Western Michigan HFMA Leadership Meeting November 19, 2014

Vickie R. Kunz, senior director, Health Finance

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About MHA

• Established in 1919; Nonprofit (501C6) • Approximately 100 employees • Locations: Okemos “campus”; Downtown Lansing (CAC) • Primary Membership: hospitals / health systems • Governance: MHA Board of Trustees; Committees, Councils, Task Force (CCTF) structure 2

Continued, About MHA

• Mission: We advocate for hospitals and the patients they serve. • Vision: We are committed to becoming the most effective health care advocate in Michigan. In that role, we will promote better health within our communities; improve the quality of patient care; and improve coverage for high-quality, affordable health care services for all Michiganians. 3

MHA & Its Related Entities/Programs

Michigan Health & Hospital Association

Non-profit Michigan corporation (501-c-6)

Hospital Purchasing Service

Michigan non-profit association

MHA Service Corporation

For-profit Michigan stock corporation

MHA Unemployment Comp Program

Informational IRS return filed by individual participants

HealthPAC

Political action committee formed under state statute

MHA Health Foundation

Non-profit Michigan corporation (501-c-3)

Hospital Councils

Non-profit Michigan corporations (501-c 6 or 3)

MHA Keystone Center

Non-profit Michigan corporation (501-c-3)

MHA Patient Safety Organization

Federally Certified PSO Represents legal control (ownership and/or complete authority to operate) Represents affiliation agreement and/or board position (operating cooperation and coordination ) 4

MHA Leadership

Advocacy

•Legislative •Regulatory •Legal / courts •State and Federal •Strengthen and build strategic partnerships 5

Examples of MHA Efforts

• Federal Issues – Medicare and Medicaid Policy and Funding • Advocacy/Legislative Issues: – Healthy Michigan Plan – Employment law – Scope of Practice – CRNAs, Advanced Practice Nurses – Lifeguards at hospital-owned health & wellness centers • Overall health and hospital leadership – Michigan Harvest Gathering – Ebola preparedness 6

MHA Health PAC

•Mission: To promote and protect access to quality health care throughout the state of Michigan by supporting state and federal candidates who are supportive of Michigan’s hospitals and health care systems.

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MHA Health PAC

•New record fundraising in 2014 •Third largest independent PAC in Michigan •Supports state-level candidates and officials •Helps inform legislators about crucial health care issues.

•Gain-sharing arrangement with AHAPAC for support of Michigan Congressional delegation .

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Examples of MHA Finance Policy Involvement

• Other activities identified by/for the MHA membership – State Quality Assurance Assessment Program (QAAP) – Medicaid implementation of Critical Access Hospital takeback that included “reject” vs “no-pay” , impact on Medicare reimbursement – Michigan Managed Care Rebid process – Medicaid implementation of MI Health Link (formerly dual eligible project) – HFMA/MPAA/ACMA, etc. outreach 9

Payer Issues

• The role of the MHA is to assist in resolving systematic payer issues.

• Individual hospital contracts determine terms and conditions and take precedence.

• Communicate issues to Marilyn Litka-Klein or Vickie Kunz at the MHA. 10

Hospital-Specific Medicare Reports

• FY 2015 Final Rules – Inpatient Prospective Payment System – Inpatient Rehabilitation Facility – Inpatient Psychiatric Facility – Long Term Care Hospital – Skilled Nursing Facility – Outpatient Prospective Payment System – Home Health • CMS comment letters shared via MHA Monday Report.

• Value-based program analyses – VBP, RRP, HAC 11

Healthcare Marketplace

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2012 2011 2010 2012 2011 2010

Hospital Average Margins

Patient MI -1.3% -1.1% -1.6% Operating MI 3.4% 3.3% 2.8% US 0.7% -0.3% -0.2% US 6.5% 5.5% 5.5% 13

History of Hospital Volume

2000 Michigan US 2011 Michigan US Michigan Hospital Median Inpatient 57% 65% 51% 57% Outpatient

43%

35% 49%

43% 67%

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Michigan Hospitals – Integration

• 1980: 236 Hospitals; 49,369 total beds – Nearly all independent • 2014: 134 Hospitals; 24,617 total beds – 20 systems = over 100 hospitals – 7 out-of-state systems (3 for-profit) – 36 Critical Access Hospitals (1,300 in U.S.) •65% of practicing Michigan physicians are either employed or “near-employed” by hospitals 15

Hospital Landscape Changing

McLaren Health Care

• • Cheboygan Memorial – 2012 Northern Michigan Regional – 2012 • Barbara Ann Karmanos Cancer Center – 2014 • Port Huron – 2014

Spectrum Health

• Memorial Medical Center West Michigan (Ludington) – 2013 • Mecosta County Hospital (Big Rapids) – 2013 • Pennock (Pending)

Other

• Catholic Health East (CHE)/ Trinity – 2013 16

Hospital Landscape Changing – Cont.

