MHA CEO Report — The Story of the MHA Program Year

MHA Rounds Report - Brian Peters, MHA CEO

“Plans are only good intentions unless they immediately degenerate into hard work.”Peter Drucker

MHA Rounds Report - Brian Peters, MHA CEOThe theme of the 2022-2023 MHA program year was telling our story. With focus and passion, we told the stories of our hospitals and health systems, the challenges and adversity they face, and how they still provide high quality and accessible healthcare to their communities. This theme was intended to ensure that we as healthcare leaders continue to help those who don’t live and breathe healthcare understand the ways we are working to meet the most pressing needs, but also the support we need from other sectors to continue to offer strong and daily access to care for all. Our theme served to frame the four distinct pillars of our association strategic action plan, which included the financial sustainability of hospitals, workforce restoration and well-being, the behavioral health crisis and continued efforts towards achieving health equity.

I’m pleased to share we made significant progress in telling our story and achieving tangible, impactful results under each of the four strategic pillars, which is summarized in the latest MHA Annual Report. This work evolved around the ending of the COVID-19 public health emergency, a pandemic that tried our member organizations, and especially their healthcare workers, like nothing has before in most of our lifetimes. A large part of our success in making this transition and achieving so many significant outcomes was due to the MHA Board of Trustees, who I want to thank for their strong leadership and commitment to advancing the health of individuals and communities. I particularly want to express my gratitude to our outgoing Chair, T. Anthony Denton, for his steadfast leadership throughout this year.

Key to our efforts to safeguard the financial viability of hospitals is our continued focus on the state budget. Not only were we successful in continuing existing supplemental payment pools such as for Disproportionate Share Hospitals, Graduate Medical Education, Rural Access and Obstetrical Stabilization, but we also secured a Medicaid outpatient hospital rate increase. Collectively, these victories generated hundreds of millions in funding for Michigan hospitals. Long a priority of our association, the MHA also successfully advocated to ensure the Healthy Michigan Plan (our Medicaid expansion program) is fully funded. Our advocacy team continues to be one of the most respected in Lansing, as we saw several MHA-supported bills signed into law while experiencing a 100% success rate in making sure none of the 10 bills we opposed became statute.

Each of the four pillars are equally important to our membership, but it is hard to overstate just how important workforce restoration and well-being is to our healthcare leaders. This is the issue that keeps each of them up at night, whether it is finding new staff or protecting and retaining their existing workers. Our advocacy efforts secured an additional $75 million in funding to support the hospital workforce while also securing $56 million in funding to support partnerships to offer Bachelor of Science in Nursing programs at community colleges. We also continue to advocate for increased penalties for those who verbally or physically harm healthcare workers, providing them with protections they deserve as front-line caregivers, much like emergency responders receive. The MHA Keystone Center has been active in offering well-being resources, trainings, safety and security risk assessments and other offerings, continuing their long history as a leader in safety and quality not just here in Michigan, but nationally and internationally. Lastly, we recently launched a statewide healthcare career awareness campaign to entice students to pursue health career pathways.

Our work on behavioral health continues, as there remains a need to expand the number of behavioral health professionals and facilities to provide better access to care. The MHA secured both $50 million in the fiscal year 2023 state budget for expanding pediatric inpatient capacity, while adding an additional $10 million to create Psychiatric Residential Treatment Facilities to alleviate state hospital capacity issues. Much of the feedback we have received is the need to add quantitative data to the conversation to demonstrate to lawmakers and stakeholders the degree of the crisis. For several months, our team has been collecting data weekly on the number of patients waiting for a behavioral health bed in Michigan hospitals. This demonstrates the degree to which patients are having difficulty finding care, while also showing how many patients are utilizing hospital resources while the facility receives no reimbursement due to not having an acute care diagnosis billing code.

Lastly, we will not rest as our members continue to address health disparities to ensure health equity. The MHA Keystone Center works closely with the Michigan Alliance for Innovation on Maternal Health (MI AIM) to help address disparities and reduce the risk of maternal death. This past program year, their efforts resulted in 77% of Michigan birthing hospitals participating in MI AIM, 94% of which are compliant with the pre-partum assessment and 89% are compliant with the post-partum assessment. Our work with the MHA Public Health Task Force also continues as they explore strategies for collaboration that can improve data collection and public health initiatives.

