Healthcare Bills Progress in Michigan Legislature

capitol building

Michigan Capitol BuildingThe Michigan House and Senate continued their work on the healthcare reform and Certificate of Need (CON) packages during the week of March 22. The House Health Policy Committee also took initial testimony on legislation to increase the state’s emergency personal protective equipment (PPE) stockpile and classify etizolam as a Schedule 1 narcotic.

The House’s healthcare reform package, which includes House Bills (HBs) 4345 through 4359, intends to lower prescription costs, expand the scope of certified registered nurse anesthetists (CRNAs), allow for out-of-state telehealth services and more. The House passed the entire package March 24 and referred it to the Senate Health Policy and Human Services Committee. The MHA has supported HBs 4351, 4352 and 4359 and is opposed to HB 4355 as written.

The Senate’s CON package, including Senate Bills 181, 182 and 183, would make several changes to the CON program. The proposed reforms would increase the threshold for capital expenditures, increase the number of members on the CON Commission, remove air ambulance services from CON and remove psychiatric beds from CON oversight in certain situations. The package was passed by the Senate and referred to the House Health Policy Committee. The MHA opposes the package as written.

The House Health Policy Committee also took initial testimony on HBs 4087 and 4089. HB 4087 was introduced by Rep. Jeff Yaroch (R-Richmond) and would make changes to increase the state’s emergency stockpile of PPE. HB 4089 was introduced by Rep. Sue Allor (R-Wolverine) and would classify etizolam as a Schedule 1 narcotic. Etizolam is a derivative of thienodiazepine and is not approved by the Food and Drug Administration for medical use in the United States. The MHA did not take a position on either bill.

For more information on state legislation, contact Adam Carlson at the MHA.

Combating the Novel Coronavirus (COVID-19): Week of Jan. 25

MHA Covid-19 update

MHA COVID-19 UpdateA leadership change in the Michigan Department of Health and Human Services ( MDHHS) took place Jan. 22 when Robert Gordon announced his resignation and Elizabeth Hertel was appointed to replace him as director of the department. The MHA has a longstanding relationship with Hertel, who has served at both the MDHHS and Trinity Health, and issued a statement of support in response to the announcement. Hertel begins her tenure as director as COVID-19 continues to evolve and affect every Michigander’s life. The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

President Biden Releases Vaccine Operational Plans

The Biden administration announced Jan. 26 new details of its plans to increase vaccine supply and distribution to states in the coming weeks and months. The state of Michigan has issued updated operational plans that will coordinate with these federal efforts and resources. These plans will continue to be modified going forward. Highlights of the Biden vaccine plan are:

  • Supply Forecasting: The Biden administration plans to provide states with a three-week planning forecast of vaccine supply, which will allow states to communicate advanced information about allocations to providers and improve their planning capabilities.
  • More Vaccine Overall: The federal government is working to purchase 200 million additional doses of Pfizer and Moderna vaccine (100 million of each). The president also increased the national vaccination goal to 1.5 million people per day rather than 1 million.
  • More Vaccine to States: The president stated that starting next week, states would receive approximately 17% more vaccine each week than they have previously.
  • Syringe Supply: Biden is using federal actions to increase production of critical vaccine-related supplies, especially the syringes needed to extract the sixth dose from Pfizer vials.

As the state of Michigan continues to hone its plan to coordinate with federal efforts, the MHA is providing feedback to the MDHHS on ensuring the allocation formulas are fair and equitable for hospitals and health systems of all sizes and geographies. The association advised the state to incorporate data on both inpatient and outpatient measures into its allocation calculations. Additional information will be shared as it becomes available. Members with questions may contact Ruthanne Sudderth at the MHA.

State Announces Protect Michigan Commission to Promote, Improve Vaccine Acceptance

Gov. Gretchen Whitmer Jan. 25 appointed the bipartisan Protect Michigan Commission, which represents a diverse array of industries, professions, and backgrounds. Housed within the MDHHS, the commission will help raise awareness of the safety and effectiveness of an approved COVID-19 vaccine, educate state residents and help protect their health and safety. The governor has named Spectrum Health President and CEO and MHA Executive Committee Member Tina Freese Decker as a co-chair of the commission, and MHA Senior Vice President of Public Affairs & Communications Ruthanne Sudderth as a commission member.

