Brian Kruger
Welcome to Richard Helppie’s Common Bridge. The fiercely nonpartisan discussion that seeks policy solutions to issues of the day. Rich is a successful entrepreneur in the technology health and finance space. He and his wife Leslie are also philanthropists with interest in civic and artistic endeavors with a primary focus on medically and educationally underserved children.
Richard Helppie
Welcome to the Common Bridge. This is your host Rich Helppie with our guest today, our returning guest, Brian Peters, the chief executive officer of the Michigan Health and Hospitals Association, Brian’s a returning guest, he has a large role in healthcare policy, not only at the state level, but on the national level as well. He has been long involved with healthcare policy advocacy, his full bio is on our website, Richard Helppie.com and today, Mr. Peters has agreed to give us a bit of a rapid update on a rapidly changing situation with the pandemic. So Brian, welcome back to the Common Bridge. We’re really glad to have you.
Brian Peters
Thank you so much. It’s always great to be with you.
Richard Helppie
Great. And before we get going, I know my producer always wants me to ask people to follow us on one of the podcast outlets or on YouTube TV and register for free at RichardHelppie.com. Brian, it seems like we’ve got some pretty good news as far as the pandemic goes, that is the headline news is pretty good. What are you seeing in terms of the effectiveness of the vaccines and the impacts on our health care providers?
Unknown Speaker
Well, rich, you’re exactly correct. In fact, if we had had this engagement about a month or so ago, which was not all that long ago, it would have been a very different conversation, because we were rapidly moving towards an all time record high in terms of our number of inpatients in our Michigan hospitals throughout the state with COVID-19. But as you alluded to, we are on a very positive trend now, where we reached a high of about 4300 inpatient hospitalizations a few weeks ago, we are now just around 1800. So we have seen a very rapid decline, which is great news, a lot of folks getting discharged in good shape from our hospitals, we still have a number of folks in the ICU. And we still have a number of pediatric patients actually about 50 pediatric patients with COVID-19, who are currently in Michigan hospitals. So that’s something to keep an eye on for sure. But as we see the vaccine now opening up not only to 16 and older population, but now to the 12 to 15s that we hope will see those numbers continue to decline as well. So the vaccines are making a positive impact. I don’t think there’s any question about that.
Richard Helppie
Just for nomenclature, a pediatric case is under the age of 18 generally? And do we know, are there any connections with geography, particularly zip codes, or complications and comorbidities? Or perhaps exposure in certain events? Or is it just kind of 50 randomly? Do we know anything more about that frightening impact on younger people?
Brian Peters
Well, the one thing we do know is that COVID-19 appears to be a precursor or a contributor to something called Miss C, which is multi inflammatory syndrome in children. Those two have been linked, not only here in Michigan, but in other states as well. And that’s a very concerning situation to be sure. beyond that. And to the point of your question, I think it’s a little soon for us to be able to draw any firm conclusions in terms of how COVID-19 has impacted that pediatric population. We’re still looking at the data, but there’s not a lot of it, because Thankfully, there haven’t been a lot of kids who’ve been hospitalized. This, as you know, as as largely been a pandemic that has affected the older population older than than 18, to be certain. But we certainly want to keep our eyes on this. Again, to your question, we’re seeing the pediatric impact in multiple regions throughout the state of Michigan. So it is not a situation where those 50 or so pediatric patients are all clustered in one region or one hospital. That’s certainly not them. Because one thing I would tell you, and when we look at the data, it’s very clear that the this most recent surge, which of course was the third surge that we’ve experienced here in the state of Michigan, it was driven almost exclusively by unvaccinated Michiganders, regardless of the age, it was unvaccinated Michiganders, we could see as the numbers began to rise very precipitously in our hospitals throughout the state. And we looked at the data and we understood that, yes, there were a handful, I mean, a very small number of what we call breakthrough cases, meaning people who were fully vaccinated, but they still were sick with COVID and becoming hospitalized. That was an incredibly small number. And again, the vast majority were those who had not yet been vaccinated. And that’s precisely why this most recent wave was driven by the younger age cohorts those age 70 and older who had driven those earlier waves. Well, they were the first in line to get the vaccine. And therefore, there was not a significant impact from those folks in terms of inpatient hospitalizations. So if you want to look at proof positive that the vaccine is making an impact, a positive impact. I point you to our Michigan hospitalization numbers in the last couple of months.
