MHA CEO Report — Pediatric Capacity Crisis

MHA Rounds Report - Brian Peters, MHA CEO

Every child begins the world again.Henry David Thoreau

MHA Rounds Report - Brian Peters, MHA CEOIn 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.

I share this perspective because there is a crisis throughout Michigan that truly hits home with me. I know the angst and exhaustion being felt by far too many parents right now – emotions that are also being acutely felt by our heroic caregivers. In short, it feels like déjà vu in Michigan’s children’s hospitals, but instead of a surge of COVID-19 patients stressing capacity to the limits, our facilities are strained by a high number of pediatric patients suffering from respiratory illnesses largely driven by RSV. Similar tactics that have been implemented in prior years, such as initiating incident command systems, have been in operation to ensure appropriate direction and communication is occurring throughout those systems impacted by this crisis.

Hospitals operating at capacity is nothing new and the staffing challenges that continue to result in Michigan operating with 1,700 fewer staffed beds than we had prior to the pandemic are well documented. What we’re seeing today is the real impact of what those staffing challenges mean: longer wait times in the emergency department, lack of available beds for patient transports (particularly in rural Michigan) and pediatric ICUs operating at beyond 100% capacity.

There are few professionals in the world that have proven to be more resilient than healthcare workers, whether they are physicians, nurses, respiratory therapists, environmental service workers…the list goes on and on (and I am proud to say that the MHA Keystone Center has played an important role with the launch of our WELL-B initiative that continues to provide resiliency tools for our clinicians and other team members). But as residents of our communities, we can no longer take our healthcare workers and the access to care they provide for granted. These workers, and their organizations, need help.

Thankfully, the Michigan Legislature provided funding earlier this year through Public Act 9 to improve the recruitment, retention and training of healthcare workers. So far, over 69,000 healthcare workers have benefitted from that funding and it has helped to stabilize existing staffing levels. Hospitals are also exploring innovative ways to grow the talent pipeline, such as investment in higher education partnerships and other apprenticeships. However, while impactful, this funding is a finger in the dyke. Without additional attention, the problem will persist.

Addressing the strain on our children’s hospitals is a multi-pronged approach, and in addition to the aforementioned work of our MHA Keystone Center, we are also deriving input and guidance from our MHA Council on Children’s Health, led by Laura Appel, executive vice president for government relations and public affairs, as well as our system chief medical officer (CMO) group, led by our own CMO Gary Roth, DO.

While the MHA will continue to pursue legislative and regulatory solutions to the staffing crisis, there are actions anyone can undertake to help our healthcare workers caring for very sick children across Michigan, particularly as COVID-19, RSV and the flu converge to drive hospitalizations.

First and foremost, ensure that both you and your children are up to date on all the relevant vaccinations that are now readily available. The MHA is a long-time supporter of I Vaccinate which is a good source of information on vaccines, and our MHA Senior Vice President of Public Affairs and Communications Ruthanne Sudderth continues to be our point person with this organization. Second, practice proper hygiene, including handwashing and staying home when sick. Third, seek the appropriate setting for care; visit the hospital for emergencies but contact your primary care physician or an urgent care facility for testing or care for mild symptoms. Lastly – and very importantly – be sure to express some grace and appreciation for any healthcare worker you meet. As we approach the winter and holiday season, they are here to provide exceptional care to all who need it and deserve to be treated with respect both on and off duty.

If you have not done so already, please join me in sharing this messaging within your networks. Our hospitals need the support from our partners in healthcare, the business community and in Lansing and Washington, DC to weather this storm. Respiratory illnesses will always be here, but there are many small actions we can take to care for the health and wellness of our communities well into the future.

As always, I welcome your thoughts.

Legislative Policy Panel Convenes for Program Year

The MHA Legislative Policy Panel convened Oct. 12 to develop recommendations for the MHA Board of Trustees on legislative initiatives impacting Michigan hospitals.

The meeting was highlighted by a presentation from Ruthanne Sudderth, senior vice president, public affairs and communications, MHA, on a storytelling campaign advocating for funding solutions to the financial challenges facing MHA members. Sudderth described the objectives of the campaign, strategies that will be utilized and ways members can get involved. The campaign is a direct result of an MHA Board directive from the strategic action plan.

The panel also held a discussion on Certificate of Need in relation to pediatric psychiatric beds in Michigan and potential measures to improve access to care and patient experience. An additional portion of the meeting was dedicated towards reviewing challenges associated with placing patients in post-acute care settings and potential legislative options to assist hospitals.