Of course, there are always other items that come up that require MHA attention and effort that are not always known during the development of the strategic action plan. Responding to the shortages of chemotherapy drugs cisplatin and carboplatin and working with Michigan’s Congressional delegation is just one example of the value of association membership and how quickly we can mobilize our relationships in a time of crisis. Other wildcards include our work on licensing Rural Emergency Hospitals, tracking and increasing awareness of candida auris infections and expanding hospital bed capacity.

As we concluded our program year during our Annual Meeting on Mackinac Island, we were able to honor a true healthcare champion with our Meritorious Service Award in U.S. Sen. Debbie Stabenow. She announced earlier this year she will not seek an additional term in office and this award is the highest honor our association can bestow on an individual for their years of work towards enabling the health and wellness of individuals and communities. We have worked closely with Sen. Stabenow from her time in elected office in the Michigan Legislature to Congress and she will leave an extraordinary legacy for which the MHA family will be eternally grateful. We also had an opportunity to honor a number of other outstanding individuals for their contributions to Michigan healthcare.

Above all else, I want to take this opportunity to thank all MHA staff for their many contributions which made it another successful program year. The challenges we confront in healthcare are daunting and constantly evolving, but my confidence in our team at the MHA has never wavered, as they continue to display their exceptional commitment to their work and embody the MHA culture of member service and value creation every single day.

Now as we formally begin our 2023-24 program year on July 1, I am excited for the leadership of our new Chair Shannon Striebich. We offer our congratulations to her and look forward to working closely together. A year from now, I am confident we will once again be able to report on the successful outcomes we were able to achieve through our unity, collaboration and plain old fashioned hard work.

As always, I welcome your thoughts.

Appel Discusses Cancer Drug Shortage with Fox 2 Detroit

Fox 2 Detroit (WJBK-TV) published a story June 8 on the nationwide shortage of two critical chemotherapy medications. The two drugs, carboplatin and cisplatin, are used to treat several types of cancer, including bladder, lung, ovarian and testicular cancers. The shortage is widespread across the country, impacting hospitals throughout all regions of Michigan.

Laura Appel, executive vice president of government relations and public policy, MHA, spoke with Fox 2 Detroit about initial manufacturing delays, how the shortage is impacting Michigan hospitals and what’s being done in response.

“Our congressional delegation who has reached out to the FDA to ask them to do whatever they can,” said Appel. “The FDA is investigating what they can do to suspend regulations on importation, so that they can bring the drug in from Europe or other places…they [hospitals] are managing on a daily basis how to try to avoid any inappropriate delay in care.”

The shortage of cisplatin was originally reported to the U.S. Food & Drug Administration (FDA) Feb. 10, 2023, while carboplatin was reported April 28, 2023.

Members with any questions regarding media requests should contact John Karasinski at the MHA.

MHA CEO Report — Impact of Drug Shortages on Hospitals

MHA Rounds Report - Brian Peters, MHA CEO

“In the midst of every crisis, lies great opportunity.” — Albert Einstein

MHA Rounds Report - Brian Peters, MHA CEOThe shortage of key cancer treatment drugs carboplatin and cisplatin made national headlines in recent weeks, as hospitals implemented multiple strategies to maintain care for their patients when supply of these two drugs was remarkably low to nonexistent. While this shortage deservedly caught the attention of the nation, hospitals must navigate dozens to hundreds of drug shortages every day. This shortage is a worst-case example of how inefficiencies in the pharmaceutical supply chain can have devasting impacts on patient care.

Unfortunately, hospitals far too often must manage short supply of drugs, seek alternative sources for drugs, adjust treatment regimens and collaborate with other health systems to maximize supply. Hospitals throughout the state used all these tactics to respond to the recent crisis.

I’m proud the MHA was able to quickly raise the flag on this issue to our lawmakers as soon as we became aware of it. U.S. Senator Gary Peters (D-Bloomfield Twp.) chairs the Senate Committee on Homeland Security & Governmental Affairs and has prioritized drug shortages as a national security concern. His report from March 2023 shares a wealth of information on the subject, including all the problems associated with drug shortages and recommended solutions. His committee has been a key partner in providing accurate information about the shortage to Michigan hospitals.

In addition, U.S. Representatives Debbie Dingell (D-Ann Arbor) and Tim Walberg (R-Tipton) led Michigan’s US House delegation in sending a bipartisan letter May 24 to Food and Drug Administration (FDA) Commissioner Dr. Robert Califf to take immediate action to mitigate the effects of the nationwide shortage. I’m happy to share every member of our House delegation signed on to the letter, showing the health of our hospitals, patients and communities is truly a bipartisan issue.