The Protect Michigan Commission, first announced in December, serves in an advisory capacity to Whitmer and the MDHHS. It is tasked with providing public leadership to elevate and reinforce the importance of an approved COVID-19 vaccine, identifying barriers that may impede Michigan residents’ acceptance of an approved COVID-19 vaccine — including identifying areas or groups that are likely to experience vaccine hesitancy — and develop an outreach action plan designed to overcome these barriers. The commission must complete its work and submit a brief final report to the governor by Dec. 31, and appointees will serve until the group’s dissolution. The MHA will keep members apprised of the commission’s work.

New Reporting Guidelines Issued for Provider Relief Fund Disbursements

The U.S. Department of Health and Human Services (HHS) recently announced that it is modifying the reporting timeline and reporting requirements for the Provider Relief Fund (PRF). The modifications delay the reporting deadlines in response to the year-end passage of the Coronavirus Response and Relief Supplemental Appropriations Act.

The HHS indicated that providers that received at least $10,000 in PRF funds may now register for the PRF Reporting Portal. This will allow them to eventually submit information to comply with HHS reporting requirements, though data reporting is not yet required. The registration process is expected to take 20 minutes and must be completed in a single session.

The HHS released new reporting guidance that supersedes previously issued guidance. The new guidance maintains the two general reporting categories — unreimbursed COVID-19 expenses and lost patient revenue — but is more flexible in what is allowed. Under the new guidance, providers may use “the difference between 2020 budgeted and 2020 actual patient care revenue.” Health systems are now also able to transfer funds received from targeted PRF distributions to other hospitals within the system.

The MHA will notify members of any substantive developments in PRF reporting requirements. Members with questions should contact Jason Jorkasky at the MHA.

AHA Partner Offers PPE Donation for Hospitals

Through a partnership between the American Hospital Association (AHA) and the web application HealthEquip, hospitals in need of personal protective equipment (PPE) may receive donations of surgical masks, face shields and other PPE for a small processing fee and shipping costs. Participating hospitals will be matched based on their need and limited available quantities of donated equipment.

Hospitals may sign up to HealthEquip’s DonorExchange to enter PPE requests; the HealthEquip team will match hospitals with the donated PPE and arrange shipment. HealthEquip also offers the ability to purchase specific PPE though its Marketplace. Members with questions about supply chain issues may contact Adam Carlson or Rob Wood 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 MDHHS Community Health Emergency Coordination Center (CHECC).

Combating the Novel Coronavirus (COVID-19): Weeks of Aug. 31 and Sept. 7

MHA Covid-19 update

Deborah Birx, MD, response coordinator of the White House Coronavirus Task Force, met with hospital representatives in Michigan Sept. 2. Shown (left to right) are Rob Casalou, president and CEO, Trinity Health Michigan Region; Birx; MHA CEO Brian Peters; and Rosalie Tocco-Bradley, MD, chief clinical officer, Saint Joseph Mercy Health System.The MHA continues to keep members apprised of developments affecting Michigan hospitals during the pandemic through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Requirements Clarified on Quarantines for Ill Employees

Executive Order (EO) 2020-166, which mandated a 10-day home quarantine period for an individual who exhibited any COVID-19 symptoms, was recently rescinded and replaced with EO 2020-172.

The previous order had provided no exception for a subsequent negative COVID-19 test or an alternative medical explanation for the symptoms. EO 2020-172 clarifies the symptoms of COVID-19, stipulates that two or more symptoms must be present to require quarantine, and allows an employee to avoid quarantine if their symptoms can be explained by another medical or physical condition. In addition, healthcare professionals and workers at specifically defined healthcare facilities are exempted from a requirement to stay at home for 14 days following close contact with someone who is COVID-19 positive.

Although the new EO does not address all the MHA’s concerns, it provides beneficial clarity. Members with questions should contact Amy Barkholz at the MHA.

