MHA CEO Report — The Story of the MHA Program Year

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

The 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.

MHA CEO Report — Benefits of the State Budget

“We must find time to stop and thank the people who make a difference in our lives.” ― John F. Kennedy

We have rightfully spent a lot of time in the past two years thanking the heroes who work in our hospitals and other healthcare settings for the incredible work they have done in the face of extreme challenge.

I want to take a moment now to thank another group of people who have recently helped our cause through their bipartisan actions; our elected officials in Lansing were extremely busy the last week of June passing the fiscal year 2023 state budget, which has since been signed by Gov. Whitmer. Our MHA mission is to advance the health of individuals and communities — and this budget absolutely provides significant help in that regard. While some elements of the new budget represent long-standing MHA priorities, others are new funding items that have the potential to reshape access to care and help our members and the patients and communities they serve.

Our MHA team does a tremendous job advocating for the importance of items such as the Healthy Michigan Plan, graduate medical education of physician residents, disproportionate share hospital funding, maximization of our robust provider tax program and Medicaid payment rates, the rural access pool and obstetrical stabilization fund, and critical access hospital reimbursement rates. Every election cycle, new legislators are welcomed to Lansing and the MHA’s efforts never stop to ensure these decisionmakers are aware of the impact these budget items play in their communities. The bottom line is the financial viability of hospitals is increasingly reliant on these important programs, and the MHA is dedicated to protecting them.

Hospital closures continue to happen across the country. However, they have occurred at a much higher rate in states that have not participated in Medicaid expansion through the Affordable Care Act. Maintaining funding for our expansion program — the Healthy Michigan Plan — has been one of our top priorities, and the pandemic has made the importance of insurance coverage more important than ever. In short, when the pandemic hit and thousands of Michiganders lost their jobs, the Healthy Michigan Plan was there to ensure access to good healthcare.

Our hospitals that treat the highest numbers of uninsured and underinsured patients also qualify for disproportionate share hospital funding, which provides enhanced reimbursement to account for the higher costs of care. This pool is funded through hospital provider taxes that reduce the state’s general fund contribution to the overall Medicaid program.

Small, rural and independent hospitals can often experience financial challenges in a particularly acute way, thus items such as the rural access pool, obstetrical stabilization fund and critical access hospital reimbursement rates also support access to healthcare services in rural areas. Labor and delivery units typically do not contribute to positive margins, but they are extremely important for families and communities. The obstetrical stabilization fund provides additional means for hospitals in rural areas to maintain these services so expectant mothers can avoid driving exorbitant distances for these services. Lastly, the state also included $56 million in new funding to increase Medicaid reimbursement rates for primary care services, which will help individuals on Medicaid receive the necessary primary and preventative care that can help prevent hospitalizations and reduce overall healthcare costs.

The top concern of hospital leaders remains workforce sustainability, and the continued funding for graduate medical education is one tool we must continue to use to maintain the physician talent pipeline that is sorely needed. At the same time, we are extremely happy to see inclusion of state funds to expand access to Bachelor of Science in Nursing degree programs at the state’s community colleges to help address the nurse talent pipeline, a $56 million line item. This proposal was supported by the MHA when it was formally introduced, and we look forward to seeing our post-secondary partners implement it to grow the healthcare workforce.

Lastly, behavioral health investments have been at the forefront of our advocacy efforts for some time and we were very pleased to see new funding to improve and enhance state behavioral health facility capacity. Michigan lacks adequate capacity to treat patients with behavioral and mental illness and this new funding is an important and necessary step to address the shortage. Included is $50 million to expand pediatric inpatient behavioral health capacity, $30 million to establish crisis stabilization units and $10 million to fund the essential health provider loan repayment program to cover behavioral health professionals.

In total, the budget includes $625 million in new investments for behavioral health funding and investments in workforce. While this will not solve all the issues impacting hospitals, it provides needed resources and demonstrates the commitment of lawmakers to a healthy Michigan. This budget also signifies that our work must continue to advocate for the resources necessary for hospitals and health systems to care for all Michiganders. Once again, on behalf of the entire MHA family, I want to acknowledge and thank both Governor Whitmer, as well as lawmakers in the state House and Senate, for their support of this latest state budget. And I would also encourage anyone who cares about access to quality, affordable healthcare to engage in the process, share your stories and input with those who can make a difference going forward. But also remember to say thank you when they support our cause.

As always, I welcome your thoughts.

Fiscal Year 2023 State Budget Signed

capitol building

capitol buildingGov. Whitmer signed July 20 the fiscal year 2023 state budget. Included in the 2023 budget agreement is $625 million in new investments for behavioral health funding and the healthcare workforce. This includes:

  • $50 million to expand pediatric inpatient mental and behavioral health capacity throughout the state.
  • $30 million to establish crisis stabilization units for mental and behavioral healthcare.
  • $10 million to fund the essential health provider loan repayment program to cover behavioral and mental health professionals.
  • New and ongoing funding of $3.5 million to support the statewide trauma system.
  • $56 million to increase Medicaid reimbursement rates for primary care clinician services.
  • $56 million to fund the Michigan Associate Degree in Nursing to Bachelor of Science in Nursing program at community colleges across the state.

Additionally, the state budget provides the resources necessary for hospitals and health systems to continue advancing the health of individuals and communities throughout Michigan. Specifically, the budget reflects the protection or enhancement of many MHA priorities, including:

  • Maintains funding for the Healthy Michigan Plan.
  • Protects funding for the graduate medical education of physician residents.
  • Supports disproportionate share hospitals.
  • Continues funding for the rural access pool and obstetrical stabilization fund.

Each of these funding sources are instrumental to keeping hospitals financially secure, particularly those serving vulnerable and underserved populations. MHA CEO Brian Peters released a statement July 1 applauding the healthcare focus of this budget and highlighting significant investments toward rural and behavioral health. These new appropriations will allow hospitals to continue and expand upon service lines that are in increased demand due to the pandemic.

The governor also made several line-item vetoes that do not directly impact hospital priorities when signing the budget, including vetoes of funding the administration argues is anti-abortion.

Members with questions may contact Adam Carlson.

Fiscal Year 2023 State Budget Advances Health of Individuals and Communities

Brian Peters

The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association. *The budget has since been signed by Gov. Whitmer on July 20, 2022.

Brian PetersThe fiscal year 2023 state budget approved by the Michigan Legislature provides necessary resources to assist hospitals and health systems in advancing the health of individuals and communities throughout our state. We appreciate the work and consideration placed by lawmakers that continues to protect hospital priorities.

These priorities include maintaining funding for the Healthy Michigan Plan, graduate medical education of physician residents, disproportionate share hospitals which treat the highest numbers of uninsured and underinsured patients, the rural access pool and obstetrical stabilization fund, and critical access hospital reimbursement rates which all support access to healthcare services in rural areas. Each of these areas are instrumental to keeping hospitals financially secure, particularly in areas serving vulnerable and underserved populations.

We are also extremely happy to see new funding to improve and enhance state behavioral health facility capacity and to address the healthcare workforce. Michigan lacks adequate capacity to treat patients with behavioral and mental illness and this new funding is an important and necessary step to address the shortage. The investment of state funds to expand access to bachelor of science in nursing degree programs at the state’s community colleges is a significant movement towards replenishing Michigan’s healthcare talent pipeline.

We look forward to a signed budget that provides the resources necessary for hospitals and health systems to care for all Michiganders.