MHA CEO Report — New Control in Lansing

MHA Rounds Report - Brian Peters, MHA CEO

“I don’t like that man. I must get to know him better.” Abraham Lincoln

MHA Rounds Report - Brian Peters, MHA CEOAs I put the proverbial pen to paper, the Michigan Legislature has completed the 2021-2022 legislative session and I am very pleased to report that in the lame-duck session, we successfully advanced several MHA-supported bills – and not a single MHA-opposed bill was signed into law. Another job extremely well done by our MHA Advocacy team as we protect access to affordable, high-quality healthcare for all.

Now shifting to the New Year: 2023 will usher in a monumental shift in power in Lansing as Democrats will control all aspects of government in the state for the first time during my 32-year tenure at the MHA. Following last November’s election results, Democrats not only retain power in all areas of the executive branch and a majority in the judicial, but both chambers of the legislative branch flipped to Democratic control. The last time Democrats had control of the Governor’s office and both chambers of the state legislature was 1984.

This change was due to a multitude of factors, including redistricting, ballot proposals, a trickle-down impact from the top of the ballot, candidate viability and record turnout. Earlier this year, the Michigan Independent Citizens Redistricting Commission established new district maps, which had previously been handled by the majority party in the state legislature in conjunction with the governor. Michigan saw a significant increase in the number of competitive districts due to their nonpartisan work. The Michigan midterm election saw record turnout again, with 4.5 million votes cast, including 1.8 million absentee ballots. This is a 2.4% increase from the prior record set in 2018 with 4.3 million votes. Turnout was partially driven by three ballot proposals as well as over 14,000 same day voter registrations, primarily from young Gen Z voters.

The MHA has a long history of being nonpartisan, but moving from divided government to one-party control will always bring about a change in the political dynamics and associated priorities. Our advocacy culture has long been to establish and maintain relationships regardless of leadership role or party affiliation so that in times of need, you have allies you can rely on. Both new Speaker of the House Joe Tate (D-Detroit) and Senate Majority Leader Winnie Brinks (D-Grand Rapids) have established track-records of working closely with the healthcare community to help us fulfill our mission of advancing the health and wellness of individuals and communities. Our MHA Advocacy team as well as our member hospitals and health systems consider them friends. And of course, our close partnership and personal friendships with Gov. Whitmer extend back to her time in the state legislature when she was recognized with an MHA Special Recognition Award at the 2014 MHA Annual Meeting. Our bonds with the governor and her administration grew even stronger as we confronted the COVID-19 pandemic together.

As a result of term limits, the new legislative session will also welcome an astounding 59 first-time legislators to Lansing. Since the Nov. 8 election, we have been busy establishing new relationships and introducing ourselves to many new faces. Most lawmakers only know healthcare through the prism of a consumer, so it is never too early to begin the education process related to this highly complex field. As part of this process, we hosted the Building Bridges event with our partners at the Small Business Association of Michigan, the Michigan Education Association, Michigan Association for Justice and Business Leaders for Michigan that helped us pursue these goals while also offering new legislators the opportunity to connect with their peers and learn how best to serve in Lansing.

Now I have no magic crystal ball so I can not predict what types of legislation we may see introduced and prioritized over the coming months. Having not held a dual-chamber majority for nearly 40 years, we anticipate there is no shortage of issues for Democrats to work on. There is no question we will continue to express the importance of access to care, which Democrats have traditionally strongly supported. Based on public comments and prior legislative track records, it is reasonable to expect continued activity on improving behavioral health, public health, health equity and addressing pharmaceutical pricing. American Rescue Plan Act funds also remain available and we strongly believe these funds should be appropriated quickly to make a difference in addressing the financial and staffing challenges that our member hospitals throughout the state, regardless of size, are experiencing. Those are positives. In reality, we need to also be prepared to address legislative proposals that we find more concerning – such as nurse to patient staffing ratio mandates which sound good in theory but would be impractical if not impossible to implement in practice.

The truth of the matter is that the Democrat majority is very slim, so we expect Republicans will still play an impactful role in healthcare funding and policy development. We certainly appreciate the work they’ve done for hospitals and healthcare over recent years and look forward to continuing those relationships during the new session.

I hope all our elected officials who will take office in January will reflect on the wise words of Abraham Lincoln above and include among their New Year’s resolutions to pause, set aside whatever preconceived notions they may have about the people across the aisle from them and make an earnest effort to truly get to know them. Will this guarantee that we come together and see eye-to-eye on all the issues? Of course not.  But hopefully, such an approach will lead to more civility in the political process and better public policy for all Michiganders.

