Whitehouse to Prez: Dude, You’re Copying My Ideas! Keep it Up!

From the Whitehouse Press office:

New Obama Administration Goals for Medicare Mirror Sen. Whitehouse Recommendations

Senator Whitehouse has Been Urging Administration for Years to Set Clear Goals to Improve Care and Reduce Costs

Goals Resemble the Whitehouse-Steinberg Compact in Rhode Island

Washington, DC – Today the Obama Administration announced that it is setting clear goals and a specific timeline for reforming the way doctors and hospitals are reimbursed when treating Medicare patients. The goals announced today come after U.S. Senator Sheldon Whitehouse (D-RI) has been urging the Administration for years to set clear targets for health care delivery system reforms, arguing as early as 2011 that, “we can and must have a clear challenge to strive toward.”

In 2013 Whitehouse co-authored an opinion piece urging President Obama to set specific goals for reforming payment systems, noting that “at least 75 percent of Medicare payments should be assessed in some way other than fee-for-service” by 2020. Whitehouse also released a report in 2012 chronicling the Administration’s progress in implementing the delivery system reform provisions within the Affordable Care Act, and identifying payment reform as one of five key areas for reform.

“As we continue working to improve the delivery of care and lower costs in our health care system, it’s vital that we set clear, accountable goals,” Whitehouse said today. “Vague calls to ‘bend the cost curve’ will never galvanize our nation’s health care providers and insurers in the same way that specific goals with a number and date will. Today’s announcement by the Obama Administration reinforces the reforms already taking place under the Affordable Care Act and could accelerate the shift to a system that works better for everyone.”

More specifically, the U.S. Department of Health and Human Services (HHS) today set a goal of tying 30 percent of traditional fee-for-service Medicare payments to alternative payment models by the end of 2016, and tying 50 percent of payments to these models by the end of 2018. HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018. Whitehouse was briefed by HHS Secretary Sylvia Mathews Burwell in advance of today’s announcement.

Since 2011, Senator Whitehouse has been calling on the Administration to set a specific cost-savings target to drive health care delivery system reform efforts, and has identified payment reforms as one of the key areas in any such effort. More recently, he and Rhode Island Foundation President Neil Steinberg brought together a coalition of Rhode Island health care leaders to develop recommendations on how the state can improve care and lower costs. Among the recommendations they agreed to was to establish specific payment reform goals this year.

Senator Whitehouse has long been a leading voice for health care delivery system reforms. He founded the Rhode Island Quality Institute during his time as the state’s Attorney General, helped secure new investments in Health Information Technology in the American Recovery and Reinvestment Act, and was a strong advocate for the inclusion of delivery system reforms in the Affordable Care Act.

Defending President Obama in the Whole Foods

I have mixed feelings about Whole Foods. A co-founder and former CEO, John Mackey, put corporate weight behind opposition to health care reform and unions. On the other hand, there are worse places to work, and they do what they do very well. And my schedule strands me in a wireless desert in Cranston with Whole Foods the nearest oasis.

So I’m hunched at a table eating out of a biodegradable box when I realize I’m being cruised by a guy in an electric wheelchair. Our heads are at about the same level. He’s younger than me, well dressed, his speech is slurred and his eyes a little unfocused.

“Can I ask you something?” he says.

I really want to concentrate on my food, but okay.

He goes into a rambling joke about the president, and the vice president, that I figure out is intended to be a shot at Barack Obama’s right to hold the office.

Some people might have been impressed with the man’s condition, which I guess is MS. But I’m a nurse. So I cut the guy zero slack.

“I find that offensive,” I told him.

“Well, he wants to raise our taxes and give away all our money,” he said.

I looked him right in the eye and told him I knew that the only way he could get through the day is with the help of a lot of good people. He conceded that was true. “Don’t they deserve a living wage?” I asked.

He asked how much they should get. “What’s fair,” I said. He nodded, as if he was seeing the faces of the home health aides who must be a part of his daily life.

“I know how hard you have to work to get through the day,” I said.

“Me, and my wife,” he said.

He took it all in good humor, he was smiling as he left.

There’s a good expression for the human condition –‘temporarily abled’. I don’t know what misfortune robbed that man of his power, maybe some immune system misfire, or car accident. I do know that it could just as easily be me. We don’t know what the next moment might bring.

We can recognize our interdependence, and build a safety net that anyone of us might need some day. Or we can blame the poor and cry about taxes and pretend that the home health aid lacks ‘individual responsibility’ when her labor is so poorly paid that she has to use food stamps to feed her family.

A level playing field doesn’t just happen, anymore than a baseball field maintains itself. Building on solid ground, taxing fairly and investing in education, infrastructure, health care and other aspects of the public good is the American way. If we settle for a gated community as our model, subversion will come in through the servant’s entrance. No one gets through life without the help of other people.

Mississippi GOP Leaders Say They Will Resist Expanding Health Care

In case you wonder what Obamacare will look like in some states, here is an example of a state, Mississippi, that is already saying “Whoa, horsie!” when it comes to implementation.

Miss. Medicaid expansion unlikely, GOP leaders say – The Dispatch.

I wonder about the implementation here in Rhode Island and whether we will be able to extend health care coverage to all, given our sagging economy. As I said in an earlier post, I see health care as a potential economic driver, and I hope Rhode Island will find ways to make this happen.

As a health care practitioner, I am particularly interested in changes specific to children and families. For more on how the law specifically impacts children and families, the Children’s Mental Health Network has a page that gives a helpful breakdown of all the changes.

[Ninjanurse butts in to Kiersten’s post]
Lt. Governor Elizabeth Roberts sent an email with this–

Rhode Island has been implementing the federal health reform law for over two years, beginning with Lt. Governor Roberts’ early efforts in 2010 to ensure Rhode Island had a clear path ahead toward achieving universal coverage for Rhode Islanders. With the Supreme Court’s ruling, that path has been cleared for the state to move forward in partnership with the federal government and continue to benefit from its support and funding.

The Supreme Court decision means up to 120,000 uninsured Rhode Islanders will be able to enroll in healthcare coverage starting October 1, 2013 and will have access to the coverage by January 1, 2014. Rhode Island families and small businesses soon will have an online marketplace known as the RI Health Benefits Exchange where they can easily buy and compare health insurance options. Some residents will even qualify for free or low-cost insurance depending on their income. Rhode Islanders will begin to hear more about this marketplace in the coming months.

These are not empty words, but a work in progress. As much as I wish we could speed it up, I know that good people are working overtime to meet these goals.

One of those good people is a Republican, Christine Ferguson, who has been appointed by Governor Chafee as head of the new Rhode Island health insurance exchange. Ms. Ferguson has a long resume of health management experience in Rhode Island and Massachusetts and is a passionate and effective advocate for people in need of access to basic healthcare. We’re lucky to have her on our team at this point in time.