Dr. Birx Meets with Governor, Healthcare Leaders in Michigan

A small group of healthcare leaders were invited to meet Sept. 2 with Deborah Birx, MD, the response coordinator of the White House Coronavirus Task Force. Birx came to Michigan to meet with the governor in Lansing and with healthcare leaders at St. Mary Mercy Livonia about Michigan’s efforts to fight COVID-19 and the continuing challenges that could be aided by additional federal action.

Part of the conversation with the healthcare group focused on growing concerns over inadequate lab and testing supplies for diagnosing both COVID-19 and other conditions. The MHA expressed several concerns related to lab supplies and other issues that were also outlined in a letter to Birx.

Birx provided input on a range of issues, including urging hospitals to be “efficient” in their use of lab supplies for COVID-19 testing, offering praise for how Michigan and Detroit, specifically, have managed COVID-19 outbreaks and the public health response, and more.

The MHA will keep members apprised of any additional communication from the White House Coronavirus Task Force in follow-up to this meeting.

Visitor Restrictions for Residential Care Facilities Updated

The Michigan Department of Health and Human Services (MDHHS) issued an order Sept. 10 that will allow outdoor visits at residential facilities while continuing to require precautions to protect against COVID-19. Residential facilities are not required to allow visitors under this order, which takes effect Sept. 15; it simply allows the visits if they meet the requirements and wish to allow guests.

The order is based in part on recommendations from the governor’s Nursing Home Preparedness Task Force and creates exceptions to the governor’s order that temporarily restricts visits at healthcare, residential, congregate care and juvenile justice facilities. The MDHHS also considered the flattening of the COVID-19 curve and the impact of the visitor restrictions on residents of these care facilities in issuing the order. Residential facilities are required to ensure that outdoor visitation areas allow for at least 6 feet of separation between all people and provide adequate protection from weather elements. Someone trained in infection control must also be within sight range for compliance reasons.

Facilities must meet certain criteria, including having had no new COVID-19 cases originate at the facility within the previous 14 days. Additional requirements and a description of the facilities the order affects can be found in the emergency order.

Authorized Use of Remdesivir Expanded

The Food and Drug Administration recently expanded the authorized use of remdesivir for treating COVID-19 patients. Remdesivir can now be used for all hospitalized COVID-19 patients, confirmed or suspected, whether the patient is on oxygen, off oxygen or intubated. This is a departure from the previous policy that restricted such treatment to those who required oxygen. For additional details, members can review the complete authorization letter issued Aug. 28.

Webinar Recording to Focus on PPE Strategies and Trends

The Department of Health and Human Services (HHS) Assistant Secretary for Preparedness and Response will hold a webinar Sept. 24 on personal protective equipment (PPE) preservation strategies, trends and lessons learned. Although the HHS webinar appears to be at maximum capacity, recordings of the event will be available upon request. The COVID-19: Optimizing Healthcare Protective Equipment and Supplies webinar will include public and private sector presenters on optimizing supplies of respirators and PPE, including crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. An online flyer provides more information on the topics to be covered and how to receive the recording.

CMS Releases Guidance for Reporting Requirements for Labs and Long-term Care Facilities

The Centers for Medicare & Medicaid Services (CMS) released COVID-19 reporting requirements Sept. 8 for laboratories and long-term care facilities. The new guidance complements a Sept. 2 interim final rule. Laboratories are expected to comply with the new requirements by Sept. 23. Those not in compliance will be subject to civil monetary penalties. The CMS also released new enforcement information for long-term care facility reporting requirements.

The MHA continues to work with both the MDHHS and the HHS to streamline the reporting process. Members with questions on data reporting should contact Jim Lee at the MHA.

Recording COVID-19 Federal Payments on the Medicare Cost Report

A recently updated CMS COVID-19 FAQs clarifies that COVID-19 Provider Relief Fund payments and Paycheck Protection Program loan forgiveness funds from the Small Business Administration should not be recorded as offsets to expenses on the Medicare cost report. This information is particularly important for critical access hospitals’ and other hospitals’ cost-based Medicare reimbursements, which would have been reduced if COVID-19 funding were to offset costs. The answers specific to Cost Reporting begin on page 98 of the document. Members with questions should contact Laura Appel.