Richard Helppie
I know that one of our earlier conversations, I think it must have been around last fall, he said that the pandemic had moved from the nursing homes into the frat houses, and there were a number of super spreader events centered around some of the college campuses.
Brian Peters
Well, that’s absolutely correct. And as you see with some of our Michigan universities who have already taken action to mitigate against those sorts of activities, and in already as we look to this fall, and a new school year, beginning, in August and September, whether you’re talking about universities, or whether you’re talking about high schools, middle schools, elementary schools, we’re all trying to adjust to the new normal, and do what we think is in the best interest of students and families and teachers and, and frankly, all Michiganders. But the rules of the game are rapidly evolving, certainly as the vaccine comes online. Certainly as we get new guidance from the CDC, we know that if history repeats itself, even in the absence of a vaccine, we saw COVID case counts decline precipitously last summer, as folks move to increasingly outdoor activities. So there are a lot of things that are going to evolve in the next few months. And the bottom line is we need to continue to keep our foot on the gas because the finish line is in sight. It really is we’re very optimistic that we can finally move on to some sense of normalcy, but we’ve got to hang in there a bit longer, people got to step up and get vaccinated. They have to continue masking and social distancing where that makes sense to do it, where that is the advice and counsel of our public health experts. We can get there we can get to that finish line.
Richard Helppie
I pray that we get there. And you know what, the summer just around the corner. Of course, in Michigan, we never know when we actually get it. But get outside. We’ve talked to more and more experts that are saying there’s almost no cases that are transmitted in the great outdoors. Perhaps that explains some of the successes that we’ve seen in some of the southern states, their ability to open that people aren’t in confined spaces getting that viral load. You know, Brian, you I’m gonna ask and it might be two questions in one. But when we first talked hospitals, it was a dire situation. Staff shortages, pp shortages, the sheer volume of people coming in the door, and how are we handling that today? And were you surprised at the seeming abruptness of the CDC policy change? Or was that perhaps something you had insight to that might be coming that they were maybe they let you in the healthcare industry know, in advance of letting the general public know.
Brian Peters
But to your second question first, Rich, I think we were just as surprised as the rest of the world, quite frankly, with the CDCs announcement. And really the fact that that was dropped in our laps rather quickly and abruptly, which is, as you know, not the norm typically, through certain channels, we understand what’s coming down the pipe. And that was not the case. So we did not know that. I can tell you that the Whitmer administration and legislative leaders here in Michigan didn’t have any more heads up than we did. Now, that’s not to say it was the wrong call in any way shape or form, but it did take us a bit by surprise. And I think one of the the realities of that is it’s going to take a little bit of time to adjust course because in many cases, as you know, healthcare is not a speedboat. It’s an aircraft carrier, and so changing on a dime, is not the easiest thing in the world to do. And we’ve had to do that multiple times through this pandemic. Now, to your first question, when we look at our member hospitals, whether you’re talking about a small independent rural hospital, in the Upper Peninsula, or in the farm or some other part of the state, where whether you’re talking about some of our large multi-hospital systems in the bigger cities, I think the fact remains that, on the one hand, we are in a much better place today than we were earlier in the pandemic, when it comes to the supply of personal protective equipment. We were in dire straits. Earlier in the pandemic, we had many of our hospitals who said we only have a day or two or three worth of PP on hand, whether that was masks, gowns, gloves, you name it. Now, because of the supply chain robustness, and a number of steps that have been taken, I think we are in a much, much better place now. And I’m optimistic that we’ll have adequate PPE supply going forward. Now, the one thing that unfortunately has not improved, and again, I would say this, regardless of the size or scale of a hospital or health system, and that is staffing. Remember that we have frontline caregivers, and quite frankly administrators to who have been dealing with this pandemic now for well over a year, the stress and strain is taking its toll. We have a number of individuals in the healthcare arena, who were on the fence about retiring before the pandemic came along. Well guess what many of them are no longer on the fence? The pandemic has accelerated their retirement plans. We have heard that consistently from our member, hospital and health system leaders in recent weeks and months, that has put a new stress on their staffing capability. So I think when you look at the burnout, in health care that existed, again, pre-pandemic, this is only exacerbating things. Remember that our hospitals have been put in a difficult situation where they have to be the bad guys telling the family members of patients that no, we can’t have you and extended family and guests come and be at the bedside of your ailing loved one, because of our infection control protocols. And we have had a number of our frontline caregivers who who have actually been the person who is monitoring a zoom call with family members who can’t be in the room. They’re the ones who’ve had to hold the hand of that patient while they expire. And you can imagine what that does to to an individual over time, if you’ve had to do that enough times. And you know, they’re blessed. They tell us they’re blessed to be in a position where they can be the one to hold a hand when someone is in that situation to what they were called to do in healthcare. But you know what? You do that enough times, it really does create an incredible amount of stress and strain, no question about it.
