Unvaccinated residents filling Michigan hospitals, getting hospitalized for COVID

MDHHS MHA

As Michigan continues to record high numbers of COVID-19 cases, new data from the Michigan Health & Hospital Association (MHA) proves that the majority of Michigan residents severely sick with COVID-19 are unvaccinated. The Michigan Department of Health and Human Services (MDHHS) and MHA are pleading with residents to get vaccinated for their own health, the safety of Michigan’s health care personnel, and to avoid additional strain on health care systems that are already stretched and struggling to respond.

“The data is clear: if you are unvaccinated, you are risking hospitalization or death,” said Elizabeth Hertel, MDHHS director. “We have a safe and effective vaccine that is quite literally saving lives. Michigan residents absolutely need to get vaccinated to keep their loved ones safe this holiday.”

Based on recent data from most Michigan health systems, MHA has found that three out of four COVID patients are unvaccinated (76%), 87% of COVID ICU patients are unvaccinated and 88% of COVID ventilator patients are unvaccinated.

“Michigan’s health care systems are stretched beyond their limits – so much so that the U.S. Department of Defense is providing clinical staffing support to hospitals throughout the state that are operating at capacity, delaying nonemergency medical procedures and placing their emergency departments on diversion,” said Brian Peters, CEO of MHA. “This data confirms what the situation in our hospitals is already telling us: get vaccinated, whether it is your first dose, vaccination for your children or a booster dose.”

Michigan’s number of hospitalized COVID-19 cases reached a new high this week, with 4,291 patients hospitalized. Recently, Michigan reached 70% of residents 16 and older who have received their first vaccine dose, but cases are surging in the unvaccinated population.

MDHHS is monitoring for the COVID-19 omicron variant which has not been detected in the state. Residents are advised that the presence of variants makes it even more important to get vaccinated, including the booster doses to increase protection, wear masks, and take other precautions.

In addition to getting vaccinated and wearing masks – particularly indoors and in crowded areas – other things people can do to protect themselves and their loved ones include:

  • Getting tested for COVID-19, especially before gatherings.
  • Physically distancing from others and avoiding crowds
  • Washing hands frequently with soap and water and cleaning hands with alcohol-based hand rub.
  • Covering your mouth and nose with a bent elbow or tissue when you cough or sneeze
  • Self-isolating until you recover if you develop symptoms or test positive for COVID-19.

MDHHS has issued a public health advisory that all Michiganders, regardless of vaccination status, should wear a mask in indoor public settings and those who are not fully vaccinated or who are immunocompromised should avoid large crowds or gatherings.

MHA Statement on Department of Defense Approving State Request for Healthcare Staffing Support

MHA CEO Brian Peters

The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.

Brian Peters

The current situation facing our hospitals and health system is dire and today’s approval by the U.S. Department of Defense to grant clinical staffing support is desperately needed to provide relief to our vital healthcare workforce. Many hospitals throughout the state are operating at capacity, delaying nonemergency medical procedures and placing their emergency departments on diversion. Receiving these teams of federal caregivers can only help those hospitals.

We want to commend Gov. Whitmer and the Michigan Department of Health and Human Services for making the formal request on behalf of Michigan hospitals and express our gratitude to the Department of Defense for granting this request so quickly.

However, the strain on our healthcare system is severe and we still need the public’s help to slow the extreme growth of cases and hospitalizations. Please get vaccinated, whether it is your first dose, vaccination for your children or a booster dose. Adhere to the public health advisory and wear a mask in crowded indoor gatherings. And contact your primary care provider or seek care at an outpatient setting for nonemergency medical needs. Together we can get through this crisis, but it will take all Michiganders doing the right thing.

Senate Introduces Behavioral Health Funding, Including MHA Priorities

capitol background

State legislative action continued during the week of Oct. 25, including committee votes on bills impacting behavioral health and certificate of need.