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 MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

MHA CEO Report – Making Progress Against COVID-19

MHA Rounds Report - Brian Peters, MHA CEO

“A pint of sweat saves a gallon of blood.” — General George S. Patton

MHA CEO Brian PetersLiving in a society with a 24/7 news cycle can be draining. It is no secret the seriousness and unprecedented nature of the pandemic we find ourselves in: a quick review of the latest metrics show 426 new cases were identified yesterday in Michigan, bringing our total to 82,782. Over 6,000 Michiganders have now died from COVID-19. However, amid daily case reports and COVID-19 outbreaks, significant progress has been made over the past few months that enables Michigan hospitals to continue to improve the health and wellness of our communities. Our hospitals are facing monumental challenges, but through continued dedication and hard work, the MHA and our members are collaborating across industries and business sectors to achieve our common goals.

There is no greater resource in this pandemic than our healthcare workforce, and ensuring they have the appropriate supply of personal protective equipment (PPE) is vital. While Michigan hospitals have purchased at least $93 million worth of PPE, the state has purchased an additional $250 million worth. A number of Michigan businesses have changed their production capacity to produce PPE, and the MHA has worked to coordinate donations directly to Michigan hospitals to every extent possible. Thankfully hospitals’ PPE “burn rates” and inventory on hand are much improved since April, and we stand at the ready in case of another COVID-19 patient surge.

To protect our workforce, the MHA also actively pushed for and ultimately secured liability protections through Executive Order 2020-61 and have advocated for the passage of Senate Bill 899. These protections are important to ensure providers serving on the front lines are not penalized for providing care during the unprecedented surge of COVID-19 patients when treatment was constantly evolving. In addition, the MHA has achieved regulatory relief through waived cost-sharing for COVID-19 testing and treatment, increased telemedicine opportunities and expansion of beds during surge through our state’s certificate of need (CON) process.

The MHA has been active in several other areas. For months, the MHA has worked with our hospitals to voluntarily publish hospital COVID-19 patient census and PPE days on hand and to share this data with interested parties. Not only does this data provide a transparent picture of how hospitals are faring amid the pandemic, but it also gives the state of Michigan valuable data for decision-making.

In addition, testing is vital in containing the spread of COVID-19. Hospital labs are an important piece in that effort, averaging 7,000 tests per day as Michigan’s overall testing capacity continues to increase. However, testing supplies such as reagents, swabs and transport media remain limited. The MHA has been coordinating with both state and federal partners to identify specific needs and advocate for more supplies in Michigan.

All of these efforts have come at a steep price. Last week the MHA released financial estimates on the impact of COVID-19 on Michigan hospitals. The 2020 COVID-19 Impact Report, Michigan’s Front Line of Defense, shows combined financial losses related to COVID-19 of nearly $3.2 billion. These estimates are based on voluntary data submitted by our members and likely represent the low end of financial losses. Even with CARES funding, our hospitals are facing a deficit of nearly $1.1 billion, which is growing every day.

These estimates also do not factor in expected losses due to the historic unemployment rates, as more patients move to Medicaid or become uninsured. During normal circumstances, the yearly total unpaid cost of care for Michigan hospitals is nearly $2.6 billion.

This financial impact is one of the largest hurdles our hospitals are trying to overcome. To address the revenue-related losses and increased expenditures, the MHA has helped to secure $2.1 billion in federal support through CARES funding, while adding an additional $25 million in state appropriations for hospitals. The MHA also actively worked with state lawmakers to ensure that the association’s priorities in the fiscal year (FY) 2020 budget were held harmless from reductions, including the rural access pool and obstetrical stabilization fund, Medicaid rates and provider tax-funded pools. Yet more support is needed, and we are closely monitoring negotiations at the federal level for additional support, particularly for Medicare loan forgiveness and liability protections, and at the state level as negotiations on the FY 2021 budget ramp up in advance of the Oct. 1 start of the new fiscal year.

Lastly, providing accurate information to the public and conveying a consistent message for our hospitals led to over 200 interviews with local, state and national media outlets being conducted. We’ve also highlighted on social media more than 250 healthcare professionals – nurses, physicians, environmental service workers and others – from communities across the state and thanked them for their dedication to fighting COVID-19 and caring for patients. More than 431,000 people shared, liked and/or commented on the posts.

