Headline Roundup: Price Transparency, Workforce Challenges and Contrast Media Shortages

Brian Peters

Brian PetersThe MHA responded to several media requests the week of May 16 on topics including the RAND 4.0 Hospital Price Transparency Study, hospital workforce challenges and the shortage of contrast media from GE Healthcare.

MiBiz and Crain’s Detroit Business published stories on the latest RAND report that includes multiple quotes from MHA CEO Brian Peters discussing the flaws associated with the study, including the use of Medicare as a reimbursement benchmark and the limited data set. The MiBiz story also cites recent findings from the American Hospital Association and Kaufman Hall on significantly increasing hospital expenses.

“So it’s not a comprehensive set. It’s looking very specifically at Medicare reimbursement rates, which we know in Michigan and other states as well does not cover the true cost of care,” said Peters to MiBiz. “Hospitals do everything they possibly can just to break even, at best, and still lose money on Medicare.”

Michigan Radio aired a feature on May 16 following an interview with Peters on workforce challenges impacting hospitals.

“We are losing employees to McDonald’s for a job that pays better and is less stressful,” said Peters. “And we are incredibly limited in our ability to compete with rising wages in other industries.”

Crain’s Detroit Business published an additional article May 18 on the topic that cited the Michigan Radio story and quotes Peters. Laura Appel, executive vice president of government relations and public policy, MHA, also spoke with WZZM-TV Channel 13 for a story on workforce challenges that aired May 19.

The Detroit Free Press and Fox 2 Detroit also reached out earlier in the week on the reported shortage of contrast media from GE Healthcare. A general statement was provided to reflect the varying impacts from the shortage on hospitals throughout the state.

Appel Addresses Specialty Integrated Plans with State of Reform

Laura Appel

Laura AppelState of Reform published an article May 2 that reviewed a panel discussion from the 2022 Michigan State of Reform Health Policy Conference on bills in the Michigan Legislature that would create specialty integrated plans to cover specialty behavioral health benefits. Participating on the panel was Laura Appel, executive vice president of government relations and public policy, MHA.

Appel expressed the MHA’s supportive position on Senate Bills 597 and 598 due to the need to integrate and reform behavioral health in Michigan, while also mentioning the role workforce sustainability has in that process.

“Here’s the thing about our current system, there are hundreds of people who don’t have a provider to worry about losing,” said Appel. “Our shortage of behavioral health professionals is dire. When a person is in crisis, any change is frightening, but the system is just not adequate right now.”

MHA CEO Report — GME’s Role in the Healthcare Talent Pipeline

MHA Rounds Report - Brian Peters, MHA CEO

“Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.” ― Rudolf Virchow

MHA Rounds Report - Brian Peters, MHA CEOAs we enter the final two months of the MHA program year, our “all-hands-on-deck” prioritization of the healthcare workforce continues, and I am pleased to share that we have made significant strides in this regard. Included in that progress is work with our partners in higher education, other Michigan healthcare associations, hospital clinical leaders and the Michigan Legislature.

One aspect of our workforce efforts is not new. For many years, the MHA has led a special Graduate Medical Education (GME) Advocacy Day, hosted at our MHA Capitol Advocacy Center (CAC) in downtown Lansing. At this event, medical students, residents from teaching hospitals and academic medical centers, and other key leaders converge on the Capitol and meet with legislators to discuss the vital importance of GME funding in the state budget process.

After a brief hiatus due to the pandemic, we are excited to play host once again for this important in-person event, as we will welcome our colleagues to the CAC on May 5.

When this event began, the primary focus was to express the importance of GME and the national prominence that Michigan has earned in medical education. We have more than 7,200 physician residents currently working in the state, which ranks fourth in the nation. In addition, Michigan is third in the country for student enrollment in public medical schools. The investment Michigan makes in GME is very valuable, as every $1 in GME generates $2.53 in federal funding in fiscal year 2022. While the current rate is enhanced due to the existing public health emergency, there is no question that GME funding for Michigan’s beginning physicians is a wise investment for the future healthcare workforce in our state. GME also improves access to care, as it allows physicians to further their medical education while delivering much-needed care to patients throughout Michigan in teaching hospitals, community clinics and laboratories.

The vital role of GME in filling the talent pipeline is more important today than ever, as Michigan hospitals (and the healthcare delivery system in general) struggle with workforce shortages that have been exacerbated by the COVID-19 pandemic. Those shortages across the state have caused Michigan to lose approximately 1,300 staffed hospital beds over the past 18 months. Nationally, the physician shortage is estimated to be between 37,800 and 124,000 by 2034, including primary care and nonprimary care specialties, as the Association of American Medical Colleges estimates two out of every five active physicians will be 65 or older within the next 10 years.