The bottom line: 2023 presents new challenges and opportunities for all who work in Lansing. While many of the players in town may have changed, the playbook for successful advocacy has not. On behalf of our member hospitals, I’d like to express my gratitude for those finishing their years of service, congratulate all those who will be serving in office this upcoming year and look forward to working together to achieving a healthier Michigan.

As always, I welcome your thoughts.

Governor Signs Several MHA Priorities Into Law

Gov. Whitmer signed several bills into law Dec. 22 that were supported by the MHA and passed during the lame-duck session. Among these were expansions to the Michigan Reconnect Program, legislation to allow for a new rural emergency hospital licensure designation and interstate licensure opportunities for psychologists.

House Bills (HBs) 6129 and 6130legislation to expand the Michigan Reconnect program – were signed by the governor. The Michigan Reconnect program is a post-secondary scholarship program designed to provide funding to learners over the age of 25 interested in pursuing credentials or post-secondary degrees at community colleges or eligible training programs. Introduced by Reps. Ben Frederick (R-Owosso) and Sarah Anthony (D-Lansing), the package allows for several additional certifications to qualify for the scholarships including high-demand healthcare credentials. The MHA was supportive of the bills and will continue to advocate for future changes to lower the age of qualification for the program.

The legislation needed for hospitals to begin converting to Rural Emergency Hospitals (REHs) in Michigan was also signed into law. Due to limited session days left, the language to allow for REH licensure in Michigan was officially included in Senate Bill (SB) 183. REHs are a new federal designation that will require hospitals to give up inpatient services in exchange for improved federal outpatient reimbursement. Members with questions about the federal rules for REH designation can contact Lauren LaPine at the MHA for more information.

Legislation to allow Michigan to join the Psychology Interjurisdictional Compact (PSYPACT) was also approved by the governor. This will bring Michigan in line with 26 other states to create an expedited pathway to licensure for psychologists who wish to practice telepsychiatry across state lines. HBs 5488 and 5489 were introduced by Reps. Bronna Kahle (R-Adrian) and Felicia Brabec (D-Pittsfield Township) and supported by the MHA to help increase access to behavioral health services in Michigan.

Members with questions on these bills or any other lame duck action may reach out to Adam Carlson at the MHA.

 

MHA Monday Report Dec. 12, 2022

MHA Monday Report

capitol building2022 Legislative Session Adjourns

The Legislature took their final votes for the 2021-2022 legislative session during the week of Dec. 5. Given the results of the election, very few bills passed during the legislative lame-duck session compared to a typical year. …


Media Join Hospital Viability Press Conference

The MHA conducted a virtual press conference Dec. 6 to discuss the economic and staffing challenges impacting hospitals across the state to generate awareness with lawmakers of these issues and the potential impact on access to timely, high-quality healthcare for Michiganders. …


MHA and Michigan hospital representatives pictured with Rep. John Moolenaar (R-Midland).

MHA Visits Capitol Hill with Member Hospitals for AHA Advocacy Day

The MHA visited Capitol Hill in Washington DC last week to emphasize year-end priorities to Michigan’s congressional delegation. The MHA and several hospital representatives met with House members and with U.S. Senator Debbie Stabenow to deliver the message that pending Medicare cuts are unsustainable and unacceptable. …


Rural Emergency Hospital Legislation Passed in Michigan

On Dec. 6th, the legislation needed for hospitals to begin converting to Rural Emergency Hospitals (REH) in Michigan was sent to the Governor’s desk for final approval. Due to the limited session days left, the language to allow for REH licensure in Michigan were officially included in Senate Bill (SB) 183. …


CMS Issues Proposal to Modify the Prior Authorization Process

The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule to modify the prior authorization process for certain payers. The proposal would require payers to: Include a specific reason when denying a request. Publicly report certain prior authorization metrics. …


MHA Workforce Webinar to Discuss Diverse Workforce Solutions

Understanding the workforce’s values, preferences, triggers and character traits is essential to developing relationships that create a healthy organization. This may sound basic, but many organizations continue to miss the mark. …


Keckley Report 

Paul KeckleyThe Transitioning of US Healthcare from A Virtuous to Vicious Cycle

“U.S. healthcare has moved into a vicious cycle marked by intensified competition and noticeable acrimony between major players. Growing tension between major health insurers and health systems is illustrative.

Virtuosity to insurers is predicated on the core belief that keeping providers honest and care affordable and their domain; its vicious pursuit is to attribute unsustainable health costs to hospital inefficiency and price gauging.