Regarding an action item, the panel recommended the MHA support proposed state legislation to expand the swing bed program.

The panel received updates on other issues at the state level, including a preview of the upcoming lame-duck session, the November election and the 340B drug pricing program.

For more information on the MHA Legislative Policy Panel, contact Adam Carlson at the MHA.

Opportunities for Immunization Grants – Applications Due Nov. 1

The American Academy of Pediatrics (AAP) recently announced multiple grant opportunities for health organizations and AAP Chapters to improve community confidence in vaccines and to support pediatricians in the delivery of on-time vaccinations. Several grant programs and funding amounts are currently available related to COVID-19, HPV, influenza and other routine childhood immunizations. Applicants are encouraged to propose activities that will address the unique needs of children and families within their communities to improve vaccination uptake.

For more information on the various opportunities, view the Call for Proposals

Applications should be submitted through Survey Monkey and are due Nov. 1.

Members with vaccine-related questions may contact Ruthanne Sudderth at the MHA. 

Combating the Novel Coronavirus (COVID-19): Week of July 11

MHA Covid-19 update

Michigan’s COVID-19 case numbers and hospitalizations have increased since early July with the onset of omicron variant BA.5. Here are the latest key statistics:

  • 875 hospitalizations with confirmed or suspected COVID-19, a 20% increase since July 1.
  • 23 pediatric hospitalizations with confirmed or suspected COVID-19.
  • 67.6% of all residents have at least one dose of vaccine.
  • 29.2% of kids aged 5-11 have now initiated vaccination.
  • Roughly 2% of kids aged 6 months-5 years have initiated vaccination since approval was granted in mid-June.

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.

Governor Signs COVID-19 Liability Legislation

Gov. Gretchen Whitmer recently signed several COVID-19 liability-related bills:

  • House Bill 5244 (Public Act 138 of 2022) amends Public Act 238 of 2020, which prohibits an employer from taking certain actions against an employee who does not report to work under circumstances related to COVID-19, to specify that the Act would not apply to a claim or cause of action that accrued after July 1, 2022. In addition, the bill will repeal PA 238 of 2020 effective July 1, 2023. HB 5244 was sponsored by Rep. Andrew Fink (R-Hillsdale).
  • House Bill 6128 (Public Act 140 of 2022) amends Section 85 of the Michigan Occupational Safety and Health Act to specify that certain conditions establishing immunity for employers whose employees were exposed to COVID-19 would not apply to an exposure that occurred after July 1, 2022. In addition, the bill would repeal Section 85 and Section 85a, which defines COVID-19 under the Act, effective July 1, 2023. HB 6128 was sponsored by Rep. Yousef Rabhi (D-Ann Arbor).
  • House Bill 6215 (Public Act 139 of 2022) amends the COVID-19 Response and Reopening Liability Assurance Act to specify that the Act, which provides immunity to a person that acts in compliance with certain federal, state and local orders related to COVID-19, would not apply to a claim or cause of action that accrued after July 1, 2022. In addition, the bill would repeal the Act effective July 1, 2023. House Bill 6215 was sponsored by Rep. Graham Filler (R-DeWitt).

Novavax Vaccine Gets FDA Authorization

The Food and Drug Administration (FDA) granted emergency use authorization to Novavax’s COVID-19 vaccine July 13. The vaccine is a two-dose series administered three weeks apart and uses a different, older vaccine technology than is used in the messenger RNA vaccines and Johnson & Johnson shot.

Novavax’s vaccine is authorized for people ages 18 and older as a primary series. It may be appealing to those adults who were hesitant to receive another brand of vaccine due to the components or development process.

In a trial of more than 26,000 adults, two doses of the Novavax COVID-19 vaccine were more than 90 percent effective at preventing symptomatic disease. For adults 65 and older, effectiveness was more than 78 percent. There were no serious side effects or safety concerns.

The Centers for Disease Control and Prevention (CDC) will next decide whether it will endorse the vaccine. The CDC Advisory Committee on Immunization Practices will meet July 19, though an agenda is not yet available.

The Biden administration recently announced that it had purchased 3.2 million doses of the Novavax vaccine. If the vaccine is recommended by the CDC, it will be made available at no cost to states, jurisdictions, federal pharmacy partners and federally qualified health centers. The MHA will keep members apprised of vaccine availability and ordering processes at the appropriate time. Members with questions may contact Ruthanne Sudderth 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).