Our work will continue on this issue far after the supply of these two drugs stabilizes, as the MHA supports several strategies that will address drug shortages. The first is relaxing prior authorization requirements from health insurers for alternative therapies during a shortage so they can be used widely. Federally, we believe establishing an early warning system will help avoid or minimize drug shortages so both manufacturers and providers have more time to respond to an upcoming shortage. Healthcare providers also welcome improved communication from the FDA and drug manufacturers, as there is often little to no transparency on the cause of a drug shortage. Lastly, changing the economic model to encourage drug manufacturers to stay in, re-enter or initially enter the market would be beneficial to all stakeholders. Many shortages occur with generic drugs due to a limited number of drug manufacturers.

In addition to the public policy arena, it is noteworthy that hospitals across the country – including several of our MHA members – helped to launch Civica, an entity that is helping to increase the production and availability of key generic drugs.  While not directly applicable to the current cancer drug shortage at this time, this effort is an example of the field looking to the future and doing all we can to ensure appropriate healthcare access to patients.

Finally, I’d like to lift up the MHA’s response to this crisis as a great example of the value of an association. Since we represent all acute care community hospitals in Michigan, we’re able to speak with a unified voice. The MHA has the relationships and institutional knowledge to quickly convene ad hoc groups in times of crisis to gather knowledge on the subject and what needs to be done, and then can execute and utilize our long-standing partnerships with lawmakers, both at the state and federal levels, to generate necessary awareness and action. By looking at national headlines, Michigan has been a leader in the shortage of carboplatin and cisplatin. That’s a testament to the health of our association and the culture we have helped to establish, whereby safety and quality engender collaboration and not competition within our hospital and health system membership.

As always, I welcome your thoughts.

Headline Roundup: Chemo Drug Shortages & Workforce Challenges

MHA CEO Brian Peters with Paul W Smith of WJR during the Mackinac Policy Conference.
MHA CEO Brian Peters with Paul W Smith of WJR during the Mackinac Policy Conference.
MHA CEO Brian Peters with Paul W. Smith of WJR during the Mackinac Policy Conference.

The MHA received media coverage the week of May 28 regarding the continued shortage of cancer drugs carboplatin and cisplatin and hospital workforce shortages.

MHA representatives appearing in published stories include CEO Brian Peters and Executive Vice President Laura Appel.

Below is a collection of headline from around the state.

Thursday, June 1

Wednesday, May 31

Tuesday, May 30

Monday, May 29

Sunday, May 28

Members with any questions regarding media requests should contact John Karasinski at the MHA.

Headline Roundup: Cancer Drug Shortage Continues

MHA CEO Brian Peters appears on the Michigan Business Beat.
MHA CEO Brian Peters appears on the Michigan Business Beat.
MHA CEO Brian Peters appears on the Michigan Business Beat.

The MHA received media coverage the week of May 21 regarding the continued shortage of cancer drugs carboplatin and cisplatin and hospital workforce shortages.

MHA representatives appearing in published stories include CEO Brian Peters, Executive Vice President Laura Appel, Senior Director of Government & Political Affairs Elizabeth Kutter and Senior Director of Communications John Karasinski.

Below is a collection of headline from around the state.

Thursday, May 25

Wednesday, May 24

Tuesday, May 23

Monday, May 22

Sunday, May 21

Members with any questions regarding media requests should contact John Karasinski at the MHA.

MHA Continues Work Towards Chemotherapy Drug Shortage

The MHA has been in frequent contact with members of the Michigan Congressional delegation since the association was made aware of shortages of the chemotherapy drugs carboplatin and cisplatin. Representatives Debbie Dingell (D-Ann Arbor) and Tim Walberg (R-Tipton) led the Michigan delegation in sending a bipartisan letter May 24 to Food and Drug Administration (FDA) Commissioner Dr. Robert Califf to urge the FDA to take immediate action to mitigate the effects of the nationwide shortage of chemotherapy medications. Every member of the Michigan delegation signed on to the letter.

U.S. Senators Gary Peters (D-Bloomfield Twp.) and Debbie Stabenow (D-Lansing), along with U.S. Representative Elissa Slotkin (D-Lansing), wrote a separate letter to Dr. Califf asking that the FDA do everything in its power to mitigate the dire shortage of cancer drugs that has reached crisis levels in recent months.

The office of Sen. Peters also provided the following information to the MHA during the week of May 22 regarding the shortages.