Richard Helppie
Look, it’s trauma. And I don’t think it would be unwise to prepare for PTSD, we know that we have a mental health crisis in the country, there is more and more emerging evidence that we are about to have a tsunami of mental health effects. And I know that in my observations and reading, kids don’t tell you they’re stressed and under strain, because they really don’t know. But it begins to emerge. And that’s another strain that’s going to hit the healthcare system. And I’m just wondering, in your peers around the country and some of the national groups that you deal with, as well as within the state of Michigan. How are you guys talking about preparation for the next viral pandemic? And for the aftermath of this one, as some of that deferred care, or perhaps care that’s been ignited the need for care that’s being knighted by this pandemic begins to come into your facilities? What kind of discussions are the people that we rely on having today?
Brian Peters
Well, those are great questions Rich, and you’re spot on. These are the discussions that dominate all of the meetings that I have with my counterparts in the State Hospital Association community throughout the country. It’s really beginning to dominate the discussions that we have with our own members, including the MHA Board of Trustees, and it really revolves around how are we going to ensure access to quality affordable health care post pandemic? What are the things that are going to look different and we’ve already talked about this new staffing challeng, right? So how do you deal with the staffing challenge when you know that there’s going to be a an explosion in demand coming from the baby boomers that we knew about even pre pandemic. And as you just said, an explosion in demand for behavioral health services. I think fueled, in many instances, by the pandemic, I agree with everything you said, particularly about our children, who have been through an awful lot in terms of their whole ability to interact in a school setting and through sports and extracurricular activities. I know because I have two teenagers of my own who’ve been in that very boat. And so I think you’re correct. A couple of things. One, we know that telehealth is going to have an important role to play, we know that it will help in many instances extend the ability to to provide services and health care to individuals where we might not have the capability to do that in a face to face setting. And to be perfectly honest, we’re already hearing from patients who are telling us, you know what, for this range of services, I’d rather interact with you from the comfort of my own home, as opposed to going to a clinic or a hospital, and waiting and waiting. And putting myself in that situation where you know, I could be in contact with other sick people, you know, in their mind. So we already know there’s going to be a patient demand for more telehealth. That means that we need to rely on technology and internet access. But we also need to rely increasingly on public policy. Why? Because right now, you know, Medicare, Medicaid, health insurers will pay for x, they may not pay for y when it comes to a telehealth visit, we know that in some instances, doctors or nurses may be able to provide a tele consult in this state, but not that state. And so we’re dealing with all of the public policy ramifications. From a behavioral health perspective, I think mha understood early on that this was going to be a game changer. And so we have a new ask it’s a matter of a public discussion now, a $125 million request in the state budget negotiations very specifically to behavioral health. And a lion’s share of that focused on how can we address the EDI boarding situation that is when someone comes into a hospital emergency department, they need behavioral health services, there are no available behavioral health beds and or the staff to provide services for someone who would be in the bed. And therefore that a patient is boarded in the emergency department literally in a in a bed in a hallway, we have seen this, it is a heartbreaking situation. Our hospitals can’t do anything about it, if there is not a available staffed bed to transfer them to either in that facility or somewhere nearby. We see this happening on a very regular basis. So our member hospitals have really raised the red flag here. We’re trying to address this with with funding and with public policy. But you know, there are going to be a lot of things that we need to tackle in the month that had rich.
