MHA CEO Report — A Program Year in Review

MHA Rounds graphic of Brian Peters

“Winning is not a sometime thing, it is an all the time thing. You don’t do things right once in a while…you do them right all the time.”  — Vince Lombardi

MHA Rounds image of Brian PetersI am pleased to share we just completed a successful MHA Annual Meeting, continuing a long-standing June tradition whereby we celebrate the conclusion of one MHA program year, and prepare for the next. Each program year is unique with the different challenges it presents. At this point five years ago, no one could have predicted how the emergence of COVID-19 would flip healthcare on its head and drastically alter the tactical objectives of our association. However, there is a constant: the MHA continues to rise to any challenge presented to us and we deliver results for our membership to improve the health and wellness of individuals and communities.

The 2023-2024 program year focused intensely on workforce, viability and behavioral health, while addressing the various “wildcard” issues that always come up. We were led with great wisdom and compassion by Shannon Striebich, president and CEO, Trinity Health Michigan, as our board chair. Due to Shannon’s commitment and leadership, the MHA accomplished numerous highly successful and impactful outcomes on behalf of our members.

One of the most significant challenges in this past year was the threat posed by government-mandated nurse staffing ratio legislation. This proposed policy had the potential to dramatically reduce access to care for individuals throughout the state. Our advocacy on the issue lasted throughout the entire year but was highlighted by an Advocacy Day we hosted in September that featured more than 150 hospital representatives, primarily consisting of nurse leaders, who came to the Capitol and conducted 118 meetings with lawmakers that day. Later in the year, the MHA successfully advocated our position at a committee hearing, where more than 60 supporters attended on very short notice to push back on false narratives and to support alternative nurse staffing solutions. As a result of our efforts, no committee votes have been scheduled, and momentum on this harmful legislation has been effectively stalled.

While we had to play defense against this harmful proposed legislation, the MHA spent the program year actively engaged in workforce development and efforts to grow the healthcare talent pipeline. The MHA worked with stakeholders to implement new funding designed to expand access to Bachelor of Science in Nursing degrees through partnerships between community colleges and four-year universities, while also engaged in partnerships with other organizations to promote healthcare careers, increase clinical faculty and nurse preceptors, address high turnover rates in rural areas and promote healthcare career options. We continued our award-winning healthcare career marketing campaign designed to attract future workers and also redeployed our annual hospital workforce survey that shows the efforts of Michigan hospitals to recruit, retain and train healthcare workers is making a real difference. Finally, we hired our first-ever chief nursing officer at the MHA, which is already strengthening our ties to the nursing community throughout the state.

The viability of hospitals was another key focus and was largely supported through our legislative advocacy work. MHA funding priorities continued to be protected in the state budget, which includes $163 million for graduate medical education, $45 million for traditional disproportionate share hospitals, $15 million through the rural access pool and an additional $8 million for the obstetrical stabilization fund. The fiscal year 2024 budget also included $60 million annually to support hospitals with Level I and II trauma centers and $34 million annually to support hospitals that provide inpatient psychiatric care. Besides state funding, the MHA protected Medicaid funding, medical liability, the 340B drug pricing program and certificate of need.

The MHA is also intricately involved in in addressing the behavioral health crisis plaguing our state and country. Expanding access to care is a key focus, which included the MHA administrating a $50 million grant program to expand access to pediatric inpatient behavioral health services. The Michigan Department of Health and Human Services (MDHHS) is a close partner in this work and the MHA participated in the MDHHS Advisory Committee on the creation of a psychiatric bed registry. The MHA launched a new member ED boarding survey to quantify the number of patients struggling with behavioral health access in the emergency department and the MHA is using this data when engaging with lawmakers, stakeholders and the public to explain the scope of the program. These learnings informed the creation of a four-bill package of legislation to address board-identified issues in the behavioral and mental health system, such as coverage parity and community mental health shortcomings.

Much of the work in the past year has focused on maternal and infant health and improving maternal health and birth outcomes. And I am pleased to share that our MHA Board of Trustees just approved the full slate of recommendations emanating from the MHA Community Access to Health Task Force, giving us the support to continue this important journey together.

And as usual, we effectively dealt with a long list of “wildcard” issues that emerged during the program year, including drug shortages, guardianship, infection control, patient transport, population growth and safety and quality. We also continued to strengthen our efforts related to the growing cybersecurity threat. Indeed, the Change Healthcare cyberattack was one of the largest and most impactful attacks ever seen and served as a clear reminder of the importance of our work in this space.

At our Annual Meeting, I spoke to our attendees about “the power of zero.” In the 2023-2024 program year, the following were true:

  • The number of Michigan acute care community hospitals and health systems that are not members of our association is zero. We have everyone at the table, which allows us to speak with one powerful, united voice.
  • We passed 39 MHA-supported bills through the state legislature that were enacted into law, with five more on their way to the governor for her signature. The number of MHA-opposed bills that made their way to the finish line was zero.
  • The MHA now has a full-time chief medical officer and a full-time chief nursing officer (as noted above). How many other state hospital associations can say this? Zero.
  • And most importantly, how many other associations – in any sector – are as relevant, as impactful, as mission-driven and successful as the MHA? I believe that number is zero.