MHA Welcomes New Tenants to Headquarters: Canada Geese

The MHA recently became home to a new group of tenants at its Okemos headquarters: a family of Canada geese, including several freshly hatched goslings. The geese originally occupied a section of the headquarters parking lot, where the mother goose nested for many weeks under the guard of father goose. Anyone visiting during this time likely noticed the use of orange cones to prevent people from approaching the nesting area.

The proximity of employees and their vehicles to the nest led to some hostility and several harrowing instances of father goose chasing employees from the area, both on foot and in their vehicles. Unfortunately, the MHA security cameras didn’t capture any of these literal wild goose chases on video, so you’ll have to take our word for it. The MHA can confirm that no permanent physical or psychological harm was done to the employees involved.

In recent weeks, the geese have relocated to the wooded area behind headquarters, where they continue to fiercely protect the goslings from onlookers. Visitors to the MHA are encouraged to view the geese from inside the building or approach understanding the risk of hissing and chasing that will likely ensue (see photo evidence). While the geese were not part of our operational planning, we extend a warm welcome to these new outside tenants and wish their family all the best. Members with questions — because we all have had some throughout this ordeal — may contact Ruthanne Sudderth at the MHA.

Combating the Novel Coronavirus (COVID-19): Week of May 9

MHA Covid-19 update

MHA Covid-19 updateCOVID-19 hospitalizations in Michigan have been rising in recent weeks, with 875 adults hospitalized with confirmed or suspected cases on May 11; 77 of that number were in intensive care units. In addition, 36 children were in the hospital with confirmed or suspected cases on that date. A daily average of over 2,700 cases were confirmed from May 5 through 11.

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.

MDHHS Shares Updated FDA Guidelines for Johnson & Johnson COVID-19 Vaccine

The Michigan Department of Health and Human Services (MDHHS) has reminded providers of updated guidelines from the Food and Drug Administration (FDA) for use of the Johnson & Johnson/Janssen COVID-19 vaccine. The new guidelines essentially limit use to individuals 18 and older who cannot or will not take one of the other approved vaccines. The risk of thrombosis with thrombocytopenia syndrome (TTS) warrants limiting the authorized use of the vaccine. TTS is a syndrome of rare and potentially life-threatening blood clots in combination with low levels of blood platelets. Members are encouraged to review the provider guidelines. For more information regarding vaccines, contact Ruthanne Sudderth 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): Week of April 4

MHA Covid-19 update

MHA Covid-19 update

The Michigan Department of Health and Human Services (MDHHS) reported there were an average of 752 new confirmed and suspected COVID-19 cases per day from April 2 through April 6. As of April 6, 453 adults and 17 children were hospitalized with confirmed and suspected cases; 96 adults were in intensive care units, 39 of them on ventilators. The MDHHS is now reporting this data once a week.

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.

FDA Revokes Sotrovimab Authorization

The Food and Drug Administration (FDA) has revoked emergency use authorization (EUA) for sotrovimab, a monoclonal antibody treatment for COVID-19 patients at risk of developing severe disease. This occurred due to the treatment’s ineffectiveness as a remedy for the omicron subvariant BA.2, which is now responsible for more than half of all U.S. infections.

The FDA authorized a new monoclonal antibody, Eli Lilly’s bebtelovimab, Feb. 11 that remains effective against omicron variants; the bebtelovimab EUA is still in place. The MHA will continue to work with the Michigan MDHHS leadership on therapeutics recommendations and availability in Michigan. Members with questions may contact Laura Appel at the MHA.

President Biden Announces Long COVID-19 Care Planning

President Joe Biden announced April 5 that the U.S. Department of Health and Human Services (HHS) will assemble a cross-government plan to manage “long COVID.” However, it is largely dependent on being funded by Congress.

The plan’s goals are broadening research, detection and treatment access to fight lingering or late-emerging effects of COVID-19 that are estimated to impact between seven million and 23 million Americans. The symptoms include shortness of breath, heart irregularities, kidney problems and more.

The American Hospital Association (AHA) and other federal advocacy groups sent a letter to HHS Secretary Xavier Becerra in March stating that there is “a need for further clinical guidance regarding the symptoms of and best course of treatment for long Covid-19 patients.” According to news reports, the Biden administration needs at least $25 million in the 2023 federal budget to build on tracking and surveillance progress, in addition to the $50 million the Centers for Disease Control and Prevention is already spending.

The long COVID-19 plan further includes establishing a Center of Excellence to treat long COVID-19 patients through in-person, multispecialty and telehealth services. The administration reportedly wants to establish long COVID-19 clinics around the country modeled after a Veterans Affairs clinic setup.