The state Senate introduced a $350 million supplemental spending request related to behavioral health. The bill includes the MHA priority of providing $100 million to fund additional inpatient psychiatric beds and $20 million to improve behavioral health services in hospital emergency departments. The proposal also includes additional funds to attract behavioral health providers and add funding to the Essential Health Provider Loan Repayment Program that would allow psychiatrists to be added to the list of professionals eligible for loan forgiveness. The supplemental was referred to the Appropriations Committee, and the MHA encourages the Legislature to quickly pass this important funding to improve behavioral healthcare in Michigan.

On a related note, the state Senate Government Operations Committee reported Senate Bills 597 and 598 that would create new specialty integrated plans to replace the current prepaid inpatient health plans and contract with each community mental health services program to deliver physical and behavioral health services to Michigan’s Medicaid population. The MHA-supported bills were amended in committee to slow the timeline for the transition from the current system, which could now take up to eight years in the committee-approved legislation. 

The House Health Policy Committee approved four Certificate of Need (CON) bills that make no substantive changes to covered services. House Bills (HBs) 507450755076 and 5077 would require CON Commission reports and minutes to be posted online pursuant to certain deadlines and would require annual meetings of the Legislature’s Joint Legislative Committee, which oversees CON.  The committee did not make changes to the legislation from the introduced version, and the MHA has confirmed that the Michigan Department of Health and Human Services does not expect the bills to hinder the success of the program. The bills will next be considered on the House floor.

The House Health Policy Committee also took testimony on HBs 526152625263 and 5264, which are related to improving the availability of an MHA-supported non-opioid directive form. The package is currently being amended based on stakeholder input and will be discussed again in future committee meetings.

Members with questions on the state budget or healthcare legislation may contact Adam Carlson at the MHA.

Medication for Opioid Use Disorder Cuts Hospital Costs, Improves Patient Care

The MHA Keystone Center is working alongside the Community Foundation for Southeast Michigan (CFSEM) through the Michigan Opioid Partnership to provide funding and technical assistance for the emergency department-based medication for opioid use disorder (ED MOUD) program. The program will increase access to medication for OUD statewide and connect patients receiving MOUD with appropriate resources to continue care in the community. An online video provides additional information on the program.

The CFSEM recently released impact stories highlighting successes of the program from previous participants. Andrew King, MD, an emergency room physician at Detroit Medical Center and advisor to the CFSEM, has witnessed the effectiveness of MOUD and reminds practitioners that it is possible to guide those with OUD down a path to recovery.

“I can see the people who are now on medications and feeling much better and doing well. They are happy and putting their lives back together, and that’s a beautiful thing!” King says. “By controlling the disease process, maybe they’re treating their kids or their spouse better or they’re doing a better job at work. That’s the whole point of why we signed up for this job — trying to keep people safe and healthy and in the game for as long as possible.” An article from the CFSEM provides additional information.

The MHA has also been advocating to improve legislation related to ED MOUD by working with the Michigan Department of Health and Human Services to ensure all hospitals interested in starting an emergency department-based medication assisted treatment program have the funding resources to do so.

Members with questions on the ED MOUD program may contact the MHA Keystone Center.

Input Needed on Allocation of Opioid Settlement Funding

The MHA and its member hospitals have been heavily committed to addressing the misuse of prescription drugs, which has increased during the COVID-19 pandemic. While the MHA continues to work with stakeholders on passing current legislation to expand treatment access related to opioid use disorders, it also supports gathering ideas on best ways to assist and increase care options for this patient population.

Therefore, the MHA has responded to the Michigan Department of Health & Human Services (MDHHS) survey asking healthcare stakeholders for input on the allocation of settlement dollars from several lawsuits against manufacturers and distributers of opioids. The results will shape the administration’s proposals to the Legislature for establishing a fund that directs settlement dollars to support substance use services and abate harm created by opioids.

Members are encouraged to complete the survey to provide the administration with hospital input on how these funds could support the best patient outcomes and sustained recovery. The survey will take approximately 20 minutes to complete. Members may also share the survey with other community stakeholders they believe can provide valuable input on how the settlement funds can best assist in treating and preventing OUD. Questions can be emailed to the MDHHS Opioids Task Force or Paige Fults at the MHA.