The participants in our GME Advocacy Day have experienced many of the challenges that we’ve shared with elected officials: stress, burnout, workplace violence, vaccine hesitancy and significant loss of life due to COVID-19 and a host of other medical issues. Their perspective is extremely valuable as we make the case for funding and public policy that ensures the viability of our healthcare infrastructure for years to come. In addition to full funding of the traditional GME pool, there are several related items on the radar screen here in Lansing, including:

  • Included in the state’s Higher Education budget proposal is House Bill 5785, which would provide funding to create a healthcare workforce collaborative between the MHA and Michigan’s public and private post-secondary educational institutions. This partnership would not only provide employers with a better understanding of statewide graduates in health professions, but further improve the knowledge of employment opportunities in healthcare for post-secondary education institutions throughout the state. Included in the collaborative would be the creation of a searchable and accessible repository that allows healthcare employers to understand current educational trends and provides prospective employees easy access to healthcare positions throughout the state.
  • The MHA also supports legislation designed to incentivize more medical school and advanced practice nursing program preceptors by providing new tax credits. Senate Bills 998 and 999 would create a new tax credit for individuals who agree to work as a preceptor for required clinical rotations. We believe this legislation could help increase the capacity for clinical rotations at hospitals across the state, which would also improve the talent pipeline.

As we advocate in support of GME and related issues, we of course greatly appreciate the collaboration of our friends from the Michigan State Medical Society (MSMS) and Michigan Osteopathic Association (MOA). Together, our three associations make up The Partnership for Michigan’s Health, which has a long history of working together on healthcare issues of common interest, including the achievement of major medical liability reforms in the early 1990s, which established the foundation for much of our advocacy work in the Legislature and the courts ever since.

Most recently, the collective voice of our three associations, along with associations representing various other areas of healthcare, led to successfully securing $300 million in state funding for the recruitment, retention and training of healthcare workers. Collectively, the Healthcare Workforce Sustainability Coalition was created to focus on workers already within the healthcare workforce. Gov. Whitmer also recently signed Senate Bill 247 that would decrease wait times for commercial insurance prior authorization requests, a priority for all three associations. We are also united in our opposition to Senate Bill 990 that would create a serious public health risk by licensing naturopathic practitioners and classifying them as physicians. As healthcare associations, the professional careers of our members are dedicated to serving their patients and protecting the health and safety of the public. This opposition is an example of our need to protect the public from a practice that lacks scientifically proven treatment methods and clinical training.

In addition, we have long collaborated with MSMS and MOA to produce The Economic Impact of Healthcare in Michigan Report, which provides a detailed look at the extensive roles hospitals and health systems play in their local economies. Work is underway on the next issue of the report. The MHA Keystone Center Board of Directors has also designated one seat each for the MSMS and the MOA since its inception to ensure physician representation as we strategize on safety and quality improvement issues. And finally, the MHA and the MOA literally got closer last year when the MOA relocated its offices to the MHA headquarters building in Okemos – an arrangement that is unique anywhere in the country.

I’d also be remiss if I didn’t mention the MHA’s new focus on engaging with our physician leaders. For the first time ever, the MHA will be hosting activities dedicated to our physician leaders during our MHA Annual Meeting, including several sessions that will include CME credits. MHA Chief Medical Officer Dr. Gary Roth is leading these efforts, which complement his work throughout the pandemic engaging with our health system chief medical officers to facilitate consistent and reliable dialogue that allowed the MHA to efficiently provide policy updates to our clinicians as well as real-time feedback to policymakers. We’re extremely fortunate to have Dr. Roth, as the MHA is one of just a few state hospital associations with a full-time CMO on its leadership team.

Lastly, in an effort to fully support our physician colleagues (and other caregivers), the MHA Keystone Center is offering the Well-being Essentials for Learning Life-Balance (WELL-B) webinar series to prevent healthcare burnout by delivering weekly webinars on evidence-based well-being topics, including prevalence and severity of burnout, relationship resilience and being present. It is encouraging to see that over 4,000 individuals have already signed up for this innovative program.

As you can see, there is no magic pill that can solve the healthcare staffing crisis overnight. It will take many years and a multitude of public and private solutions to protect access for all of Michigan’s communities. GME is one of those key solutions, and we call on our elected officials – and all Michiganders – to give it the support it deserves.

As always, I welcome your thoughts.

Peters Focuses on Rural Hospital Challenges in Rural Innovation eXchange Story

MHA CEO Brian Peters

MHA CEO Brian Peters

Rural Innovation eXchange interviewed MHA CEO Brian Peters for a story published April 28 that examines the challenges facing rural hospitals in Michigan.

Peters discussed staffing shortages and efforts to improve workforce sustainability, the impact of COVID-19 on hospital finances and cybersecurity threats.

