The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.
Healthcare access is vital for the physical and economic health of our local economies. This budget proposal presented by the Whitmer administration checks the boxes hospitals and health systems need when it comes to crucial state funding. It includes new funding that can make significant impacts on maternal and infant health, behavioral health and the healthcare workforce, while maintaining existing support for a variety of needed healthcare programs.
Hospitals and health systems are focused on addressing health disparities. Supporting additional maternal health services can help reduce the disparity in maternal health outcomes among non-white women. Expanded Medicaid reimbursement for behavioral health services will improve access across the state and benefit the workforce. We’re encouraged to see funding for tuition-free community college pathways for Michiganders. This can increase the number of students pursuing healthcare pathways and address workforce shortages. Continuing funding pools to support rural and critical access hospitals, obstetrical services, graduate medical education, the Healthy Michigan Plan and Michigan’s Medicaid populations will help maintain access to care for underserved populations throughout Michigan.
Gov. Whitmer is clearly a healthcare champion. We look forward to working with other legislative healthcare champions during the budget process to make sure Michigan healthcare providers have the necessary funding support to advance the health and wellness of Michiganders and communities.
Hospitals are urged to apply for additional graduate medical education (GME) full-time equivalent (FTE) resident cap slots for fiscal year (FY) 2025 by March 31. Section 126 of the Consolidated Appropriations Act, 2021, made available an additional 1,000 GME FTE slots, phased in over five years, beginning in FY 2023. 10% of slots must go to hospitals in rural areas, but only two geographically rural hospitals received slots in the most recent round of slot distribution.
Hospitals must qualify in at least one category:
Located in a rural area.
Train residents in excess of their GME cap.
Located in states with new medical schools.
Serve areas designated as health professional shortage areas (HPSAs) – geographic HPSAs only and not population HPSAs.
Section 125 requires at least 10% of the cap slots go to hospitals in each of the four categories, and no single hospital can receive more than 25 additional FTE resident cap slots. Hospitals can apply for FTE resident cap slots under Section 126 by accessing the online application system.
The Rural Residency Program Development Technical Assistance Center is hosting a webinar Jan. 17 at 12 p.m. ET, titled Expand GME Training at Your Hospital: How to Apply for Section 126 Positions. The session will provide a background on Section 126 GME slots and discuss the application process for round 3 (e.g., timeline, eligibility, requirements, etc.). Members are encouraged to register in advance.
“Let us not seek the Republican answer or the Democratic answer, but the right answer.” ― John F. Kennedy
Given that the Michigan Legislature has officially adjourned sine die, it is now an appropriate time to reflect on the success of our MHA advocacy throughout 2023. As always, healthcare was in the spotlight as a political and public policy priority. Our team was incredibly busy as we worked to support bills that would advance the health of individuals and communities, and to oppose those bills that would run counter to our mission.
A full recap of these pertinent bills is available, but I want to lift up a few of particular importance. First, for many years, the MHA has advocated for healthcare workers to have similar protections from violence as other first responders. We’re thankful House Bills 4520 and 4521 that increase the penalties for assaulting a healthcare worker or volunteer are soon to be signed by Gov. Whitmer. We know this legislation is just one step towards improving workplace safety and our association will continue to work on more opportunities to protect the healthcare workforce from violence through our advocacy at the state and federal level, the MHA Keystone Center and the MHA Service Corporation.
In addition, the governor signed legislation that will add protections found in the Affordable Care Act to Michigan law. Public Acts 156-163 of 2023 memorialize important protections for Michiganders, such as no-cost essential services, including preventive, mental health and emergency services. A variety of other bills await the return of the legislature in 2024 on issues including auto no-fault insurance, telemedicine, sharps containers, behavioral health policy, maternal and infant health and more.
Of course, seeing no action besides testimony on House Bills 4550-4552 is another testament to the work of our team. These bills would mandate one-size-fits-all nurse staffing ratios for all Michigan hospitals and create significant access issues for patients. As discussed at length in a recent CEO Report, the MHA has communicated with all 148 state legislators to explain the complexity associated with hospital staffing and the tangible solutions that will actually address workforce shortages. We have significantly increased the awareness and understanding of the issue for lawmakers, and the bills not receiving a vote in committee is an example of our effectiveness in that regard.
