“Today we are talking about keeping a dialogue going that you so successfully started on earlier this year,” Raimondo said, referring to Reinventing Medicaid. She added that she seeks to take the work that was done there, in the public healthcare system, and move it forward.

“Today is about bringing that same level of innovation in all that we do in healthcare delivery in the state of Rhode Island,” she said.

The Governor has set forth four specific goals for the task force to achieve, under specific deadlines. They are to develop a global healthcare spending cap; plan out and implement the “80 by ’18,” goal, which would tie 80 percent of healthcare payments to quality by 2018; bring the state’s healthcare system technologically up to date; and establish a framework to achieve health and wellness goals outlined by the Centers for Disease Control.

Raimondo said that the biggest goal, which all of these are to work together to achieve, is to reduce the costs of healthcare, improve outputs, and improve the patient experience. She said that these goals are the “holy grail,” of providing healthcare, and making Rhode Island more effective overall.

“I believe it’s doable, I know it’s doable. It’s doable if we commit ourselves,” she said. “We’ve got to catch up and we’ve got to be competitive. Rhode Island has to be competitive.”

The focus of the task force will draw from suggestions made by a group of healthcare stakeholders that Governor Raimondo received back in December. Many members of this group, which was put together by United States Senator Sheldon Whitehouse and Rhode Island Foundation President Neil Steinberg, will now be serving with on the new task force.

Whitehouse also spoke in support of Raimondo’s initiative, citing that the United States spends more money per capita in relation to life expectancy than almost every other developed country. The United States’ life expectancy is also lower than many countries that pay less per capita. Whitehouse also mentioned that since 1960, health care expenditures have risen from $27.4 billion to $2.8 trillion. Healthcare spending has declined in recent years, but reducing costs remains a priority.

“It’s not a system where you can tell it what to do and it’s going to change,” Whitehouse said, speaking about how healthcare reform works. “You actually need to change the system. What you say is a whisper, how you pay is a shout.”

Secretary Roberts, who will head the group, said that even though healthcare reform is a very complex issue, the working group can find a solution because they want to get the community involved in the process. Rather than just having a conversation about what needs to be done, Roberts said, there will be collaboration on both ends of the project. By doing this, they will create a long-term plan.

“I am excited to see the Governor take a very direct interest, and give us a very direct charge, because that, to me, is absolutely crucial to a statewide approach,” Roberts said about her enthusiasm to begin working. “I am excited to see the range of people who have stepped forward to participate, and know that we will make some real progress.”

Roberts has had experience working with the Rhode Island healthcare industry in the past, as former Lieutenant Governor during the Chafee Administration. Roberts has also worked in health insurance before she was involved in government, and as a legislator, she chaired the Health Committee.

“Many of us have met before, and have worked together before,” she said. “But the charge of the Governor, to really come together, and really make some measurable differences, is going to move us forward.”

The Working Group for Healthcare Innovation will begin meeting in August, and give its first set of recommendations to Governor Raimondo in December. Members of the group come from several communities, including government, insurance, hospital workers, labor, and business. There are 36 total members.

The congressional fix repeals and replaces the flawed Medicare physician reimbursement system known as the sustainable growth rate (SGR). For the past 13 years, physicians have faced the possibility of an arbitrary cut in their Medicare payments unless congressional lawmakers passed a so-called “Doc Fix” Medicare bill. Since 2003, Congress has passed 17 short-term bills to block these cuts in Medicare doctors’ fees that were called for under the existing law.

On April 14, the Senate passed the MACRA by a whopping 92 to 8 (the House passing its version of the bill in late March by a large margin, 392-37). Two days later, at an outdoor signing ceremony in the Rose Garden, President Obama signed the legislation into law, with the House bill brokers, Speaker John Boehner (R-Ohio) and House Minority Leader Nancy Pelosi (D-Calif.) in attendance. .

A Permanent Fix Prevents Payment Cuts

Just hours before a cut in reimbursement that would take place this week, a rare bipartisan congressional effort prevented a 21 percent cut in Medicare payments to occur. It’s a permanent fix. And the new law extends the Children’s Health Insurance Program, which has provided coverage to millions of American children.

At the signing, Obama called the passage “a milestone for physicians, and for the seniors and people with disabilities who rely on Medicare for their health care needs,” noting that it would also strengthen the nation’s health care delivery system for the long run.

Obama stated this new law “creates incentives to encourage physicians to participate in new, innovative payment models that could further reduce the growth in Medicare spending while preserving access to care.”