Further Hearings Held on Behavioral Health and Guardianship Bills

The Michigan Legislature took testimony on two bill packages that would impact Michigan hospitals during the week of Sept. 20. In the Senate, another hearing was held on Senate Bills (SBs) 597 and 598, which would require the Michigan Department of Health and Human Services (MDHHS) to phase-in integration of physical and behavioral health services by 2026. In the House, testimony was taken on House Bills (HBs) 4847, 4848, 4849 and 4850, which would create new regulations and certification for professional guardians in Michigan.

The Senate Government Operations Committee addressed the Senate behavioral health package, which the MHA supports. SBs 597 and 598 would create new specialty integrated plans that would replace the current prepaid inpatient health plans 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 the provision of substance use disorder and school-based behavioral health services and establish a new Behavioral Health Accountability Council at the state level. The MHA provided written testimony to the committee and will continue to work with members to strengthen the bills.

The House Judiciary Committee held its second hearing on the guardianship package, HBs 4847-4850. The MHA has not taken a position on the bills but provided written testimony to the committee to voice some concerns on the potential impact to hospitals. The proposed legislation would significantly increase requirements on professional guardians and limit the number of individuals an uncertified guardian could represent. The MHA supports a strong guardianship program in which qualified individuals are available for incapacitated patients in need of a decision maker, but remains concerned that hospitals will struggle to find guardians for some patients without increased funding. The MHA will continue to discuss the package with bill sponsors and follow its progress.

Any questions or comments on this legislation may be directed to Adam Carlson at the MHA.

Behavioral Health Integration Bills Receive First Senate Hearing

capitol building

The Senate Government Operations Committee took testimony Sept. 14 on a pair of bills that would make several changes to Michigan’s behavioral health system. Introduced by Sens. Mike Shirkey (R-Clark Lake) and John Bizon (R-Battle Creek), the bills would require the Michigan Department of Health and Human Services to phase-in integration of funding for physical and behavioral health services by 2026.

Senate Bills (SBs) 597 and 598 would create new specialty integrated plans that would replace the current system of using prepaid inpatient health plans to manage care for Medicaid beneficiaries with serious mental illness or behavioral health needs. The new system would use the managed healthcare plans to contract with each community mental health (CMH) services program and other providers to deliver physical and behavioral health services to Michigan’s Medicaid population. The bills would also eliminate language requiring CMH entities to coordinate the provision of substance use disorder and school-based behavioral health services and would establish a new Behavioral Health Ombudsman and Behavioral Health Accountability Council at the state level.

Further hearings on SBs 597 and 598 are expected to be held in the coming weeks, and the MHA will keep members apprised of progress on the bills. Questions or comments may be directed to Adam Carlson at the MHA.

Registration Required for Sept. 20 Launch of OBRA Electronic System

MHA members are encouraged to complete registration for the new electronic system that will be used to complete required Omnibus Budget Reconciliation Act (OBRA) forms 3877 and 3878 beginning Sept. 20. The new electronic system will replace the current paper process for completing forms 3877 and 3878, which are required for discharging certain patients from an inpatient hospital to post-acute care settings. Note that Microsoft Edge and Google Chrome are the suggested browsers for this system.

Hospitals should ensure that the skilled nursing facilities and other post-acute facilities to which they commonly discharge patients are aware they must register and that the date the system will go live is quickly approaching.

When registering, users must submit a letter requesting access to the OBRA electronic system on their organization’s letterhead. The OBRA office provided a sample letter to assist in the process. In addition, the Michigan Department of Health and Human Services OBRA office has released several training modules for the system.

The MHA has convened a work group since January to identify issues and provide input to the OBRA office. The final work group meeting is scheduled for Oct. 1, after the system is live. Members with specific questions should contact the OBRA office. General questions should be directed to Vickie Kunz at the MHA.