“The [workforce] pipeline is going to be so important,” said Peters. “The pipeline as it exists today is not adequate, particularly in rural areas, which are significantly older than non-rural areas and have older and sicker patients. This also means that the phenomenon of folks leaving the field is felt more acutely in rural communities.”

Other healthcare executives appearing in the story include John T. Foss, vice president of operations, Mercy Health Lakeshore Campus; Steve Barnett, president and CEO, McKenzie Health; and JJ Hodshire, president and CEO, Hillsdale Hospital.

The MHA also provided comment to Michigan Radio for a story published April 27 on increasing COVID hospitalizations due to the omicron BA.2 variant.

“…[B]ut there are clear indications that the severity of illness is down and so we hope there will not be a surge of COVID hospitalizations like the state has experienced previously,” said John Karasinski, director, communications, MHA.

Media Recap: Workforce Sustainability & Strategic Partnership Legislation

Laura Appel

The MHA received media coverage since March 25 on hospital and nursing workforce challenges amplified by the pandemic, and legislation introduced in the Michigan Legislature that would eliminate the need for a second public vote to sell or lease a hospital that was previously transferred from a public authority to a private, nonprofit corporation.

The Detroit Free Press published March 25 a story that reviews the many factors that are influencing healthcare workforce shortages, particularly in the area of nursing. Laura Appel, executive vice president, government relations & public policy, is quoted in the article discussing the magnitude of workforce shortages for hospitals.

“We’ve been talking about a nursing shortage, we’ve been talking about tech shortages, whether it’s pharmacy tech or things like that. We didn’t really know what shortage was until this experience,” said Appel.

The story also include results from a recent MHA member survey that indicates more than 40,000 jobs are currently vacant at Michigan hospitals statewide.

MiBiz published March 27 an article on legislation introduced in the state House and Senate that can benefit small hospitals in Michigan that were originally formed by public authorities should they opt to pursue a merger. Adam Carlson, senior vice president, advocacy, spoke with MiBiz about the unique challenges small, independent hospitals experience and the potential benefit of strategic partnerships.

“At the end of the day, it’s all about access to care, and oftentimes that’s what you get with strategic partnerships,” said Carlson. “You really preserve the access to care that is so important. You keep your facility in your community, serving the residents of your community.”

Carlson Discusses Workforce Funding with MiBiz

Adam Carlson

Adam CarlsonMiBiz interviewed Adam Carlson, senior vice president, advocacy, for a story published Feb. 27 on the $300 million funding appropriation for healthcare recruitment, retention and training recently signed by Gov. Gretchen Whitmer.

Carlson discussed existing vacancy rates at hospitals, the benefits of the funding, how funding can be used and the process for distributing the funds to hospitals.

“COVID has taken a really serious toll on the mental, physical and emotional wellbeing of our health care employees in the state,” said Carlson. “(The funding) will allow us to start the healing process, provide additional recognition to workers for what they’ve done throughout the pandemic, and really recruit and retain excellent employees so our hospitals can provide safe, high-quality care.”

MHA CEO Report — Auto No-fault: Our Work Continues

MHA Rounds Report - Brian Peters, MHA CEO

“I pass my life in preventing the storm from blowing down the tent, and I drive in the pegs as fast as they are pulled up.” — Abraham Lincoln

MHA Rounds Report - Brian Peters, MHA CEOYou may have seen recent media coverage noting that the MHA is joining efforts to address and reform Michigan’s auto no-fault insurance law. The reality is our efforts to protect and preserve what we viewed as the best system in the nation for ensuring access to care for auto accident victims dates back decades. Despite those efforts, in 2019, we clearly understood that the political stars were aligning in such a way that substantial reforms were imminent and, hence, our work in the months and years since has pivoted.

I am proud that we led an effort to assist consumers in making educated purchasing decisions in light of those 2019 reforms, and we are pleased that most Michigan drivers to date have seen the wisdom in continuing to purchase unlimited coverage to protect themselves and their families in the event of a catastrophic accident. While this effort was intended to be very visible to the public, some of our other efforts have played out behind the scenes and relate to the regulatory aspects of the new law that impact how hospitals and other care providers are compensated for the important services rendered to accident victims.

The changes to reimbursement that went into effect last July created several significant difficulties for hospitals. In effect, the new law created price controls, something we argued is never a good idea because they inevitably create real inequities. Throughout the no-fault debate, we have argued hospitals and other providers need to be fairly compensated to ensure we have the physical space, the technologies, the staffing expertise, and everything else that is necessary to provide care in the hospital emergency department, intensive care units and in the venues that provide rehabilitative and attendant care. Every step of that process is very important for the physical, mental, and fiscal health and well-being of those auto accident victims and their families.