According to the Center for Medicare Advocacy (CMA), a national nonprofit, nonpartisan law group that provides education, advocacy and legal assistance to older people and people with disabilities, the estimated cost of the new law is roughly $214 billion over 10 years. CMA says roughly half (approximately $35 of the total $70 billion over 10 years) will come from Medicare beneficiaries through changes that will increase their out-of-pocket costs for health care.(through means testing of higher-income Medicare beneficiaries, increased Part B premiums, and added deductibles to Medigap plans purchased in the future.”

CMA adds that the nation’s pharmaceutical and insurance industries were not required to pay for any of this law, although doing so would have paid for a major portion of the SGR replacement.

Crossing the Aisle

“The Sustainable Growth Rate formula threatened the stability of the Medicare program, and I’m glad we were able to pass a long-term solution to address it. I believe it was a reasonable compromise that will provide financial certainty to health care providers while protecting benefits for low and middle-income seniors,” said Senator Sheldon Whitehouse. The Democratic senator, a member of the Senate Special Committee on Aging, notes that the new law will “boost efforts to pay providers based on quality and outcomes of care, an area where Rhode Island has been a leader.”

Rep. David N. Cicilline gave his take on the new law. “Fixing the Sustainable Growth Rate formula will help ensure that more than 180,000 Rhode Islanders who receive Medicare benefits can keep their doctor and continue to receive quality, affordable health care when they need it, the Democratic Congressman said, noting that “We need to see more bipartisan solutions in Congress like this one.”

Finally, Rep. Jim Langevin, adds, “Although this compromise wasn’t perfect, I am pleased that Congress could come together in a true display of bipartisanship to reach an agreement that increases access to quality heath care for our most vulnerable seniors, provides stability and predictability for physicians and extends the crucial Children’s Health Insurance Program.”

On the Backs of Medicare Beneficiaries

Aging advocacy groups, including the Center for Medicare Advocacy and AARP, failed in their attempts to improve the Senate bill Medicare beneficiaries, including a repeal of the annual therapy caps, raising eligibility standards for low-income programs and permanently extending outreach and education funding for critical programs aimed at low-income beneficiaries. The Senate bill passed without amendments.

While many gave thumbs up to the new law, Max Richtman, president and CEO of the Washington, DC-based National Committee to Preserve Medicare and Medicaid, sees big problems with MACRA.

“The Senate ‘Doc Fix’ vote has traded one bad policy for another, shifting the costs of Congress’ failed Medicare payment formula for physicians to seniors who can least afford to foot that bill. Contrary to claims by supporters, on both sides of the aisle, this ‘doc fix’ will hit millions of seniors who aren’t ‘wealthy’ by any stretch of the imagination. Seniors at all income levels who are already paying steep premiums for Medigap plans to help control their health care costs will now be hit with even higher costs. 46 percent of all Medigap policy holders have incomes of $30,000 or less, he said.

“Medicare beneficiaries will also be forced to contribute nearly $60 billion in premiums over the next decade thanks to passage of this so-called ‘fix,’” Richtman added. “It’s no surprise that conservatives applaud this legislation as ‘the first real entitlement reform in two decades’ because it fulfills their political goal of shifting costs to seniors, cutting benefits and expanding means-testing to push Medicare further and further away from being the earned benefit seniors have long valued and depended on. Trading a bad deal for doctors for a bad deal for seniors is not a legislative victory and it is a surprising move from so many in Congress who have previously vowed to protect Medicare from harmful benefit cuts and seniors from cost-shifting.”

AARP CEO Jo Ann Jenkins also expressed strong disappointment in the Senate not passing an amendment that would have removed Medicare’s arbitrary cap on physical therapy, speech language pathology, and occupational services. “Many Medicare patients, particularly stroke victims and people with Parkinson’s and Multiple Sclerosis would have benefited,” says Jenkins. With a majority of the Senate agreeing with this amendment, Jenkins says that AARP will continue to lobby to remove the arbitrary coverage cap.

But, Jenkins sees the positives. “Passage of MACRA moves Medicare in the right direction toward better quality health care and greater transparency for patients. These changes will benefit Medicare beneficiaries, as well as physicians and other providers, hospitals, and the overall health care system,” she says.
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Through the enactment of MACRA Congress put aside its political differences that made a permanent fix to a flawed law. If you can do it once, let’s see our lawmaker do this again, to provide improved programs and services to our nation’s older population.