the MHA. Desai shared her experiences working with the MHA Advocacy Division and how it will influence her future medical career.
The board spent time providing input and direction on the key pillars of the association’s action plan, which is focused on supporting financial viability, promoting workforce sustainability, fostering health equity and addressing behavioral health needs. This strategic conversation included a review of recent state budget initiatives, including the MHA’s successful advocacy to secure $75 million for healthcare worker recruitment, retention and training for Michigan hospitals, which is the latest victory in a series of state budget appropriations that has resulted in $1.45 billion in new hospital funding since January 2020.
In addition, the board expressed support for ongoing efforts to work with the state to maximize the federal Medicaid match to increase overall Medicaid reimbursement rates and funding for targeted services such as obstetrics, outpatient, psychiatric and trauma care. In furtherance of workforce sustainability, the board supported the association’s social media campaign to promote and increase awareness of a broad range of healthcare careers. The board also engaged in a discussion of health equity and the association’s continued work to assist members in eliminating disparities in healthcare through the leadership of the MHA Health Equity Taskforce. Improving access and funding for behavioral health continues to be a key priority for the association and board members provided input to the MHA on data collection efforts to advance advocacy strategies to reduce emergency department wait times for patients seeking inpatient psychiatric care. Finally, the board approved Type 2B association membership for Southwest Michigan Behavioral Health.
For more information about the actions of the MHA Board of Trustees, contact Amy Barkholz at the MHA.
“We do not have government by the majority. We have government by the majority who participate.”―Thomas Jefferson
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. Look no further than the pandemic and the numerous bills and policies considered and enacted that helped hospitals and health systems during extremely challenging times. As an association, we are very appreciative and value the help we received from both the administration and legislature – at both the state and federal level – during that time.
This Election Day is a vital component to our healthcare priorities, as it includes the state’s gubernatorial race, followed by attorney general, secretary of state, all 13 U.S. House of Representatives seats, all seats in both the Michigan Senate and House of Representatives, two Supreme Court seats, three ballot proposals and local races.
As you can see, this year’s ballot is packed with important races that will determine the outlook of our state and nation’s political landscape for the next two years or more. In addition, several factors, including redistricting, have made for a number of highly competitive races. As a result, many observers believe that control of each chamber may be at stake.
Through our concerted efforts, the MHA HealthPAC has grown to become one of the largest political action committees in the state and is one of the important tools in our advocacy toolbox. And whether it is through HealthPAC, or through our many other activities, the MHA has a long history of remaining nonpartisan while highly encouraging all Michigan residents, particularly those in the healthcare community, to participate fully in the political process – and at no time is this more important than election season. Elections have consequences and the best way to ensure that our needs are addressed in the future is to use your constitutional right to vote for the candidates that best represent your values.
Healthcare is influenced by all three legs of the public policy stool – the executive branch, legislative branch and judicial branch. The Michigan medical community needs people in office at every level who understand their role in policy decisions that affect healthcare. The challenges facing hospitals are numerous and significant, such as financial viability, healthcare workforce restoration and wellness, behavioral health and health equity. Our elected officials are critical partners for identifying and implementing solutions to these issues.
Before completing your ballot, make sure to do your research. As always, we are pleased to share a series of useful resources on the MHA website. In addition, the Citizens Research Council of Michigan has over 100 years of experience providing non-partisan, independent analysis on governmental policy and are another valuable resource when evaluating this year’s ballot proposals.
And while this election may change the political landscape of Lansing and Washington, D.C., it will not change the intensity or commitment of the MHA and our team at the MHA Capitol Advocacy Center towards our advocacy and policy work. Following the election will be a lame-duck session that could see a lot of activity prior to the end of the calendar year. In addition, once this year’s elected candidates are sworn into office, we will continue to meet with and identify healthcare champions that will be important partners towards improving the health and wellness of all Michiganders. And because of term limits, there will be a lot of them. One example: there will be over 50 new members of the Michigan House, all of whom will need to be educated and informed of the many complex issues in the healthcare domain.
Whether you’re planning to vote by absentee or in person on Nov. 8, you’re making a critical contribution to our democratic process. Every vote matters, particularly for the future landscape of healthcare.
“Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.” ― Rudolf Virchow
As we enter the final two months of the MHA program year, our “all-hands-on-deck” prioritization of the healthcare workforce continues, and I am pleased to share that we have made significant strides in this regard. Included in that progress is work with our partners in higher education, other Michigan healthcare associations, hospital clinical leaders and the Michigan Legislature.
One aspect of our workforce efforts is not new. For many years, the MHA has led a special Graduate Medical Education (GME) Advocacy Day, hosted at our MHA Capitol Advocacy Center (CAC) in downtown Lansing. At this event, medical students, residents from teaching hospitals and academic medical centers, and other key leaders converge on the Capitol and meet with legislators to discuss the vital importance of GME funding in the state budget process.
