New Reform Analogy at National Policy Conference

WASHINGTON — HHS Secretary Kathleen Sebelius offered a new analogy for health care reform this week, setting the tone and sparking feedback — positive and negative — at the National Health Policy Conference hosted by AcademyHealth.

“I think of this as synchronized swimming. There’s a lot of focus on bathing caps, but there are a lot of things happening under the surface,” Sebelius said. The shift to electronic health records, preparation for expanding Medicaid and payment reform are examples of changes under way below the surface, Sebelius said.

Several speakers and panelists picked up the imagery and ran with it over the two-day conference.

“Think of synchronized swimmers going over Niagara Falls,” said Rep. Michael Burgess (R-Texas), founder of the Congressional Health Care Caucus, member of the Tea Party Caucus and a staunch opponent of the Affordable Care Act.  

“But I haven’t been right yet, so we’ll see,” added Burgess, who predicted the ACA would not be passed by Congress, would be struck down by the Supreme Court and would be repealed when the Republicans moved into the White House this year. “I was wrong every time, but I can tell you there is a lot of high anxiety about this.”

Burgess, a doctor of obstetrics and gynecology, predicted that “this is going to be the golden age of health care and medicine with changes coming from gene therapy research and technology improvements. It really will be a great time on the clinical side, but we screwed up the policy side pretty good,” Burgess said.

Farzad Mostashari, national coordinator for health information technology at HHS, said Sebelius’ analogy worked on multiple levels.

“There’s a certain synchronization between the reforms of how we pay for care and how it’s delivered,” Mostashari said. “Both those changes need to be synchronized, and a lot of that is going on right now but you don’t necessarily see it.”

Stumping for Medicaid Expansion

Sebelius used her podium time at the policy conference to urge support for the ACA, particularly for Medicaid expansion.

“We have a rare opportunity over the next year to make huge strides … to speed up the pace of change,” Sebelius told 700 health policy researchers and health service stakeholders. “We need influential voices like yours right now because several states are weighing the option of expanding Medicaid. Now is the time to get in the game,” Sebelius said.

Through the ACA, states have the option of expanding Medicaid eligibility up to 138% of the federal poverty level. The federal government will pay 100% of the cost for those covered under the expansion program for the first three years and 90% thereafter. California officials intend to expand Medi-Cal, which will bring an estimated additional $3.5 billion in federal funding to California in 2014.

“There’s never been a federal-state partnership that looks like this,” Sebelius said. “In exchange for picking up a tiny percentage of the tab, states can greatly expand their ability to care for people. It’s as good a deal as any state can get.”

“Transformation won’t happen overnight, but when this group convenes again next February, things will be substantially different,” Sebelius said.

Perspective Offered on Health Care’s Economic Role

The two-day policy conference included insight from two well-known economists. Uwe Reinhardt — economist at Princeton University – and Alice Rivlin — former director of the Office of Management and Budget in President Clinton’s first term and now an analyst at the Brookings Institution — tried to put health care’s economic role in perspective during a session titled, “Economic Health of the Nation.”

“Some people keep talking about Reagan and Reaganomics as if that might be the way to go,” Reinhardt said in a funny, entertaining presentation. “Reaganomics was hugely debt-financed. Under Reagan, the public debt tripled. Under Bush Sr., it quadrupled. I’m not saying that is or isn’t the best way to go, but I think we should be accurate in how we portray things.”

Rivlin, a member of the Simpson-Bowles Commission on the economy and co-chair of the Bipartisan Policy Center’s Debt Reduction Task Force, said she’s more worried about the country’s political health than economic health.

“I’m not nearly as pessimistic about economic growth as Uwe and a good many of the people at this meeting,” Rivlin said. “What I am worried about is the political system. They are in gridlock, and we can’t afford gridlock. The problems we have will get worse if we do nothing, and we’re doing nothing,” Rivlin said.

Rural Health Leaders Meet a Few Blocks Away

While policy researchers and stakeholders convened for the AcademyHealth conference, about 500 rural health officials, providers and stakeholders met a few blocks away for the National Rural Health Association’s 24th annual Rural Health Policy Institute.

USDA Secretary Tom Vilsack, a keynote speaker on the first day of the rural conference, said his department and HHS are working together to improve health care delivery in rural areas. Vilsack and Sebelius teamed up this week to announce new proposed rules intended to reduce financial and regulatory burdens on rural hospitals and clinics across the country.

In a conference call broadcast at the rural conference, Sebelius and Vilsack predicted the proposed changes would result in $676 million this year and $3.5 billion over five years for hospitals and other health care providers.

Vilsack, acknowledging that rural health care requires different approaches than urban and suburban care, said these changes will be good news for rural providers.

The proposed changes included:

  • Eliminating a requirement that physicians be on-site once every two weeks at some very small hospitals, rural health clinics and federally qualified health centers;
  • Allowing registered dietitians to order patient diets without a physician’s approval;
  • Allowing hospital nuclear technicians to prepare certain medicines without the supervision of a doctor or pharmacist; and
  • Eliminating some requirements that ambulatory surgical centers must meet in order to provide radiological services.

“This regulatory relief should be very welcome,” Vilsack said.

“We are committed to cutting the red tape for health care facilities, including rural providers,” Sebelius said. “By eliminating outdated or overly burdensome requirements, hospitals and health care professionals can focus on treating patients.”

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