In addition to all these policy-oriented items, we successfully advocated to protect Medicaid funding for hospitals, including graduate medical education, rural access and OB stabilization, and also secured new funding for recruitment and retention of healthcare workers and for pediatric behavioral health. And of course, we stood tall to prevent any erosion in our Certificate of Need laws, or our medical liability reform protections, both of which continue to play an important role in ensuring access to quality, affordable care for all.
Our work also extends to Washington DC and Capitol Hill. We continue to work closely with the American Hospital Association on federal advocacy that supports Michigan hospitals on issues including Medicare policy, site-neutral payments, the 340B drug pricing program, the healthcare workforce and much more. And just as we have benefitted tremendously from our partnership with Public Affairs Associates (PAA) as our long-time advocacy firm here in Lansing, we are also pleased with our new partnership with Cornerstone Government Affairs, which is helping us with our important work at the federal level.
We cannot accomplish our advocacy goals without the individual commitment from our member hospitals and health systems, large and small. At the end of the day, our unity is our strength; a great example of this is the unified opposition letter – representing 100% of our membership – that we shared with lawmakers last month in opposition to the nurse staffing legislation.
There is a lot of uncertainty in the year ahead. As widely reported, the state House is evenly split between Republicans and Democrats until special elections are held next April. It is also no secret that 2024 is a presidential election year, with all the political dynamics and theatre that will inevitably accompany the entire process. Finally, depending on the outcome of the November election, the lame-duck session that will follow could either be a low-key affair with not much on the agenda…. or a nerve-wracking period fraught with unexpected twist and turns that could directly impact multiple priority issues. Regardless, I am extremely confident the MHA will continue to deliver outstanding results that support our healthcare workers, our patients and communities.
“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.
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.
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.
The fiscal year 2024 state budget approved by the Michigan Legislature renews a longstanding commitment lawmakers have made to the health and wellness of Michigan’s hospitals, health systems and communities.
We are extremely pleased to see the inclusion of new funding to support trauma centers and inpatient psychiatric services that will provide a net benefit of $92 million. Trauma centers at hospitals provide lifesaving treatment to people with the most severe injuries, ready at a moment’s notice for mass casualty events and catastrophic accidents with a vital network of EMS services. This added funding makes Michigan a national leader in recognizing the importance of access to trauma services and makes sure trauma centers can continue to be equipped with the resources needed to staff these services 24/7, year-round.
Michigan is also in the middle of a behavioral health crisis where the demand of patients needing inpatient care continues to increase. We commend the Legislature for recognizing this need and increasing rates to inpatient psychiatric facilities based on patient acuity to help hospitals afford the staffing, security and facilities necessary to accept patients with more severe illness.
In addition, the budget continues to support long-standing programs crucial to access to healthcare services throughout Michigan. These include funding for rural and critical access hospitals, obstetrical services, graduate medical education, the Healthy Michigan Plan and Michigan’s Medicaid population.
We look forward to a signed budget that provides hospitals with the needed support to continue to provide high-quality care to every patient.
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.
Gov. Whitmer and her administration demonstrated their commitment to protecting hospitals and supporting healthcare workers with the release today of the 2024 executive budget recommendation. Not only does it continue to protect vital funding pools in the state budget, but also provides health equity resources and includes significant workforce investments that should help grow the healthcare talent pipeline.
Important items included in the state budget include support for rural and critical access hospitals, obstetrical services, graduate medical education, the Healthy Michigan Plan and Michigan’s Medicaid population. The investments to expand the Healthy Moms, Healthy Babies program and to implement recommendations from the Racial Disparities Task Force should help improve health outcomes and reduce disparities in care. The announced workforce development investments such as lowering the eligibility age for Michigan Reconnect are long-term strategies that should help fill the incoming talent pipeline as staffing challenges continue to impact hospitals and their overall patient capacity.
Actions like today show Gov. Whitmer is a healthcare champion and on behalf of Michigan’s hospitals, we thank her for helping Michigan advance the health and wellness of individuals and communities. The MHA is committed to working with lawmakers throughout the budget process to identify funding solutions that expand access to care, protect the viability of hospitals and assist healthcare workers.
“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.
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.
Gov. 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.
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.
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.
The 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.
The full Michigan House and Senate advanced their budget recommendations for the fiscal year 2023 budget beginning Oct. 1. The Michigan Department of Health and Human Services budget bills, House Bill 5784 and Senate Bill 828, were reported to the opposite chambers for further consideration in the coming weeks. Both budget proposals …
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 …
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
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 …”
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.