After a brief hiatus due to the pandemic, we are excited to play host once again for this important in-person event, as we will welcome our colleagues to the CAC on May 5.
When this event began, the primary focus was to express the importance of GME and the national prominence that Michigan has earned in medical education. We have more than 7,200 physician residents currently working in the state, which ranks fourth in the nation. In addition, Michigan is third in the country for student enrollment in public medical schools. The investment Michigan makes in GME is very valuable, as every $1 in GME generates $2.53 in federal funding in fiscal year 2022. While the current rate is enhanced due to the existing public health emergency, there is no question that GME funding for Michigan’s beginning physicians is a wise investment for the future healthcare workforce in our state. GME also improves access to care, as it allows physicians to further their medical education while delivering much-needed care to patients throughout Michigan in teaching hospitals, community clinics and laboratories.
The vital role of GME in filling the talent pipeline is more important today than ever, as Michigan hospitals (and the healthcare delivery system in general) struggle with workforce shortages that have been exacerbated by the COVID-19 pandemic. Those shortages across the state have caused Michigan to lose approximately 1,300 staffed hospital beds over the past 18 months. Nationally, the physician shortage is estimated to be between 37,800 and 124,000 by 2034, including primary care and nonprimary care specialties, as the Association of American Medical Colleges estimates two out of every five active physicians will be 65 or older within the next 10 years.
The participants in our GME Advocacy Day have experienced many of the challenges that we’ve shared with elected officials: stress, burnout, workplace violence, vaccine hesitancy and significant loss of life due to COVID-19 and a host of other medical issues. Their perspective is extremely valuable as we make the case for funding and public policy that ensures the viability of our healthcare infrastructure for years to come. In addition to full funding of the traditional GME pool, there are several related items on the radar screen here in Lansing, including:
Included in the state’s Higher Education budget proposal is House Bill 5785, which would provide funding to create a healthcare workforce collaborative between the MHA and Michigan’s public and private post-secondary educational institutions. This partnership would not only provide employers with a better understanding of statewide graduates in health professions, but further improve the knowledge of employment opportunities in healthcare for post-secondary education institutions throughout the state. Included in the collaborative would be the creation of a searchable and accessible repository that allows healthcare employers to understand current educational trends and provides prospective employees easy access to healthcare positions throughout the state.
The MHA also supports legislation designed to incentivize more medical school and advanced practice nursing program preceptors by providing new tax credits. Senate Bills 998 and 999 would create a new tax credit for individuals who agree to work as a preceptor for required clinical rotations. We believe this legislation could help increase the capacity for clinical rotations at hospitals across the state, which would also improve the talent pipeline.
As we advocate in support of GME and related issues, we of course greatly appreciate the collaboration of our friends from the Michigan State Medical Society (MSMS) and Michigan Osteopathic Association (MOA). Together, our three associations make up The Partnership for Michigan’s Health, which has a long history of working together on healthcare issues of common interest, including the achievement of major medical liability reforms in the early 1990s, which established the foundation for much of our advocacy work in the Legislature and the courts ever since.
Most recently, the collective voice of our three associations, along with associations representing various other areas of healthcare, led to successfully securing $300 million in state funding for the recruitment, retention and training of healthcare workers. Collectively, the Healthcare Workforce Sustainability Coalition was created to focus on workers already within the healthcare workforce. Gov. Whitmer also recently signed Senate Bill 247 that would decrease wait times for commercial insurance prior authorization requests, a priority for all three associations. We are also united in our opposition to Senate Bill 990 that would create a serious public health risk by licensing naturopathic practitioners and classifying them as physicians. As healthcare associations, the professional careers of our members are dedicated to serving their patients and protecting the health and safety of the public. This opposition is an example of our need to protect the public from a practice that lacks scientifically proven treatment methods and clinical training.
In addition, we have long collaborated with MSMS and MOA to produce The Economic Impact of Healthcare in Michigan Report, which provides a detailed look at the extensive roles hospitals and health systems play in their local economies. Work is underway on the next issue of the report. The MHA Keystone Center Board of Directors has also designated one seat each for the MSMS and the MOA since its inception to ensure physician representation as we strategize on safety and quality improvement issues. And finally, the MHA and the MOA literally got closer last year when the MOA relocated its offices to the MHA headquarters building in Okemos – an arrangement that is unique anywhere in the country.
I’d also be remiss if I didn’t mention the MHA’s new focus on engaging with our physician leaders. For the first time ever, the MHA will be hosting activities dedicated to our physician leaders during our MHA Annual Meeting, including several sessions that will include CME credits. MHA Chief Medical Officer Dr. Gary Roth is leading these efforts, which complement his work throughout the pandemic engaging with our health system chief medical officers to facilitate consistent and reliable dialogue that allowed the MHA to efficiently provide policy updates to our clinicians as well as real-time feedback to policymakers. We’re extremely fortunate to have Dr. Roth, as the MHA is one of just a few state hospital associations with a full-time CMO on its leadership team.