  • The shortages for each drug are caused by the manufacturer Accord deciding to place production on hold, pending further assessments. Four other manufacturers of the drugs have not been able to fill the supply gap left by Accord.
  • The FDA has continued to work with Accord on prioritization of their assessments for product release and cisplatin and carboplatin are prioritized for release. Cisplatin is now being released following the assessment and supplies are making their way to hospitals and cancer centers. Meanwhile, carboplatin is planned to be released soon.
  • The FDA is also working with the other four manufacturers to increase supply and are offering expedited review of anything needed to increase supply, such as additional manufacturing lines, facilities and suppliers.
  • The FDA is requesting the manufacturers provide data to extend expiration dating for lots on the market that remain in distribution but are nearing expiration. Once received, the FDA will post the drug, old lot number and new lot number on the Extended Use database on the Drug Shortage website.
  • In addition, the FDA is exploring temporary importation to meet patient needs during the shortage. During temporary import, the FDA evaluates the overseas product attributes, as well as the manufacturing facilities, to ensure no risks exist for US patients.

Updates for both cisplatin and carboplatin are being provided by the FDA on the drug’s FDA Drug Shortage webpages.

Members with questions may contact Renee Smiddy with the MHA.

Headline Roundup: Chemotherapy Drug Shortages & Hospital Workforce

Laura Appel

The MHA received media coverage the week of May 15 regarding a shortage of two critical chemotherapy medications, hospital nurse staffing legislation and the well-being of hospital workers. A press release was published May 17 by the MHA regarding the shortage of cisplatin and carboplatin and the strategies hospitals and health systems are implementing to continue chemotherapy treatments for patients.

MHA representatives appearing in published stories include CEO Brian Peters and Executive Vice President Laura Appel. MONL President Kim Meeker, RN, BSN, MBA, also appears in a story on the nurse staffing legislation, while MHA Keystone Center WELL-B partner Bryan Sexton, PhD, from the Duke Center for Healthcare Safety and Quality, appears in a story about how hospitals assist healthcare workers with feelings of grief and loss.

Below is a collection of headlines from around the state.

Friday, May 19

Thursday, May 18

Wednesday, May 17

Tuesday, May 16

Members with any questions regarding media requests should contact John Karasinski at the MHA.

Patient Treatment Impacted by Shortage of Cancer Drugs

Manufacturing delays at several pharmaceutical companies are causing nationwide shortages of two critical chemotherapy medications – forcing Michigan hospitals and health systems to find alternative treatments for patients, some of which may be less effective. The two drugs are cisplatin and carboplatin and are used to treat several types of cancer, including bladder, lung, ovarian and testicular cancers. The shortage of these chemotherapy drugs is widespread across the country, impacting hospitals throughout all regions of Michigan.

Both drugs are provided by healthcare providers as injections to oncology patients. The shortage of cisplatin was originally reported to the U.S. Food & Drug Administration (FDA) Feb. 10, 2023, while carboplatin was reported April 28, 2023. Both shortage durations are expected to last at least into June 2023.

To reduce the impact of shortages on patients, hospitals are trying many different solutions, including managing existing supply, seeking alternative sources for drugs in short supply, adjusting chemotherapy regimens for impacted patients and working with healthcare systems, as well as state and federal officials, to mitigate these challenges.

“The priority of hospitals is delivering the right care to every patient, every time,” said MHA CEO Brian Peters. “Drug shortages severely hamper a hospital’s ability to provide patients with the best treatment, while forcing hospitals to implement strategies that may increase the cost of care and sometimes do not offer the same effectiveness in treatment.”

This current shortage follows a national trend of drug shortages impacting healthcare providers for years. A survey of medical oncologists published in the New England Journal of Medicine found 83% were unable to prescribe their preferred chemotherapy agent due to shortages.

The MHA supports the following strategies that will address the issue:

  • Relaxing prior authorization requirements from health insurers for alternative therapies so they can be widely used, as appropriate.
  • Establishing an early warning system to help avoid or minimize drug shortages.
  • Removing regulatory obstacles faced by manufacturers and the FDA as a way of averting or mitigating drug shortages and allowing drug imports.
  • Improving communication with healthcare providers, including extent and timeliness of information. There often is no transparency on the cause of a drug shortage and many shortages occur with generic drugs.
  • Exploring incentives to encourage drug manufacturers to stay in, re-enter or initially enter the market.

Patients concerned about the impact of this drug shortage should contact their healthcare provider.