The impact on post-acute facilities has already been well publicized, as reimbursement inequities are leaving many to reduce their patient load or close their doors entirely. While most of these patients have no immediate needs that require hospitalization, the lack of available alternatives means they increasingly have nowhere else to go; some patients are now being transferred to hospitals at a time when we are short staffed and operating at high capacity. Emerging from yet another COVID-19 surge, hospitals need every available bed for patients requiring acute hospital care.

Also impacting hospitals has been a lack of consistency in payment rates and confusion on payment limitations. Claims processing from insurers has been significantly delayed, and there are serious inconsistencies in reimbursement rates across payers due to confusion over Medicare rates. The definitions from the law passed in 2019 are insufficient, and additional clarity is needed to ensure reimbursement rates are accurate and consistent with the intent of the law. The MHA has spent much time working with the Department of Insurance and Financial Services on the need for a proper definition of Medicare rates to address this problem. The payment inadequacy, discrepancies and delays are at odds with the negotiations that occurred in 2019 and the intent of the law. The law was designed to reduce the cost of auto insurance. Instead, it is creating an unfair and unstable system of reimbursement and threatening access to certain types of patient care.

Many hospitals across Michigan operate on razor thin patient care margins and have done so for many years. In fairness to all involved, when the auto no-fault reform legislation was signed into law back in 2019, no one could have foreseen an impending pandemic and the unprecedented financial stress it would impose on hospitals and the entire healthcare ecosystem. But we clearly see the reality of the situation now.

The MHA is fully supportive of reforms that will address our concerns. It is often said that “politics is the art of the possible.” We will continue to do all that we can to advocate for public policy that ensures access to much-needed care, in the context of a challenging political environment.

On that note, I would be remiss if I didn’t thank the governor, as well as Republicans and Democrats in the state Legislature, for their bipartisan support of House Bill 5523, which will deliver critically needed funding support to address our healthcare workforce crisis. Our elected officials came together and got it right. When it comes to our auto no-fault system, I am optimistic that we will ultimately make things right as well.

As always, I welcome your thoughts.

Media Recap: Appel Discusses Workforce Issues

Laura Appel speaks Feb. 14 with WILX News 10.
Laura Appel speaks Feb. 14 with WILX News 10.
Laura Appel speaks Feb. 14 with WILX News 10.

Laura Appel, senior vice president, health policy & innovation, MHA, was quoted in stories the week of Feb. 14 discussing issues impacting the healthcare workforce.

Hospitals across the country are concerned about anticompetitive activity and questionable pricing from healthcare staffing agencies. Appel spoke with WILX News 10 and WXYZ Detroit on the issue, addressing topics that include a bipartisan letter sent on behalf of nearly 200 members of Congress asking the White House Coronavirus Response Team to investigate healthcare staffing agencies and claims that some agencies are taking 40% or more of the amount being charged to hospitals in profits. Appel also stressed that the concern is regarding profiteering by nursing agencies and not the wages provided to traveling workers.

“I also think that there is profit-taking and perhaps even inappropriate pricing happening from staffing agencies. We were part of an effort by the American Hospital Association to send a letter from our members of Congress to the White House Coronavirus Taskforce asking them to look into the practices of staffing agencies,” said Appel to WILX.

Appel also appears in a story from Bridge published Feb. 15 that looks at how industries in Michigan are preparing for the next possible COVID-19 wave. Appel stressed that the number one focus of hospitals is on healthcare workforce sustainability.

“We need to work on retaining the workforce we have and recruiting (more workers),” said Appel.

Headline Roundup: Workforce Funding, Executive Budget and More

The MHA responded to several media requests the week of Feb. 7 on topics including passage Feb. 9 of House Bill 5523 that provides $300 million in healthcare workforce funding, Gov. Gretchen Whitmer’s Feb. 10 executive state budget recommendation and COVID-19 hospitalizations.

The MHA published statements on behalf of MHA CEO Brian Peters in reaction to the Michigan Legislature passing HB 5523 and the executive budget recommendation.

Below is a collection of headlines from around the state that reference the statements or include quotes from MHA representatives.

Thursday, Feb. 10

Wednesday, Feb. 9

Tuesday, Feb. 8

Members with any questions regarding media requests should be directed to John Karasinski at the MHA.

MHA Statement on Passage of Vital Healthcare Workforce Funding

Brian Peters

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

MHA CEO Brian PetersHospitals throughout all regions of Michigan are experiencing significant workforce shortages. The passage today of House Bill 5523 provides critically needed resources for recruitment and retention of healthcare workers to care for our communities. This funding is vital to assist hospitals and health systems in addressing high job vacancy rates, providing training and development, and supporting existing workers who have resiliently provided care for patients throughout the two years of this pandemic.

We’d like to express our gratitude to the Michigan Legislature for prioritizing this funding that will go directly toward Michigan healthcare workers. We encourage Gov. Whitmer to sign this bill as soon as it reaches her desk to bring urgently needed relief to our healthcare workforce.