Lastly, in an effort to fully support our physician colleagues (and other caregivers), the MHA Keystone Center is offering the Well-being Essentials for Learning Life-Balance (WELL-B) webinar series to prevent healthcare burnout by delivering weekly webinars on evidence-based well-being topics, including prevalence and severity of burnout, relationship resilience and being present. It is encouraging to see that over 4,000 individuals have already signed up for this innovative program.
As you can see, there is no magic pill that can solve the healthcare staffing crisis overnight. It will take many years and a multitude of public and private solutions to protect access for all of Michigan’s communities. GME is one of those key solutions, and we call on our elected officials – and all Michiganders – to give it the support it deserves.
During the week of March 21, the Michigan Legislature advanced several bills related to MHA priorities, including legislation to change the prior authorization process for commercial insurers, expand the Essential Health Provider Loan Repayment Program, and to provide supplemental appropriations to implement statewide broadband. Hospital testimony was also provided to the House Health Policy Committee on the ongoing staffing crisis for Michigan hospitals.
Senate Bill (SB) 247, which would decrease wait times for commercial insurance prior authorization requests, is now heading to Gov. Gretchen Whitmer’s desk for signature. Introduced by Sen. Curt VanderWall (R-Ludington), the legislation would shorten the timeline for approval to seven calendar days, or 72 hours for urgent requests, as well as ensure that emergency care can be provided without prior approval. Both the House and Senate voted during the week of March 21 to advance the bill before legislative spring break. The MHA provided testimony in support in both chambers and has shared a letter with the governor encouraging her to sign the bill.
The governor March 24 signed SBs 246 and 435 into law, which will expand the allowable use of the Essential Health Provider Loan Repayment Program. The two MHA-supported bills would increase the total allowable repayment from $200,000 to $300,000 and make certain mental health professionals eligible for the program. An MHA-proposed amendment to SB 435 was added in the House that will extend the sunset on the Physician Licensure Compact, which was set to expire March 28. More information on the program is available on the Michigan Department of Health and Human Services website.
The Michigan Legislature passed SB 565, sending the $4.7 billion supplemental appropriation bill to the governor for signature. The new spending was infrastructure focused, including $250 million and eight new full-time positions for the Michigan High-Speed Internet Office (MIHI). The MHA supports the MIHI funding, which will help Michigan take advantage of available federal funding to ensure access to reliable broadband for telehealth.
In the House Health Policy Committee, Julie Yaroch, DO, president of the Charles and Virginia Hickman Hospital, spoke to members on behalf of the MHA about the ongoing staffing crisis. Yaroch shared how the shortage is directly impacting her hospital, as well as the data from the most recent MHA survey that revealed there are 50,000 open positions across the state, with an average hospital vacancy rate of 16.6%. She told the committee that “staffing shortages took an average of 1,200 beds offline during the most recent surge, which in terms of bed capacity is equivalent to pulling the entire U of M Health System offline.”
Questions regarding state legislation affecting healthcare should be directed to Adam Carlson at the MHA.
The Michigan Health & Hospital Association is promoting Laura Appel to executive vice president of government relations and public policy from her prior role as senior vice president, health policy & innovation. In this role, which takes effect Feb. 28, Appel will have executive oversight of the MHA’s Capitol Advocacy Center.
Appel joined the MHA in 2000 following a career at the Michigan House of Representatives as a director and policy analyst. Throughout her time at the MHA, Appel has focused on strategic priorities related to state and federal lobbying and healthcare policy analysis, including issues such as auto no-fault insurance, behavioral health, Medicare and Medicaid policy and the 340B drug pricing program.
“It is clear that Laura has earned the respect of the MHA Board of Trustees, as well as her peers, and I am confident that she will help lead the MHA effectively into the future,” said MHA CEO Brian Peters.
Also joining the MHA Advocacy team as of Feb. 22 is Elizabeth Kutter, JD, now the MHA’s senior director, government & political affairs. Kutter joins the MHA from Wayne State University, where she served as director, state relations, since May 2020. Prior to that, Kutter worked as manager, government affairs, at Henry Ford Health System.
In addition to these advocacy-focused changes, the MHA also welcomes Sarah Scranton, MPA, MPP, as the MHA’s new vice president of safety and quality and the MHA Keystone Center’s new executive director effective Feb. 28. Scranton has more than 20 years of experience in nonprofit management and public policy. She is the former executive director of the Arthritis Foundation of Michigan. She has also served as executive director at Tomorrow’s Child and Planned Parenthood Advocates and Affiliates of Michigan. As executive director, Scranton will work closely with MHA and MHA Keystone Center staff and governing boards to execute the association’s mission, vision and values.