The virtuous cycle for hospitals is premised on community health and provision of services to those unable to pay; the vicious cycle is the unwelcome intrusion of insurers and private investors who put profit above all else by paying them less so they can keep more. …”

Paul Keckley, Dec. 5, 2022


News to Know

Medtel was approved for associate membership in Nov. 2022. Medtel was founded in 2016 with a mission to improve surgical care experiences and outcomes for patients and providers by developing and delivering technology solutions. …


Brian PetersMHA in the News

The MHA received media coverage the week of Dec. 5 following a virtual press conference Dec. 6 on the financial and staffing challenges impacting hospital viability, as well as topics including hospital capital improvements, mergers and acquisitions and respiratory illness hospital admissions driven by RSV and COVID-19. …

MHA Monday Report Dec. 5, 2022

MHA Monday Report

capitol buildingLame Duck Session Begins in Senate

The 2022 lame-duck session in the legislature got off to a slow start in the Senate during the week of Nov. 28. Several bills impacting hospitals saw unsuccessful votes on the floor, including legislation to make changes to the operation of the 340B drug pricing program and a package to integrate behavioral and physical health for state regulated insurance plans …


MHA Keystone Center 2021-2022 Annual Report Highlights Collaboration and Partnership

The MHA Keystone Center recently released its 2021-2022 Annual Report, which showcases the center’s commitment to working alongside members to improve safety and quality in healthcare. Through support from Blue Cross Blue Shield of Michigan, this report highlights …


Expanded Scope of Practice Creates Opportunities

To optimize cost savings, patient experience and staffing, hospitals and health systems are using multidisciplinary teams working to deliver care. Fortunately, new legislation expanded certified registered nurse anesthetists (CRNAs) abilities to practice without direct physician supervision. …


MHA CEO Report — Pediatric Capacity CrisisMHA Rounds Report - Brian Peters, MHA CEO

“Every child begins the world again.” ― Henry David Thoreau

In all of my life experiences to date, none have been so challenging in every sense as those times when my young children were hospitalized in the NICU, fighting for their very lives. We were incredibly fortunate to have positive outcomes with both of them, thanks to the efforts of our Michigan hospitals and the incredible people who work there every day …


The Keckley Report 

Out of Sight, Out of Mind: The 6 Populations that Lack Adequate Voice in the US Health SystemPaul Keckley

“Trade groups and lobbyists for high profile special interests will be active; others less noticed will be under-represented in lawmaking and budgeting. Six groups top this list for healthcare…

These populations are out of sight, out of mind in most consideration of the health system’s future, but they represent perhaps it’s greatest opportunities for innovation and public-private collaboration.”

Paul Keckley, Nov. 28, 2022


MHA in the News Laura Appel

The MHA received media coverage during the weeks of Nov. 21 and 28 on the capacity status of hospital pediatric units amid the surge of hospitalized pediatric patients with respiratory illnesses driven by respiratory syncytial virus (RSV) …

Lame Duck Session Begins in Senate

capitol building

capitol buildingThe 2022 lame-duck session in the legislature got off to a slow start in the Senate during the week of Nov. 28. Several bills impacting hospitals saw unsuccessful votes on the floor, including legislation to make changes to the operation of the 340B drug pricing program and a package to integrate behavioral and physical health for state regulated insurance plans.

The 340B legislation, Senate Bill (SB) 1088, threatened to strike important protectionist language that was secured in Public Act 12 of 2022. That bill signed into law in February prohibits a pharmaceutical manufacturer from requiring the use of a modifier on non-Medicaid claims, protecting 340B entities from industry implemented administrative hurdles. Removing this language would negatively impact the communities served by Michigan 340B hospitals. The MHA and its member hospitals have been working hard to advocate to elected officials the importance of the program. SB 1088 was introduced as a vehicle bill by Sen. Curt VanderWall (R-Ludington) and was discharged and substituted on the floor before voting. The vote on SB 1088 on Nov. 29 ultimately failed twice on the floor and it is not clear if the legislation will be considered again.  The MHA will continue to oppose SB 1088 and other threats to the 340B program.

SB 597 and 598, the Senate’s behavioral health integration package, also did not find the votes to pass on the floor. Introduced by Sen. Majority Leader Mike Shirkey (R-Jackson) and Sen. John Bizon (R-Battle Creek), the package would create new specialty integrated plans (SIPs) that would replace the current prepaid inpatient health plans (PIHPs) and contract with each community mental health (CMH) services program to deliver physical and behavioral health services to Michigan’s Medicaid population. The bills would also eliminate language requiring CMH entities to coordinate substance use disorder (SUD) and school based behavioral health services and create a new statewide ombudsman.