In efforts to support public health, the Partnership for Michigan’s Health, which is comprised of the MHA, the Michigan Osteopathic Association and the Michigan State Medical Society, also issued a joint release urging residents to remain vigilant about distancing and wearing masks to prevent a second large surge of COVID-19 in the state. In addition, the partnership also published a joint op-ed in The Detroit News on the importance of vaccinations. Fighting the spread of misinformation to promote appropriate safety precautions can help limit the number of patients who become infected and ultimately require treatment.

Overall, even with an FDA-approved COVID-19 vaccine, we know it will take time and effort to eradicate this disease. Our hospitals have discharged more than 16,000 COVID-19 patients, and we know that number will only continue to grow over the coming months. However, that figure also represents parents, grandparents, friends and colleagues who have been stricken by COVID-19 and recovered. The actions we’re taking are helping our front-line caregivers make a difference and save lives. These efforts that I just reviewed are vital in ensuring the viability of our healthcare organizations and the health of the patients we serve.

The bottom line is that our collective hard work and determined efforts related to COVID-19 are unquestionably saving lives. Despite the exhaustion this entails, we must commit to continuing this critical work.

As always, I welcome your thoughts.

P.S. Don’t forget to participate in tomorrow’s state primary election, as the 2020 presidential election is critical to Michigan’s healthcare future. Please visit our MHA elections webpage for more information and resources.

New Report Reveals Negative Financial Impact of COVID-19 to Michigan Hospitals

Michigan's Front Line of Defense

MHA COVID-19 Impact ReportMichigan hospitals collectively have financial losses of nearly $3.2 billion as a result of the COVID-19 pandemic, according to a report released by the Michigan Health & Hospital Association (MHA).

Based on data voluntarily submitted by member hospitals from March through mid-June, the 2020 COVID-19 Impact Report, Michigan’s Front Line of Defense, highlights how hospitals across the state are responding to the COVID-19 pandemic and the significant financial impact it has had on every hospital or health system. Since the pandemic began:

  • Lost patient volume, canceled and delayed medical procedures, and unbudgeted expenses related to staffing and personal protective equipment have contributed to $2.7 billion in lost revenue and an additional $440 million in emergency expenses. Even with $2.1 billion in Coronavirus Aid, Relief, and Economic Security (CARES) Act funding, Michigan hospitals have a total deficit of nearly $1.1 billion as of June.
  • Michigan hospital labs have been vital in the state’s efforts to provide widespread testing, accounting for over 400,000 COVID-19 polymerise chain reaction (PCR) diagnostic tests as of July 12, with an average of 7,000 tests conducted by hospital labs per day.
  • COVID-19 created global demand for personal protective equipment (PPE) that has never been seen before. To protect patients and staff, hospitals purchased PPE at exponentially higher rates at a total cost exceeding $93 million and counting.
  • Hospitals increased general and intensive care unit (ICU) bed capacity, developed COVID-19-only units and refurbished existing facilities to improve infection prevention and treatment. Overall thousands of beds were added by hospitals statewide. During the peak surge, Michigan hospitals cared for 4,700 COVID-19 patients April 10, including 1,700 COVID-19 patients in ICUs. During the study’s time frame, more than 16,000 COVID-19 patients have been discharged from Michigan hospitals.

The report also addresses the uncompensated cost of care, which during normal circumstances approaches $2.6 billion in Michigan. Due to historic unemployment rates and fewer patients on employer-sponsored coverage, hospitals anticipate this number to only increase as more patients move to Medicaid or are uninsured. According to the National Center for Coverage Innovation, Michigan had the sixth highest increase in newly uninsured adults, with 222,000 individuals becoming uninsured due to job losses; that is a 46% increase from 2018 levels.

“When COVID-19 arrived in Michigan, hospitals became the front line of defense against the highly contagious and dangerous disease,” said MHA CEO Brian Peters. “As this report demonstrates, responding to the COVID-19 pandemic has come at a steep price. Now more than ever, support is needed for the hospitals and healthcare providers that have been serving on the front lines of the pandemic.”

A full copy of the 2020 COVID-19 Impact Report, Michigan’s Front Line of Defense, is available online.