Richard Helppie
Brian, I know that you and I have had many discussions. You and I are both in strong agreement that the healthcare system is not designed for the needs of the day we’ve we’ve talked about that I’ve had other experts on the Common Bridge, amazingly, from different perspectives all arriving in the same place. We know another thing beneath the surface is the financial health of the hospitals today, which were devastated by the pandemic because most of them are still dependent on volumes. Can you keep the beds filled? Can you keep the ORs busy? And that business model that they’re forced into sometimes can preclude both capital and operating expenses for pandemic response and for behavioral health response. And I think punctuated by your good work and the need to get out there and try to find $125 million of new money for behavioral health. A third element I’d add to this, even with the expansion of Medicaid, and with our green population becoming more Medicare eligible, we still have a big problem in the middle, particularly with gig workers or the self employed who can Can’t afford good health insurance. And we’re really undoing the triple aim of cost, quality and access. And I’m just wondering with your impact on the national scene, are, we finally going to get a chance to say, look, let’s fix the problem. And as I’ve made this a really long question, I’ve got to add that I think your average person thinks there’s some big data system that counts all this. And the city says this, and the state of New York says this. And no, people are trying to call eight different data from antiquated systems, different definitions, paper handling. I mean, is this maybe the pivotal moment, we can say that what we’re doing is not working very well, and maybe look at system wide reform?
Brian Peters
A lot to unpack there. But you’re right. The questions that have to be asked, and you know, I think it’s a good opportunity for me to to recognize the work, you’re doing Rich, I think, you know, the Common Bridge, and I’ve listened almost all of the podcasts and think you’re doing a phenomenal job and contributing to a debate that needs to occur, and creating visibility, to the issues that we need to talk more about, I think, to your point, there’s nothing like a crisis to draw attention to what’s wrong with a traditional system. In this case, we’re talking about a healthcare delivery and financing system. What did the pandemic teach us about the financing system and the delivery system as well? You alluded to it, when we had to essentially shut down elective procedures in Michigan and American hospitals earlier in the pandemic, for infection control purposes. Well, the lifeblood of health care funding for hospitals was cut off. That’s where the volume based reimbursement model really comes into play. And it was turned off, it showed the vulnerability of that model. And we could be there again in the future, maybe not with a Corona virus, but with some other event or activity that puts us in a similar situation. So I think it opened a lot of eyes. In that regard.
Richard Helppie
Brian, if I may, let me interject just because most of our listeners are not healthcare policy wonks, let me illustrate this. And Brian, correct me if I’m wrong, that when we most need our health care providers, our hospitals, our doctors, our clinics, is would be exactly the time that the financial rug would be pulled out from underneath them. Fair enough?
Brian Peters
That’s exactly correct. That is exactly correct. And I think this was just one example of how that can occur and did occur. And so for those policymakers, who for some time now had been talking about moving away from a volume based system to more of a value based system. This is giving them new ammunition, new talking points. And I think that debate is going to get louder in Washington, DC, I think you you’re going to see that between now and the November election of next year. We have time for that debate to occur. And I think the two parties get a bit more of a temperature check on the American public, who may feel a bit differently about some of these health policy questions now than they did pre pandemic, right. So I think you’re gonna see more more of that discussion.
Richard Helppie
I was gonna say, if we can get the news off of like Liz Cheney or something like that, then we can actually have these discussions because I think there’s enough people in the public that are dissatisfied, but don’t know where to turn or how to turn or the dire consequences if we don’t get this right, or fail to act in an emergency, we came close to the brink here.
Brian Peters
Well, that’s absolutely true. Now, what we’ve seen since the early days of the pandemic MHA, the American Hospital Association and other advocacy groups have been successful in creating a pathway to relief funding that has helped to keep the doors open for many of our hospitals. We’ve done a number of things at the state level that have secured the supply chain for PPP as we discussed that have helped in some ways to address the healthcare staffing challenges, but simply creating new funding mechanisms, while it’s vital in the short run does not solve a problem in the longer run. And that’s where we need to to really focus many of our energies. So you know, whenever there is a change in leadership in DC See whether that’s in the White House or Congress, you have a bit of a different philosophy and what we’ve seen over the last decade now, when it comes to Medicare, which is a major payer, as you would imagine, and sets the tone in terms of what Medicaid and private payers often do, well, Medicare has really bounced back and forth on this volume, purchasing philosophy, and how much they want to move Medicare into a volume based purchasing philosophy versus the traditional value to volume. That’s going to be a game changer. I think, if the Biden administration when all is said and done fully embraces this volume to value shift, I think the jury is still out on that. My read of it, the jury’s still out. But I think in the next few months, we’ll have a much better sense of where the federal government is going to go in that domain.
