May 28, 2024

At RI Health Care Summit, Whitehouse Outlines Opportunities to Strengthen Federal Reimbursement and Improve Patient Care

Providence, RI – U.S. Senator Sheldon Whitehouse today delivered remarks at the RI Health Care Summit hosted by House Speaker K. Joseph Shekarchi and Senate President Dominick J. Ruggerio.  Whitehouse is a senior member of the Finance Committee, which oversees the federal Medicare and Medicaid programs.  His remarks focused on opportunities to strengthen Rhode Island’s federal reimbursement, expand primary care, and improve the quality of care by transitioning away from fee-for-service payments and building baselines for hospital cooperation.  

Whitehouse applauds Speaker Shekarchi and President Ruggerio for convening a summit for Rhode Island health care stakeholders to plan for improvements in the state’s delivery system, insurance programs, workforce capacity and equitable, affordable, quality care.

Senator Whitehouse’s as-delivered remarks are below.  Video of the full event is available here.

It is very much a hallmark of Speaker Shekarchi’s leadership to be inclusive and energetic, and so the Shekarchi touch of having moved to this room, and this crowd, is very welcome and I’m grateful.  

I want to thank the Speaker for including me, and President Ruggerio for including me.  I, as you know, have long worked toward the goal of trying to make Rhode Island’s health care system a model for health care delivery around the country.  And I had hoped, as many of you know, that the Lifespan/Care New England merger would be the vehicle for moving forward and completing that work, but that was not to be.  Even without that vehicle, though, the work can and should go on, and we have two important opportunities before us that I wanted to flag.  

These opportunities won’t last, by the way.  There is a window in which they are real, and then they’re not around any longer, so we shouldn’t waste them.  And they’re things that we have to do together or not at all. 

One would be to look to the regulatory system and create a consensus health regulation to protect our Rhode Island-owned hospitals from predation from out-of-state and secure improved cooperation between our hospitals.  It’s very hard for them to talk to each other with lawyers looking over.  Once you’re in the safe harbor of a regulation conversation, you can have that conversation and I think it’s important. 

I remember when all the major bank headquarters left our state.  The economic ecosystem that those bank headquarters supported fell apart as the jobs and the professional support moved to where the new headquarters were.  Downtown hollowed out, downtown Providence still has not recovered, and a lot of civic leadership in Rhode Island was lost.  There was a lot of pain and I don’t want to see that replicated with our hospitals.  We have to make sure that local control prevails. 

I don’t want to lose the initiative that comes from local control nor do I want to lose the opportunity for system-wide improvements that are deliverable only through government-enabled cooperation.  By regulation, we could set firm terms for out-of-state acquisitions of hospitals and terms for in-state cooperation between and among hospitals.  This can form a structure for continuing Rhode Island progress toward a true value-based, local, efficient and cooperative health care system. 

Many of us can remember when our big hospital organizations were not getting along with each other.  And many of us can remember when they were not getting along well financially.  Now, we have a window of sunshine while they are getting along with each other, and we should use that window to prepare in the safe harbor of a regulatory environment for stormy days that still may come.  So that’s one opportunity. 

The second opportunity is to use the AHEAD program, and Rhode Island’s application to it, to improve our reimbursement levels.  I worked very, very hard to undo the imputed rural floor mischief, which for those of you who lived through it knew that it was a dramatic blow to hospital revenues driven by a very unfortunate decision out of the federal government that we were able to correct.  That put Rhode Island on a better payment footing.  But it solved only part of the problem. 

The persistent hole Rhode Island is still in, with lower federal health care payments then neighboring Connecticut and Massachusetts, is a persistent aggravation – aggravation of decades.  And it doesn’t lend itself to an easy solution. 

The AHEAD program moves participants more clearly to full value-based, annualized payment. With a little pressure, it could also give us the opportunity to set that value-based reimbursement commensurate with our neighboring states in our regional market.   Not based on past rates held back by the unfair fee-for-service system, but on regional rates.  I know that the delegation will gladly put our shoulders to the wheel to use the AHEAD plan as the vehicle to at last get out of that funding reimbursement hole.  And I don’t see any other escape vehicle from that fee-for-service hole anywhere on the horizon.  This is an opportunity and I do not want to submit to decades more of unfair Rhode Island payment levels. 

A health hospital cooperation regulation and an AHEAD reimbursement success will each only come with consensus.  I repeat, neither is going to work without consensus.  The Rhode Island Foundation has been a particular force for good in this area, as have Integra and Coastal – our high performing ACOs.  Our unions are at the table with expertise and experience to bring to bear.  The bad old days of warfare among hospitals and insurers are behind us, and we have leaders in those organizations who well understand the triple aim. 

If we pull together, there is the chance of achieving a long sought common good.  A major move away from fee-for-service to value-based reimbursement that brings us out of our regional funding hole, and a secure environment for hospitals to secure the cooperative environment that lowers costs through better care. 

I cannot guarantee that we’ll succeed, but this moment of possibility may not last.  So, let’s at least try.  Thanks very much.

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