Registration Open for Completing OBRA Forms Electronically

The electronic system that will be used to complete required Omnibus Budget Reconciliation Act (OBRA) forms 3877 and 3878 will go live Sept. 20. The new electronic system will replace the current paper process for completing the forms, which are required for discharging certain patients from an inpatient hospital to post-acute care settings.

The MHA encourages users to complete registration for the system as soon as possible. Note that Microsoft Edge and Google Chrome are the suggested browsers for this system. The Michigan Department of Health and Human Services OBRA office has released several training modules and the OBRA coordinator list to assist in transitioning to the electronic process.

The MHA continues to convene a workgroup to identify issues and provide input to the OBRA office. Members with specific questions should contact the OBRA office directly. General questions should be directed to Vickie Kunz at the MHA.

Combating the Novel Coronavirus (COVID-19): Week of June 21

MHA Covid-19 update

The COVID-19 vaccines appear to be effective in protecting against serious illness from the more contagious delta variant of the virus. However, the variant continues to infect many in regions throughout the world, with news reports of renewed lockdowns in Australia and New Zeeland and increasing numbers of cases in U.S. states including Missouri, California, Florida and Texas, where fewer residents are vaccinated. Meanwhile, Michigan’s vaccine dashboard shows more than 61% of residents ages 16 and older have received at least one dose of a COVID-19 vaccine, with nearly 9 million doses administered.

The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Emergency Orders Rescinded Effective June 22

Several emergency public health orders that have been in place for much of the last 15 months are rescinded as of 12:01 a.m. June 22. The orders rescinded and the dates on which they took effect are:

  1. Gatherings and Face Mask Order (June 1, 2021)
  2. Temporary Restrictions for Entry into Congregate Care and Juvenile Justice Facilities (Oct. 29, 2020)
  3. Mandatory Testing for Michigan Department of Health and Human Services' Juvenile Justice Facility Staff (Sept. 18, 2020)
  4. Mandatory Testing for Michigan Department of Health and Human Services Hospitals and Centers Staff (Sept. 14, 2020)
  5. Exceptions to Temporary Restrictions on Entry into Congregate Care and Juvenile Justice Facilities (June 29, 2020)
  6. Exceptions to Temporary Restrictions on Entry into Certain Facilities (June 3, 2020)
  7. Safe Housing for Housing Unstable Individuals (May 12, 2020)
  8. Handling of Bodily Remains (May 4, 2020)
  9. Safe Housing for Michigan Homeless (April 28, 2020)

While the rescission of the facemask and hospital visitor restrictions would seemingly allow hospitals to stop screening visitors and make their own determinations about masking, the Michigan Occupational Safety and Health Administration (MIOSHA) announced new rules June 22 that essentially defer to the OSHA at the federal level. The OSHA rules currently in place still require healthcare facilities to screen visitors and require masks for employees. However, some exceptions are outlined by the OSHA for well-defined areas where employees are fully vaccinated; a flowchart on the OSHA website provides details. The OSHA also refers healthcare facilities to Centers for Disease Control and Prevention recommendations that continue to urge mask requirements for visitors. The MHA is reviewing the OSHA complete set of rules.

Because the MIOSHA adopted the OSHA rules by reference, the OSHA effective and compliance dates apply. The OSHA COVID-19 Emergency Temporary Standard (ETS) is effective June 21, 2021. The compliance date for the ETS is July 6, 2021, with a few exceptions. Compliance with paragraphs (i) Physical Barriers, (k) Ventilation, and (n) Training is required by July 21, 2021.

As an interim final rule, the new OSHA standard is open for comment. The MHA will submit comments on behalf of its members after a more thorough review of the rule, and members are encouraged to share content for the MHA comment letter with Laura Appel. The MHA will continue to advocate with the MIOSHA for consistency in state and federal rules for healthcare settings and keep members apprised of any developments on this issue. Members with questions may contact Adam Carlson at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the Michigan Department of Health and Human Services Community Health Emergency Coordination Center (CHECC).