MHA Monday Report May 9, 2022

MHA Monday Report

capitol building

Budget Bills Advance in House and Senate


Workforce Challenges Focus of GME Advocacy Day


MDHHS Addresses Medicaid Attending Physician Claim Edit

The Michigan Department of Health and Human Services recently issued an L-letter regarding attending physician claim edits that were implemented Jan. 1, 2022. The letter addresses concerns raised by the MHA and hospitals regarding the claim edit that has resulted in denied claims. …


The Keckley Report

Paul Keckley

Why May 2022 is Pivotal to U.S. Healthcare: Four Reasons

“Since March 2020, America’s focus has been on the pandemic. … Since January 2022, the U.S. economy has eclipsed its 41-year record inflation rate … Since February 24, 2022, America’s attention has been drawn to the Ukrainian invasion by Russia and NATO’s response. …

“And starting yesterday, May begins in what is likely the most consequential for healthcare in years due to the cumulative impact …”

Paul Keckley, May 2, 2022


News to Know

  • The Spring 2022 Michigan Health Policy Forum will take place virtually from 1 to 3:30 p.m. May 23.
  • Applications for the 2023 Foster G. McGaw Prize will be accepted through July 30.

MHA in the News

MHA EVP Laura Appel appears in a State of Reform article on bills that would create specialty integrated plans to cover specialty behavioral health benefits.

Workforce Challenges Focus of GME Advocacy Day

Rep. Luke Meerman (R-Coopersville) meets with Trinity Health Saint Mary’s residents during their GME Advocacy Day visits.

The MHA Graduate Medical Education (GME) Advocacy Day welcomed 32 physician residents from more than a dozen member hospitals to the MHA Capitol Advocacy Center offices May 5 for a day of meetings with members of the Michigan Legislature and their staffs. Each group of residents met with a combination of lawmakers and legislative staff throughout the day, with conversations focusing on the importance of GME funding and the role it plays in Michigan’s healthcare workforce talent pipeline.

Meetings were held in the Michigan Capitol, the Anderson House Office Building and the Senate Binsfeld Office Building. Most of the meetings involved current members of both the House and Senate health policy committees, which is where the majority of healthcare legislation originates. Participating lawmaker offices included those of Senate Health Policy Minority Vice Chair Winnie Brinks (D-Grand Rapids), Senate Health Policy member Sen. Kim LaSata (R-Niles), House Health Policy Majority Vice Chair Luke Meerman (R-Coopersville) and House Health Policy Minority Vice Chair Angela Witwer (D-Delta Township).

Residents used and shared with lawmakers an infographic that provides facts regarding GME and the healthcare workforce shortage. With the nation experiencing a shortage of healthcare workers, residents reinforced the value of GME investment and physician residency training to help address physician shortages.

Members with questions on GME and state legislation related to the healthcare workforce should contact Elizabeth Kutter at the MHA.

MHA CEO Report — GME’s Role in the Healthcare Talent Pipeline

MHA Rounds Report - Brian Peters, MHA CEO

“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

MHA Rounds Report - Brian Peters, MHA CEOAs 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.

As always, I welcome your thoughts.

Apply by March 31 for New Graduate Medical Education Residency Openings

Applications are due March 31 for hospitals to apply for new graduate medical education (GME) residency slots provided under Section 126 of the Consolidated Appropriations Act (CAA). Hospitals will be required to complete their applications and submit them through the Medicare Electronic Application Request Information System.

The CAA included 1,000 new GME residency slots, with no more than 200 new slots established annually beginning in fiscal year 2023. The Centers for Medicare & Medicaid Services (CMS) will prioritize applications for the new slots from eligible hospitals that serve geographic areas and underserved populations with the highest need, as required under the CAA. Section 126 outlines the following categories for distribution:

  • Rural Hospitals.
  • Resident Cap Relief – this category covers hospitals with very low resident full-time equivalent caps and per resident amounts. The application deadline for this category is July 1, 2022.
  • States With New Medical Schools, including Michigan.
  • Hospitals Serving or located in Health Professional Shortage Areas.

The MHA recently submitted comments to the CMS regarding the agency’s interim final rule on distribution of the new slots. The association urged the CMS to use a clear and simple method and to distribute the needed slots quickly, given the approaching application deadline. Members with questions should contact Vickie Kunz at the MHA.