The Senate’s Health Policy and Human Services Committee also met to advance several bills to the floor for a potential vote in the final days of session. Among those bills was House Bill (HB) 6086, introduced by Rep. Jeff Yaroch (R-Richmond). HB 6086 would establish an alternate licensure process for paramedics in Michigan. HB 6086 would require the state to develop a new Michigan-specific certification course, separate from the currently required course from the National Registry of Emergency Medical Technicians. The MHA is opposed to HB 6086, which could have implications for a paramedic’s ability to work in multiple states. The National Registry of Emergency Medical Technicians certification is currently used in 48 states and is required for all newly licensed paramedics in Michigan.

The MHA will continue to monitor all these bills for any further action in the coming weeks. Members with questions about these issues or other state legislation related to healthcare can be directed to Adam Carlson at the MHA.

MHA Monday Report Nov. 21, 2022

MHA Monday Report

Urge Congress to Support Hospitals by Enacting Key Priorities in Lame-duck Session

The American Hospital Association (AHA) recently released an action alert to impress upon lawmakers the immediate need to support hospitals and health systems. It is important the last session days of the year are used as an opportunity to advance key priorities at the federal level …


Webinar Outlines CRNA’s Role in the Future of Clinical Operations

Michigan legislation in 2022 modernized the scope of practice for certified registered nurse anesthetists (CRNAs), eliminating the state requirement that a CRNA must work under direct physician supervision. Hospitals can now choose the anesthesia care model that best fits their location, staffing and resources to offer safe and effective patient care …


Keckley Report 

Paul KeckleyThe Two Lessons Healthcare Should Take from Campaign 2022

“The public’s opinion (vote) on healthcare issues is defined by personal circumstances and core beliefs about a single issue. Most lack an informed view about the entire system. Healthcare must do a better job in educating citizens about our system of health and the roles of personal responsibility, commercial operations and governmental oversight. It must do a better job in understanding consumer needs and expectations especially in younger and independent-minded users.

The healthcare market is not homogenous: a one size fits all approach to service delivery, pricing, and user experiences is short-sighted. While single-issue voter blocks in healthcare matter (i.e., abortion, Medicaid expansion, drug prices, et al), they’re unlikely to advance a system of health that contributes effectively and appropriately to the future of our democracy—a key issue in Campaign 2022.”

Paul Keckley, Nov. 14, 2022


News to Know

  • DataGen is hosting a national webinar to review the 2023 Medicare fee-for-service outpatient prospective payment system final rule and hospital impact analysis at 3 p.m. on Nov. 30, 2022.
  • MHA Endorsed Business Partner NextJob is hosting a free webinar on Actionable Neuroscience Insights for Improved Workplace Performance at noon ET Dec. 7, 2022 to educate employees about the brain processes of perception, cognition and neuro-linguistics and share tips to help improve performance at work.

Laura AppelMHA in the News

The MHA received media coverage during the week of Nov. 14 on financial and staffing challenges impacting hospitals in Michigan and the potential for further state funding support …

Urge Congress to Support Hospitals by Enacting Key Priorities in Lame-duck Session

The American Hospital Association (AHA) recently released an action alert to impress upon lawmakers the immediate need to support hospitals and health systems. It is important the last session days of the year are used as an opportunity to advance key priorities at the federal level. The AHA has already urged congressional leaders to include a number of important provisions in a year-end legislative package to ensure that hospitals and health systems can continue their mission of caring for the communities they serve.

Lawmakers need to hear how managing the aftermath and aftershocks of the biggest public health crisis in a century has left hospitals and health systems facing significant financial and workforce challenges that are jeopardizing access to care for patients. Members are asked to contact their legislators today and continue to make the case why additional support and resources are needed.

Lawmakers should be urged to:

  • Prevent any further damaging cuts to health programs, including stopping the forthcoming 4% Statutory Pay-As-You-Go (PAYGO) sequester.
  • Establish a temporary per diem payment targeted to hospitals to address the issue of hospitals not being able to discharge patients to post-acute care or behavioral facilities because of staffing shortages.
  • Extend or make permanent the low-volume adjustment and the Medicare-dependent hospital programs — critical rural programs that are due to expire on Dec. 16.
  • Make permanent the expansion of telehealth services and extend the hospital-at-home program.

Participate in AHA Advocacy Day on Capitol Hill: Members are asked to inform the MHA if they will be in Washington, D.C. on Dec. 6 and would like to be included in the schedule for visits with members of Congress.