Richard Helppie
And look, it’s a very difficult industry to be in because a lot of times your success is viewed by how little people need you. I mean, if we all ate a better diet, got fresh air and exercise took care of any underlying genetic conditions that we might be experiencing, we’d need less healthcare services, and therefore less revenue. But that’s what we need to do is kind of manage the big system, the way you might manage your own personal health or your households health. And of course, we do perform miracles every day within the healthcare system. People very close to me are alive today, because of the dramatic changes in the ability to treat injury and disease.
Brian Peters
The truth is, you mentioned the Healthy Michigan Plan Medicaid expansion here in Michigan, I just wanted to lift up the fact that, you know, there are people here in Michigan who are alive today, because we had a Healthy Michigan Plan. In the midst of this terrible pandemic. I say that because we have seen an increase in enrollment in the Healthy Michigan Plans since the start of the pandemic here in Michigan, about a quarter of a million individuals. And remember, these are people who would have been completely uninsured, if not for that Healthy Michigan Plan Medicaid expansion. So who knows how many opportunities, there were to make a preventive care appointment, where we could nip a cancer in the bud where we could nip some terrible issue in the bud, where if someone was completely uninsured, they may not have gone into the hospital or to see a doctor at all. And we know that that can make a huge difference. And so public policy matters. Medicaid expansion matters. And to your point, Healthcare matters, we need to continue sharing that access,
Richard Helppie
and all of the plans and protocols and benefits under Healthy Michigan, if you make a little bit too much money, now that’s not available to you. And you’re thrown into the system of either employer provided health care which that method is way past overdue, or into one of the very expensive programs on the exchange. And so we’ve got a lot of work to do in terms of health care policy. Brian, I do want to pivot back a little bit toward the pandemic. And I, as you know, do a lot of reading on this. And I’ve asked people what questions they would like asked, so some of the things that people want to talk about our things like adverse reactions and the scare stories, most of which are disinformation, about the vaccines themselves. So let me put it like this. To your knowledge. Do you have any deaths, injuries or hospitalizations, within either Michigan or what you might know of around the country that is attributable to a vaccine reaction or Vaccine Injury, pick your nomenclature,
Brian Peters
Certainly here in the state of Michigan. I’m not aware of any hospitalization that has occurred strictly because of some side effect from the COVID-19 vaccine. As I mentioned, we have had a very small number of breakthrough cases where someone who was vaccinated, contracted COVID-19 nevertheless, but that is such a very small number, not just looking at Michigan data, but looking at the national data. And quite frankly, because this is a global pandemic, we now have over a year’s worth of real data to look at from across the globe in terms of the pandemic itself, and now many months of actual data since the first shots began going into arms in the latter part of last year just before the holidays. And so here in the state of Michigan, just to give you some numbers, we have now administered approximately 7.7 million doses of COVID-19 vaccine. And the fact that I can’t tell you of a single hospitalization that’s occurred as a side effect, tells you, I think everything you need to know the risk of these vaccines is very, very nominal. But at the same time, the risk that accompanies COVID-19, I can tell you is very significant, because we are now closing in on 19,000 Michiganders who have lost their life from COVID-19. And so you look at the risk of one, on the one hand, you look at the risk of the other. On the other hand, you know, I think that’s a pretty clear cut case. Now, what some folks would lift up is the long term potential for an adverse outcome from one of these COVID vaccines. And what I can tell you there is, there were no corners that were cut in the development of the COVID-19 vaccine, simply, there was an accelerated effort, but just as with, you know, flu, with anything else, the COVID-19, vaccines had to go through that same rigorous process.