CEO Report — Addressing Staffing Challenges

MHA Rounds Report - Brian Peters, MHA CEO

“There is time for work. And time for love. That leaves no other time.” — Coco Chanel

MHA CEO Brian PetersHospitals have displayed tremendous resiliency over the past year and a half responding to the COVID-19 pandemic. That resiliency has come from the healthcare heroes who have served on the front lines of this crisis and experienced extreme physical and mental stress over the course of three trying surges. Yet that toll has elevated staffing, an already existing concern, to the top of every hospital executive’s mind.

We have said throughout the pandemic that the most significant determining factor of a hospital’s capacity is not physical space, beds or technology — rather, it is available staffing.  Even before the pandemic, we understood that healthcare staffing was a challenge. We currently have a population where the baby-boom generation is maturing, leading to an increased demand for healthcare services. It just so happens that many of those baby boomers also work in healthcare, and the incredible pressures brought about by the pandemic have accelerated their retirement plans.

On top of that dynamic, it has become very difficult for hospitals to recruit and retain staff in an increasingly competitive labor market where many opportunities exist outside of healthcare that offer competitive wages, signing bonuses, free or low-cost training, and the like. Nationally, 80% of nursing leaders have reported an increase in nurse turnover due to the pandemic. According to a 2021 study by Incredible Health, the demand for intensive care and emergency nurses grew by 186% over the past year. We are simply in a situation where the demand for labor currently outpaces supply, with 1.4 million job openings currently in the national healthcare sector according to the Labor Department’s Job Openings and Labor Turnover Summary. In Michigan, simply visiting the Careers webpage of your local hospitals will likely show the dramatic number of openings that are currently available.

Lastly, pent-up demand for healthcare services has stretched existing staff over recent months, as those who were hesitant to receive care for fear of contracting COVID-19 delayed seeing a provider and are now visiting our emergency departments (EDs) at very high levels. In fact, we have seen a 16% increase in hospital ED visits during the latest quarter compared to pre-COVID times in the second quarter of 2019. This pent-up demand is increasing the pressure on our hospitals and staff as people use the ED as a point of entry to the healthcare system.

A contributing factor to the staffing shortage prior to the pandemic was the rate of stress and burnout in the healthcare setting. It is apparent that there are certain jobs, especially those dealing with direct patient care, where the burnout factor is especially pronounced. In response, the MHA has assisted our members in recent years in adopting the Quadruple Aim, a framework that focuses on achieving better healthcare outcomes and has the added goal of improving the mental wellness and work/life balance of healthcare providers to address the issue of burnout. The pandemic has added new urgency to this work.  

In addition, our member hospitals and health systems throughout the state have been active in identifying solutions for our healthcare heroes. Some have offered bonuses and hazard pay to staff to show their appreciation for their hard work. Hospitals are also deploying more resources toward behavioral health support to help staff cope with the traumatic stress that they have experienced over the past 17 months. During Michigan’s three COVID-19 surges, many hospitals also brought in contract workers and traveling nurses to supplement their existing workforce due to staffing shortages, the cost of which came well above standard rates due to the demand. Hospitals have also gone to great lengths to procure record amounts of personal protective equipment for their staff — yet another unplanned and unbudgeted expense.   

For years, the MHA has advocated strenuously to support graduate medical education (GME) in the state budget process, and we have hosted in-person GME Advocacy Day in Lansing events in the past with our partners at the Michigan Osteopathic Association and the Michigan State Medical Society to connect medical residents with their elected officials. GME is critical to attracting medical students and residents from around the globe to Michigan.   

In addition, we advocated for passage of House Bill 4359, which modernized the scope of practice for Certified Registered Nurse Anesthetists (CRNAs). Rural providers have a difficult time hiring anesthesiologists, and this new law will allow 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 by eliminating the state requirement that a CRNA must work under direct physician supervision. We appreciate all the stakeholders that made this bill possible, as it eliminates a costly regulation while maintaining patient safety.