• DMC – Vanguard/Tenet – 2011 • Marquette – Duke/LifePoint – 2012 • Bell Hospital & Portage Health – LifePoint – 2013 • Metro Health – Community Health Systems – 2013 • Garden City – Prime Healthcare Services 2014 • Beaumont – Oakwood – Botsford – 2014 • Crittenton ?

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Hospital Landscape Changing – Cont.

• Mercy Memorial Monroe – ProMedica (Pending) • Mercy Cadillac & Mercy Grayling – Munson (Pending) • Allegiance – University of Michigan –(Pending) 18

Why Hospital Consolidation?

• Access capital • Reduce administrative expenses • Gain expertise • Retool processes • Increased volume doesn’t equal long-term success without fundamental changes to operations 19

MHA Health Foundation (501C3)

•Grant administration •MHA Keystone Center / PSO •Excellence in Governance Fellowship •Physician Leadership Academy •Educational webinars •Major conferences 20

MHA Keystone Center

Formed in 2003 to voluntarily bring together Michigan hospitals and clinical experts to identify and share evidence-based best practices to improve healthcare safety and quality.

Vision

Healthcare that is safe, effective, efficient, patient centric, timely and equitable.

Mission

To lead the nation in quality and patient safety through the diffusion of change using patient-centered, evidence-based interventions supported by cultural improvement.

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MHA Keystone Center Funding

• State of Michigan Grant – Stroke • Blue Cross Blue Shield of Michigan • Two five year donations to support all hospitals participating in statewide collaboratives.

• Centers For Medicare Medicaid Services - Partnership for Patients (Hospital Engagement Network) • • 26 HENs nationally Care Transitions and Hospital-Acquired Conditions • Hospital subscription – patient safety organization • Agency for Healthcare Research and Quality – national contracts 22

Michigan Hospitals’ Patient Safety & Healthcare Quality Advancements

• • • • • Reduced the incidence of central-line associated bloodstream infections by 66 percent from 2004 – 2013.

From 2010 - 2013, participating hospitals reduced the number of babies admitted to the NICU by nearly 60 percent.

Participating hospitals reduced hospital-acquired pressure ulcers by 32 percent from 2011 Q1 – 2013 Q4. Reduced the mortality rate for septic patients by 36 percent and increased the rate of compliance for care of a septic patient by nearly 40 percent from 2011 Q2 – 2013 Q4.

Surgery hospitals reduced the surgical specimen defect rate by 84 percent from 2010 Q1 – 2013 Q4.

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Collaboratives and HEN

• MHA Keystone Center is one of 27 organizations nationally to become a Hospital Engagement Network (HEN).

• 95 Michigan hospitals participate in the MHA Keystone HEN.

– Share and implement best practices aimed at reducing preventable hospital-acquired conditions by 40 percent and preventable hospital readmissions by 20 percent by the end of 2014.

– Early elective deliveries reduced by about 80 percent – Launching new interventions in adverse drug events • Reducing opioid use for surgical pain management • Data capture from Great Lakes Health Information Exchange (glucose and INR values) • Mental Health Project – Grand Rapids hospitals and community using visual stream improvement methods to improve access and reduce ED utilization 24

MHA Keystone HEN Participation

Hospital-acquired Condition

Central-line-associated Bloodstream Infection Ventilator-associated Pneumonia Surgical-site Infection Perinatal Harm Falls Pressure Ulcers Catheter-associated Urinary Tract Infection Adverse Drug Events Venous Thromboembolism Care Transitions/Readmissions Sepsis

Keystone Participants

77 77 104 65 120 65 30

HEN Participants

56 55 61 47 43 31 60 8 37 37 25

Quarterly Scorecard

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The Michigan Model – Exporting Patient Safety and Quality

• On The CUSP* Stop CLABSI – 47 states participated with over 1,000 hospitals. Health Research Educational Trust (HRET) engaged in enrollment of remaining states. Partners in project include HRET, JHU and MHA.

COMPLETE – Results 43 percent reduction in CLABSI

• On The CUSP* Stop CAUTI – Nearly 900 hospitals in 41 states, Washington, DC, and Puerto Rico seeking to reduce catheter-associated urinary tract infections – 16 percent relative reduction at the end of January • CUSP* for Mechanically-ventilated Patients – Cohort 1 under way (55 hospitals, 10 states) – Seeking to prevent harm to patients on mechanical ventilator *CUSP: Comprehensive Unit-based Safety Program 27

What is a PSO?