I would like to recognize and thank our outstanding MHA Board of Trustees, our members, sponsors and business partners, but most of all, our incredible MHA staff for coming together to achieve such tremendous results for the patients and communities we collectively serve. I hope you will take the opportunity to celebrate these results with us.

As always, I welcome your thoughts.

MHA CEO Report — Implementing Behavioral Health Solutions

MHA Rounds graphic of Brian Peters

“If you can’t fly, run. If you can’t run, walk. If you can’t walk, crawl, but by all means, keep moving.” — Martin Luther King, Jr.

Behavioral health is one of the four key strategic pillars for the MHA this program year. The MHA Board of Trustees tasked our association with prioritizing the issue and to identify solutions that can make a meaningful difference for patients and providers. This issue is particularly important to current MHA Board Chair Shannon Striebich, president and CEO of Trinity Health Michigan, who specifically focused on this topic during her opening remarks as chair during the 2023 MHA Annual Meeting last June. At Chair Striebich’s direction, the MHA team is hard at work on a variety of initiatives that I’m happy to share.

The MHA Behavioral Health Integration Council, chaired by Linda Peterson, MD, from McLaren Greater Lansing, and staffed by Lauren LaPine, senior director, legislative and public policy, MHA, guides our policy efforts for behavioral and physical health integration. The council develops recommendations addressing access to behavioral healthcare services and fostering integration with the greater healthcare delivery system. Their agendas are robust and the member engagement is fantastic.

The MHA collects data through a weekly survey of our member hospitals to better understand and document our behavioral health challenges in real time. This data shows more than 150 patients, including children, are sitting in a Michigan hospital emergency department (ED) every day waiting for the appropriate healthcare services. Many are waiting for an available behavioral health bed, while one-third are waiting just for an evaluation to determine treatment needs. And many of these patients are the most vulnerable in our community, supported by Medicaid or Medicare. Unfortunately, we know 33% of the Medicaid patients will spend more than 48 hours waiting in the ED. These patients are not in the appropriate setting to receive the services and care they need, while hospitals are spending significant resources to care for these patients until they find placement. This includes anything from attending to basic needs, including food and clothing, to their clinical needs, whether that is through psychiatric services, prescription drugs and additional safety and facility needs.

With the council’s encouragement, the MHA last year was successful in securing new funding from the state in the amount of $50 million to support a competitive grant program for Michigan healthcare entities to expand access to pediatric inpatient behavioral health services. The MHA was the fiduciary of this program and disseminated the funding to our members in a timely fashion.

The MHA is an advocacy organization, and in addition to funding like this, the concept of identifying public policy that can help to address specific healthcare challenges is one of our core competencies. In that vein, we worked very hard with our members, and subsequently with our legislative champions, to draft and introduce important behavioral health legislation. We are very pleased that just last month, several bills were formally introduced that will address some of the challenges hospitals experience when behavioral health patients seek care in the ED. The four bills would require sharing the availability of community based mental health and substance use disorder services (Senate Bill 802), expanding pre-admission screening responsibilities in the ED to more clinically qualified staff (Senate Bill 806), expanding hospital swing bed eligibility to include inpatient behavioral health patients (Senate Bill 811) and removing arbitrary commercial insurance limitations on the duration of inpatient behavioral health admissions (Senate Bill 833).

These bills will be a focus for our advocacy and policy teams for the remainder of this legislative session. We developed an infographic that is now available and will be shared with lawmakers to help them understand the significance of the behavioral health crisis, but also the solutions that can help patients receive the care they need in a timely manner, while alleviating the stress placed on healthcare workers and hospitals.

The Michigan Department of Health and Human Services (MDHHS) is a key partner in this work and the MHA is engaged with the MDHHS on several initiatives. First is collaborating with the MDHHS to create a statewide psychiatric bed registry, as outlined in state law signed in 2018. Such a registry has the potential to better inform healthcare providers of bed availability to reduce the amount of time patients are waiting to receive available placement. The MHA is also participating in a committee to improve behavioral health patient transport. Lastly, our organizations are working closely to expand access to Psychiatric Residential Treatment Facilities (PRTFs), with the aim to establish 150 PRTF beds across the state.

The MHA also represents the interests of hospitals and health systems in several workgroups. Those include the Michigan Judicial Council Behavioral Health Improvements Workgroup to develop new strategies to divert adults and youth with mental health and substance use disorders away from the justice system and to connect them with needed behavioral health services. The MHA also participates in the Assisted Outpatient Treatment (AOT) Workgroup, which developed an AOT toolkit for courts, community mental health agencies, jails and hospitals and health systems to use to expand statewide access to AOT. These workgroups demonstrate the breadth of the MHA’s work and the number of stakeholders involved across the state on this issue.

We know our behavioral health challenges will not be solved overnight, and it would be easy to throw up our hands and shift our attention and energy to “easier” issues.  Many behavioral health patients have complex needs that require many partners working together to fill in the gaps within the system and to improve access to care. The good news is there has never been a brighter light shined on this issue, and the stigma associated with behavioral health challenges is beginning to fade. The MHA is proud to work with our member hospitals and all our partners in this critical work, and I am confident that we are making a real difference. As Dr. King encouraged, we need to keep moving.

As always, I welcome your thoughts.