Contact Laura Appel at the MHA for more details.

MHA Monday Report Nov. 14, 2022

MHA Monday Report

MI Vote Matters logoRecapping 2022 Election Results

Midterm election results are in, bringing new leadership to the Michigan Legislature and a returning administration at the top of the ticket. Election 2022 will bring significant change to Lansing, as Democrats will now control the Governor’s office and both chambers of the state legislature for the first time since 1984 …


capitol buildingLegislature Returns for Lame Duck Session

The legislature returned during the week of Nov. 7 to vote on legislative leadership and kickoff the 2022 lame-duck session. Only a handful of MHA-tracked bills saw action, including legislation to implement the new federal Rural Emergency Hospital (REH) designation …


CMS Finalizes Rate Cuts in 2023 Medicare Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) recently released the 2023 Medicare Physician Fee Schedule (PFS) final rule, effective Jan. 1, 2023. The rule reduces the PFS conversion factor by $1.55 (4.7%) to $33.06 in a calendar year (CY) 2023 from $34.61 in CY 2022 …


October MA Enrollment Increases by 17,000 Beneficiaries

Medicare Advantage (MA) enrollment in Michigan totaled approximately 1.22 million in October, an increase of 17,000 beneficiaries since July. The October enrollment is spread across 48 MA plans that are currently operating in the state …


The MHA Keystone Center Offers Ongoing Workforce Well-Being Courses

Through a partnership with the Duke Center for Healthcare Safety and Quality, the MHA Keystone Center is pleased to offer the second iteration of its WELL-B webinar series geared to support healthcare workers experiencing burnout …


The Keckley Report 

Paul KeckleyThe Physician Pay Rule in Context: Profession “Heal Thyself”

“Last Tuesday, the Center for Medicare and Medicaid Services (CMS) published its 2023 payment schedule for physicians along with changes in the Medicare shared savings program, outpatient, behavioral and home health services…

Healthcare is at a crossroad. Physicians are caught in the crossfire of policies to lower health costs and capital necessary to transform the system from specialty care and volume-based incentives to value and wellbeing.”

Paul Keckley, Nov. 7, 2022


Laura AppelMHA in the News

The MHA received media coverage on the continued surge of RSV cases across Michigan’s pediatric hospitals that is stressing hospital capacity during the week of Nov. 6. Laura Appel, executive vice president …

Legislature Returns for Lame Duck Session

capitol building

capitol buildingThe legislature returned during the week of Nov. 7 to vote on legislative leadership and kickoff the 2022 lame-duck session. Only a handful of MHA-tracked bills saw action, including legislation to implement the new federal Rural Emergency Hospital (REH) designation.

During the House Health Policy Committee, Senate Bill (SB) 450 received another hearing and was reported to the full House of Representatives. SB 450, introduced by Sen. Jim Stamas (R-Midland), would ensure visitors of cognitively impaired patients are permitted in healthcare facilities. The bill would prohibit the directors of the Michigan Department of Health and Human Services (MDHHS) or a local health officer from issuing an order that prohibits a patient representative from visiting a cognitively impaired individual in a healthcare facility. As written, the legislation does not prevent a healthcare facility from implementing reasonable safety measures for visitors and will still allow for facilities to limit the number of representatives per patient. The MHA is neutral on the bill and will continue to monitor any action taken.

MHA staff was also in attendance to support House Bill (HB) 6380. Introduced by Rep. Andrew Fink (R-Hillsdale), HB 6380 would make the necessary changes to state law to allow for Michigan hospitals to pursue a new federal designation of REH status. An REH designation comes with significant requirements such as limiting total beds to 50, maintaining an average length of stay of 24 hours or less and a required transfer agreement with a level I or II trauma center. Hospitals that choose to convert to an REH will receive enhanced federal reimbursement to provide critical emergency and outpatient services, especially in geographic areas. The MHA provided testimony on the bill in September and will continue to advocate for its passage before the end of the year.

On the Senate side, the Health and Human Services Committee took action on SB 1172, introduced by Sen. Stephanie Chang (D-Detroit). SB 1172 would amend the Mental Health Code to allow for conservation officers to transport behavioral health patients to the proper care setting. Currently, conservation officers and Michigan’s state parks and public venues are required to contact another form of law enforcement if they encounter someone experiencing a mental health crisis. The MHA is supportive of SB 1172, which will help shorten patient wait times for these particular cases.

If members have questions about these issues or any others impacting healthcare, please contact Adam Carlson at the MHA.