Richard Helppie
Right. And there, will be people who point out that the vaccine manufacturers don’t have any liability to adverse outcomes as the counterweight to that, but I’m looking for, okay, where are the bad clinical outcomes. And also, you know, frankly, it’s going to be years before we really have a fix on this, you and I both know how bad the data systems are. And there’s even the CDC says, “Well, we don’t have pathological confirmation, this is COVID, but it kind of looks like one. And we’re going to call it a COVID case.” And there’ll be forensic dives into COVID as a contributor, COVID as a primary cause, and COVID, as you know, something that was there, but had nothing to do with the death, we’ve got a long way to go to sort this out, and maybe get a more clear picture. But will it be crystal clear? I don’t think so. But I think we’ll get more clear as time goes on,
Brian Peters
I think you’re exactly correct that, you know, as time goes on, we will have a better handle on all of the different elements in the data collection and analysis. Around COVID-19. As you know, no data collection and analysis tool is perfect. And so what I have said in my many interactions with the state and, and local and even national media over the last year and a half now, is that, you know, when you look at the Michigan numbers, for example, I mentioned closing in on 19,000 deaths, you know, we could argue about whether some of those are really driven by COVID, or whether COVID was just, you know, confirmed, but the the patient died of something else. Well, you know, let’s say that that was a few 1000. Just for the sake of argument, that still means that 15,000 Michiganders died from COVID. And the point is, it kind of brings me back to the discussion we had back in the 1990s, when the two areas human report first came out and talked about the very large number of deaths that occurred in American hospitals as a result of medical error, preventable medical error. And there was a debate at the time where someone had to say, well, that data is flawed, the numbers are wrong. It’s not that many. We in Michigan at the Michigan Health and Hospital Association said you know what, it doesn’t matter if the number is 100,000 or 1000, or 100, or one one preventable death, because of medical error is one too many. Let’s get this right. Let’s do everything we can to get it right. And so we launched the MHA Keystone center for patient safety and quality. I look at this in the same way. Yes, the data is likely flawed, we can punch holes in in much of it, but directionally Is it correct, in my view is absolutely directionally, it is correct. And, yes, we need to get our arms around it so we can learn and really do the right things going forward to the extent possible. But I think we understand at this point, what COVID is all about and what it’s doing to Michiganders,
Richard Helppie
I’d sure like to see Keystone take a lead role on this. There’s been some amazing work that you’ve done there, Sam Watson and your entire team have been able to do over the years in terms of actually getting to improve health care and reducing the noise Number of hospital acquired infections and just making it a better healthcare system. And you know me, I’m a data guy, it’s like, okay, let’s define what the problem is, and let’s go after it. So we’re of like mind. Brian, you’ve been incredibly generous with your time. And I know this is a really stressful time for you. And it has been for over a year now. Not that it was ever unstressed vowel. Is there anything else that that you’d like to cover, or make sure that the listeners and viewers of the Common Bridge, understand before we sign off today,
Brian Peters
Rich again, thanks for having me on. And again, you’re doing a great thing with the Common Bridge and really elevating these important discussions. So I encourage you to please keep doing that. And please let me know how the Michigan Health and Hospital Association and our members can support you in that cause. I would just leave you with the fact that we all know as we drive around the state, we’ve seen the yard signs in the billboards thanking our healthcare heroes, those individuals, those men and women on the front lines who’ve been dealing with COVID-19 for over a year now. They need our support, they need our continued show of gratitude. And one way we can really show that support is to get vaccinated to do the right thing. If we are in those age cohorts, and we’re able to get a vaccine. We know that the supply is there. We know that our hospitals have been part of that process of delivering now over 7 million of vaccine doses. Many of our hospitals and health systems and their caregivers have been the ones putting shots in arms. And we’re very, very happy to do it. But now we need Michiganders to step forward and, and get those shots. So again, rich, thanks for all you’ve done to help advance the cause of Michigan Health Care. appreciate it very much.
Richard Helppie
Oh Brian, I’ve done very little. I’ll put up a little bit of a show but I do appreciate that I’m people do like the health care stories in the health care episodes that we do. Your first episode was very well received, as I’m sure this one will be and again want to reaffirm what Brian Peters says on behalf of all healthcare providers, get your vaccination or follow the protocols and hug a healthcare worker would do it after you got your vaccine. Okay, let them know that you appreciate it. We’ve been talking to them the Common Bridge with the chief executive officer of the Michigan Health and Hospital Association Brian Peters, please follow the Common Bridge on Apple, Amazon Spotify I Heart Radio buzzsprout or wherever you get your podcast please subscribe. Please rate us rate is high. Watch us on YouTube and follow us there Twitter as well. And of course register for free at RichardHelppie.com This is Rich Helppie today with our special guest Brian Peters signing off on the Common Bridge.
Transcribed by https://otter.ai