The MHA will continue to work closely with the AHA about the viability of this plan, both operationally and politically, and will keep members apprised of progress or plans that may impact hospitals, health systems and their patients. Members with questions may contact Laura Appel 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): Week of March 21

MHA Covid-19 update

MHA Covid-19 updateWith the number of new cases trending downward, Michigan hospitals continued to have patients with severe cases of COVID-19 in their intensive care units (ICUs). As of March 25, 100 Michiganders with confirmed or suspected COVID-19 were in ICUs, 44 of them on ventilators. They were among the 516 adults and 22 children hospitalized with confirmed or suspected cases that day.

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.

Legislative Action Will Assist Hospitals in Providing High-quality Care

The Legislature has sent Senate Bill (SB) 247 to Gov. Gretchen Whitmer to be signed into law, making significant changes to prior authorization in the state of Michigan. The MHA-supported  bill would shorten the timelines for approval of authorization requests, ensure that emergency care can be provided without prior approval, and require insurers to post their prior authorization policies on their website and accept electronic requests, among other improvements to the process.

Whitmer signed SBs 246 and 435, increasing forgivable loan amounts for health professionals who work in medically underserved communities as part of the Michigan Essential Health Provider Program and expanding the physician specializations that qualify for the program to include behavioral health professionals. The new law also extends the sunset on the interstate Physician Licensure Compact, ensuring that physicians coming to Michigan from another compact state can quickly become licensed to practice in the state.

More information on these bills and other legislation affecting hospitals is available in a related article.

Vaccination Progress Among Michiganders Highlights Racial Disparities

More than 60% of all Michigan residents aged 5 and older are fully vaccinated against COVID-19. However, only slightly more than 40% of Black residents are among those fully vaccinated. Nearly 28% of Michigan children aged 5 through 11 years have received their first dose of the vaccine, but fewer than 17% of Black Michigan children in that age range have received their first dose. Providers should continue efforts to reach families with young children and nonwhite patients to reduce the disparities in the impact of COVID-19 on different populations. For information on vaccines, contact Ruthanne Sudderth at the MHA.

MHA Creates State/Federal COVID-19 Guidelines Tracker

The MHA recently developed a tracking tool outlining state and federal COVID-19 protocols for healthcare personnel. The document is updated as agencies revise their guidelines or mandates and includes vaccination, masking and COVID-19 testing guidelines from both the Centers for Disease Control and Prevention and the Michigan Department of Health and Human Services (MDHHS). The downloadable tool can also be found on the MHA website on the COVID-19 Resources page under Resources for Healthcare Professionals. Members with questions may contact Lucy Ciaramitaro 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): Week of Feb. 28

MHA Covid-19 update

MHA Covid-19 updateThe state of Michigan reported that 1,842 new cases of COVID-19 were confirmed statewide March 3 and 4, with an average of 921 cases per day. Out of 68 recorded COVID-19-related deaths for the two days, 54 were identified during a Vital Records review. Adults in the hospital March 4 with confirmed cases of COVID-19 numbered 865, along with 27 children. This is a significant drop from early January, when more than 4,000 Michiganders were hospitalized with the disease.

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.

Webinar Recap: Navigating Paxlovid and Drug-Drug Interactions

The MHA recently hosted a webinar in partnership with the Michigan Department of Health and Human Services (MDHHS) and Michigan Medicine to provide information regarding Pfizer’s Paxlovid (nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use) and drug-drug interactions. Paxlovid has been authorized by the Food and Drug Administration for emergency use for the treatment of mild to moderate COVID-19 in adults and children (12 years of age and older, weighing at least 88 pounds). Paxlovid is available by prescription only and should be initiated as soon as possible after diagnosis of COVID-19 and within five days of symptom onset. A Paxlovid drug-drug interaction summary will be updated by Michigan Medicine as more information becomes available.

The MDHHS confirmed Paxlovid is available at all Meijer pharmacies and encouraged providers to prescribe Paxlovid to eligible patients as soon as possible. Meijer pharmacies were selected due to market coverage and the ability to conduct home deliveries for patients unable to travel. As relative supply of oral antivirals increases and demand remains low, the MDHHS anticipates expanding to additional dispensing sites soon. Facilities interested in making this available through outpatient pharmacies should check with the MDHHS. Members with questions regarding Paxlovid drug-drug interactions should contact Nicholas Dillman, PharmD, at Michigan Medicine. Other questions can be directed to Renée Smiddy 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).