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    This interview was with Kevin Downey, the Director of Public Affairs at the Michigan Health and Hospital Association on October 13, 2011

     

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    Q: Your mission statement says “We advocate for hospitals and the patients they serve”. Could you elaborate a little more on what this actually means? Are there examples of what MHA stands for?

    A: Sure, I would say that we could probably break it down into a handful of things that we are most focused on. I would say what we call “mission driven funding”, but really what that is funding for health care providers. Basically, we figure if we can make sure we protect funding for health care physicians, than that means that patients still have hospitals to come to and doctors to see them. So one of those things is protecting funding for hospitals. Another thing we do is we have a great focus on community health improvement. Another major one is patient safety and quality. Also, patient access, which is kind of wrapped up in the first one. What I mean by patient access is that no matter who you are or where you are in the state, you are able to access health care.


    Q: Can you explain a little more about what “community health improvement” means?

    A: That would kind of fall under a lot of the voluntary action at MHA. We’re working right now pretty closely with the governor on his “dashboard” for community health. After he got elected, two of his major indicators are infant mortality and obesity. So we have been sort of advising the office on those issues. We’ve been working with an organization called Tomorrow’s Child, and also with a patient safety intervention on obstetrics. It’s about delivering healthy babies, making sure certain things are done and not done, to make sure that babies come into the world healthier. Those are our two things focused on infants. In terms of obesity, we have an initiative called Healthy Food Hospitals, which is a voluntary initiative that we rolled out this year, and I think we’ve got probably around 80 hospitals participating in now. It’s about modeling healthy food choices. So hospitals now are out with the trans-fat, out with the fatty kind of menu items, and we are replacing them with items of more nutritional value. We’re getting rid of pop, that sort of thing. So community health improvement, is partnered with like-minded organizations to improve the health status of everybody in Michigan. That’s the idea. Healthier babies, less obesity.


    Q: What differentiates you from other groups? Are there even other groups like MHA?

    A: I would say this has a two part answer. I’d say first of all, we are fortunate enough that the MHA actually represents all of the hospitals in Michigan. We have about 137 hospitals that we represent, or if you go beyond that, to some of our sort of “rehab” hospitals, things like psychiatric care, that number actually jumps up to 174 hospitals that we represent. Because of that reach, we are the sole hospital association representative in the state. A lot of other states have an association for for profit hospitals, non-profit hospitals, rehabilitation hospitals, we are sort of that overall organization. Because of that, we are the hospital association in Michigan, there’s no other players in town. That gives us an incredibly strong advocacy voice with law makers, because they know that when we talk to them, either about whatever the issue may be, it might be about funding, might be about patient safety, about community health improvement, or about patient access, any of those topics, when we come to them, they know that we are speaking the voice of 137 community hospitals, or 174 overall. That sort of differentiates us from not only other states, in that we have only one organization, but from a lot of different trade organizations, these advocacy organizations, in Michigan. A lot of them are broken up into pieces, because they only represent segments, and we represent all hospitals. So that gives law makers a more powerful voice, and more credibility with the media, because when they come to us, they know that we know what we’re talking about. We’re fortunate, very few states have that sort of ability.


    Q: What are some of your other big goals for this legislative session, in terms of funding?

    A: Definitely preserving medicaid funding. That is the top advocacy goal we have. There are a lot of different ways in which it’s threatened, a lot of which gets pretty deep. But medicaid funding is always in danger, and that is such a large part of hospital funding, and obviously medicaid patients in Michigan, there are close to 2 million medicaid patients in a state where there are around 10 million people, so when you look at how many people are affected, you’re looking those 2 million people, and everybody, actually. Everybody’s affected, because hospitals can’t afford to treat certain services anymore, hospitals treat everybody who walks in the door, so if you cut medicaid, you’re not hurting medicaid recipients, you’re hurting everybody, hospitals can’t function if they’re not funded, and that medicaid funding is such a large part of the hospital budget. We typically tend to work very diligently, we weight that in terms of our advocacy. So medicaid funding is one. The second thing is, and this is just a dream of ours, but full medicaid funding. Because medicaid still only covers a fraction of a cost. If something costs us a dollar, we typically get about 67 cents from the state of Michigan, since the state is in such bad shape. So, we’re even getting underfunded with medicaid. so hospitals have to be incredibly resourceful with how they handle that. A lot of healthy companies have margins, profit margins, at 6 percent, 15 percent, and hospitals are hovering around 2 percent or less, and even that is basically so that if something breaks in the hospital we can get a new one. Hospitals are getting better at being resourceful, but it’s that protecting the medicaid that is keeping them going.


    Q: How has having more Republicans in Lansing changed your work? Is it easier or harder to accomplish your goals?

    A: It does make a difference. I’d actually say that the balance of power that makes the difference, it’s not even necessarily who’s in power, it’s the underbelly of politics and it’s unfortunate that no matter who’s in power, there is still somebody not in power, and there is always somebody trying to obstruct something. I’m just saying that the political system is wrought with challenges, because of the fact that when you have two parties, one is constantly trying to make sure the other doesn’t look good. What we’ve seen before, historically, is that democrats usually try to protect medicaid more. But this new republican governor, actually protected medicaid better than any governor in the last 12 years, which is fascinating because typically the republicans are looking for funding levels to be cut, they like to reduce the cost of government, and medicaid is such a huge part of funding for the state, that usually the cost errs when their is republican leadership. So it was an unbelievably refreshing and wonderful thing that the governor protected medicaid in the last budget cycle. There was a cut to something called Graduate Medical Education, but overall, with that exception, he protected medicaid, which is more than any other republican or democratic governor did before him, so that’s a little bit different kind of politics. Because the governor himself is a little bit more of a moderate republican than what we typically see, which is somebody either on the very left or the very right.

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