Patient Safety Organization: An organization created under federal law by the Patient Safety & Quality Improvement Act of 2005 to facilitate the collection and sharing of data on adverse events with the aim of improving patient safety nationally.

MHA PSO certified in 2009; recently re-certified as one of 84 PSOs in United States. 28

MHA Patient Safety Organization

• Event reporting • Standardize Patient Alert Wristbands • Standardized Pediatric Dosing • Safe Tables • Keystone Integration • Member Expansion – Long Term Care – Physician Organizations 29

MHA Patient Safety Organization

• Annual subscription – 99 percent participation • Safe Tables – 20 over the past 11 months – Overarching themes • Communication – at both system and individual levels, generational gap (younger nurses don’t know what to do when systems are down and older nurses have trouble using the systems) and hierarchy between physicians and nurses • HIT Issues – workarounds, forced new processes on staff, EMRs adding complexity to an already complex environment, nurses feel as though they are treating the chart not the patient 30

MHA Service Corporation (for-profit)

•Unemployment Compensation •Data Services (MIDB, MODB) •CB Tracker •Healthcare Loan Program (HELP) •Career Center •Graphic Design / Print Shop 31

MHASC Data Services

• A wholly owned for-profit subsidiary of the MHA • The majority of our clients are also members of the MHA • Clients in 12 states, including 2 other hospital associations 32

State Data Organization in Michigan

• Voluntary data state collecting inpatient and outpatient data – Able to maintain control of what our hospitals must do – Collect data at a much lower costs – Control who has access to the data – Do NOT have punitive capability • We provide data to: – Clients that license our products – MHA divisions – ARHQ - Healthcare Cost & Utilization Project (HCUP) – MDCH – Other state associations – Researchers 33

Products We Develop &/or License

• Data Koala & Interactive Data System – Michigan Inpatient Database – Michigan Outpatient Database – Michigan Emergency Department Database (Pilot) – Physician Loyalty Reports – Special Data Processing • Community Benefits Tracker – Hospital Events Module – Association Survey Module 34

Products We Develop &/or License

• Southwest Utilization Reports • MARQI Readmission Project • MHA Salary Survey Report – Contract with Colorado Hospital Association • MI Hospital Inform Website • *New* technology partnership product Data 2 Discover • *New* readmission tool being developed working with MHA Keystone Center 35

MHASC Products

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Community Benefits Tracker

• Community Benefits Tracker Hospital Events Module is a web-based data collection and reporting system designed to streamline the collection of hospitals’ community benefit activities • Tracker helps users assemble IRS 990 Schedule H quickly and easily 37

Community Benefits Tracker

• Hospital Event Module – 175 clients, 19 systems – 12 states – Low cost, highly competitive product • Association Survey Module – Michigan – South Carolina – Virginia 38

What is Data Koala / IDS?

• The Data Koala/Interactive Data System contains the MIDB & MOBD • Allows clients to run various reports for market share, patient demographics, outcomes & utilization • Clients compare their hospital to competitor hospitals • Almost every hospital marketer and planner in Michigan uses DK/IDS on a daily basis 39

Product Comparison

Report run-time Trending time periods Data years available Report generated charts Software platform Recorded trainings Sharing Scheduling of reports Saved report results Hiding visible columns User activity logging 5+ minutes 5 periods maximum 5 years maximum Not available Desktop installed* Not available Not available Not available Manually save report results to computer Not available <10 seconds Up to 20 1998 – current data System generated Web-based In-browser video support Share reports, filters, UDFs between users Automatically generated with new data release Report results saved on server Only displays desired data columns on reports Limited us for future planning

MI Hospital Inform

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MHA Resources

• • • • • • • • Monday Report is available FREE to anyone and is distributed via email each Monday morning.

– Go to website and select “Newsroom”, then Monday Report MHA Monday Report – electronic publication issued weekly Request password if you don’t have one.

– Email Donna Conklin at [email protected] to obtain MHA member ID number Advisory Bulletins – Extensive communications available only to MHA members, as needed. (Require password to obtain from website).

Hospital specific mailings as needed for various impact analyses, etc.

Periodic member forums See mha.org for other resources.

Monthly Financial Survey provides free benchmarking of financial and utilization statistics. 42

???Questions???

Vickie R. Kunz Senior Director, Health Finance

Michigan Health & Hospital Association

110 West Michigan Avenue, Suite 1200 Lansing, MI 48933 Phone: (517) 703-8608 email: [email protected]

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