The MHA has also been active in bringing together stakeholders to identify solutions to healthcare staffing. The MHA Service Corporation (MHASC) Human Resources (HR) Committee was created as a collaborative body for HR leaders to come together and address issues specific to healthcare workforce issues. Led by Peter Schonfeld, senior vice president, policy & chief operating officer, MHASC, the committee has met to discuss current HR leadership priorities and review its role in guiding the purpose and direction for the MHASC efforts to address workforce resources, education, data staff development and more. The committee has also addressed priorities including vaccination policies, staffing shortages, and diversity, equity and inclusion.

We also recently formed the MHA Human Resources Council as a resource for healthcare professionals to provide input on legislative and regulatory issues relevant to healthcare employers. Staffed by MHA COO Nancy McKeague, the council will provide networking and educational opportunities for HR professionals, dissemination of best practices, and data collection and reporting relating to hospital and health system workforce metrics.

The MHASC has also been providing staffing solutions to our members through both the Unemployment Compensation Program and our Endorsed Business Partner (EBP) Program. The Unemployment Compensation Program has seen a dramatic increase in the number of cases filed since the pandemic began, processing over 70,000 unemployment claims in the last year alone, from clients in Michigan and across the country. Their decades of expertise have saved our client organizations tens of millions of dollars while addressing unemployment fraud that has become rampant recently.

We currently have six EBPs that focus on workforce solutions, including Merritt Hawkins, which provides permanent physician recruiting and consulting services. These EBPs have been carefully vetted to ensure they provide high-value services for our members in need of workforce assistance. In fact, we recently added NextJob as our newest EBP to help hospitals better support healthcare workers with re-employment services, which enhances the work of our unemployment program. I’m extremely happy that we have these services available, with other EBPs in this space focusing on compensation, workplace violence training, consulting and performance coaching.

Finally, as we look to the future, we know that telehealth and virtual care, which has seen an acceleration during the pandemic, has the potential to be real game changers for the delivery of healthcare. We will need to do all we can to help ensure that new technologies are adopted in such a way as to maximize access and affordability for all populations, while also doing right by our healthcare staff.

As you can see, the staffing challenges hospitals face are complex; yet across Michigan we are pursuing every tool in our toolbox to create solutions that both bring in top-notch caregivers and retain our healthcare heroes who have treated over 125,000 COVID-19 patients during the pandemic. Michigan hospitals remain committed to protecting our staff and doing everything we can to ensure they feel safe and protected while caring for their patients. From physicians and nurses to environmental service workers and support staff, our hospitals need all levels of team members to efficiently and effectively operate 24/7/365.

As always, I welcome your thoughts. 

Chris Mitchell Discusses Legislative Priorities with State of Reform

Chris Mitchell

MHA Executive Vice President Chris MitchellState of Reform published a story March 10 with Chris Mitchell, executive vice president, advocacy & public affairs, discussing the MHA’s priorities for the current Michigan legislative session.

The story reviews several key funding areas that are historically included in the state budget, including support for graduate medical education, rural and critical access hospitals and the Healthy Michigan plan. Mitchell also advocated for the continued use of increased outpatient Medicaid reimbursement rates for all hospitals, which was new for the fiscal year 2020 budget.

“We want the continued investment in graduate medical education program (GME),” said Mitchell. “What we’ve learned from the pandemic is we cannot have enough caregivers in the pipeline. So, continuing to fund the GME program remains a top priority for us.”

Read the article

MHA Appreciates Continued Support of Healthcare Priorities in Executive Budget Presentation

MHA CEO Brian Peters

The following statement can be attributed to MHA CEO Brian Peters.    

MHA CEO Brian PetersHospitals and health systems throughout Michigan appreciate the protections for vital healthcare funding and access to care that Gov. Gretchen Whitmer included in her executive budget presentation. As we are near almost a year of combatting the COVID-19 pandemic in our state, it is crucial that support continues for rural and critical access hospitals, obstetrical services, graduate medical education and the Healthy Michigan Plan. Maintaining these programs allow hospitals to continue to focus on caring for patients and improving the wellness of our communities.

We also do not want to lose sight of the short- and long-term impacts created by the pandemic. We are thankful for the additional funding that has supported testing, personal protective equipment, vaccinations and more over the past year and encourage considerations to address other pandemic consequences, such as funding to improve behavioral health. The prompt allocation of state and federal funds allows front-line caregivers to operate at the highest level. We look forward to the budget process and working with the Legislature in ensuring the improved health and wellness of all Michiganders.