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Whitehouse Pushes for Medicare to Pay for Person-Centered Care

Published on July 11, 2016 in Pawtucket Times

At a June hearing of the U.S. Senate Special Committee on Aging, Senator Sheldon Whitehouse calls for improving care for over 90 million Americans with advanced illnesses like Alzheimer’s disease, cancer, and heart disease. On the day of this Aging panel hearing, the Rhode Island Senator unveiled his legislative proposal, “Removing Barriers to Person-Centered Care Act,” at this panel hearing that would promote better coordination between health care providers, and place greater emphasis on the care preferences of Medicare beneficiaries with advanced illnesses.

The hearing, titled “The Right Care at the Right Time: Ensuring Person-Centered Care for Individuals with Serious Illness,” explored ways to improve the quality and availability of care and examined care models that are helping people with serious illness and their families.

Having Important Life Conversations

The June 23 hearing pulled together witnesses who called for “about the need for families and health care providers to prioritize these important life conversations, so that individuals’ wishes are known and person-centered care is prioritized,” noted U.S. Senator Susan Collins, who chairs the Senate Special Committee on Aging. In her opening statement the Maine Senator called for federal policies to “support efforts to relieve suffering, respect personal choice, provide opportunities for people to find meaning and comfort during serious illness, and – most important – remain in control of their own care.”

Advance care planning conversations to a patients’ physical, emotional, social and spiritual well-being are important in the care of a patient, says Collins. However, studies reveal that less than one-third of physicians have reported that their practice or health care system has a formal program in place to assess patients’ goals or preferences, she notes.

Collins also shared a personal story of a close friend who benefited from the person-centered care she received while she was a patient at the Gosnell Memorial Hospice House in Scarborough, Maine. “Despite her serious illness, because of hospice care her days were filled with visits from friends and families and many joyful moments, and she was surrounded by her family when she died peacefully,” she said.

“I’ve heard from Rhode Islanders about how difficult it can be for patients battling serious, advanced illnesses to get the care and respect they want,” said Whitehouse.

Whitehouse noted that “We can do better by these patients. Because so many of the rules and incentives in our health care system are tied to the payment structure, we should design payment systems that support models of coordinated care that focuses on the full person. Payment systems should reward providers for honoring patients’ own preferences for their care.

As Dr. Atul Gawande, surgeon and author of the New York Times best-selling book, “Being Mortal, mentioned in his testimony, “people with serious, potentially life-limiting illnesses face substantial and increasing suffering, particularly during the last year of life. Medical care today typically exacerbates this suffering, often without any benefit of lengthened life. We have an opportunity to change this.”

“The goal is not a good death. Instead, the goal is to have as good a life as possible all the way to the very end,” say Dr. Gawande.

In her testimony, Amy Berman, a nurse and senior program officer at the John A. Hartford Foundation, who is living with stage IV inflammatory breast cancer stand stressed the importance of palliative care, which is designed to improve the quality of life for patients with serious illness.

“Palliative care is the best friend of the seriously ill,” said Berman, “Studies have shown that when palliative care is added at the beginning of a serious illness that people feel better and live longer.”

Finally, Dr. Kate Lally, Chief of palliative care for the Providence-based Care New England Health System, Medical Director of the Integra Accountable Care Organization, and Assistant Professor of Medicine at Alpert Medical School of Brown University, urged Congress to consider legislation that would improve the quality, not just the quantity, of life of the seriously ill. “I feel blessed to do this work, and to be able to reflect with my patients on the life they have lived, their joys and regrets,” she said. “I feel I am able to share some of the most sacred moments of their life, and be at their side as they consider what is most important to them in their limited time.”

“The healthcare system as a whole, as well as Medicare and Medicaid, need to face growing expectations about how people with serious or terminal illnesses are treated,” said AARP Rhode Island State Director Kathleen Connell. “We are investing in prevention and early treatment and getting better results. Ultimately, however, people will still face serious illness and palliative care. Person-centered care is the proper prescription, and we must strive to make sure that it’s available. We need to be vigilant when it comes to supporting a healthcare environment in which patients with serious illness feel they are well informed and can remain properly in control of their options. And while families still tend to avoid these discussions in advance, when the time is right proper guidance makes a world of difference.

“People form especially strong opinions about decisions made that may prolong their existence, but add little to the quality of lives and, in fact, can prolong suffering,” Connell added. “Conversations on this phase of life are critical and we applaud Senators Collins and Whitehouse for their contribution to this dialogue.”

Legislation to Support New Models of Coordinated Care

The thrust of Whitehouse’s legislative proposal is to promote better coordination between health care providers, and place greater emphasis on the care preferences of Medicare beneficiaries with advanced illnesses.

“Too many Rhode Island Medicare patients battling difficult illnesses are struggling to get the right care at the right time,” said Whitehouse. “We need to break down the barriers between patients and the care they need. Because so many of the rules and incentives in our health care system are tied to the payment structure, we should design payment systems that support new models of coordinated care that are focused on human beings and not some rule or regulation.”

Whitehouse’s legislation would establish a pilot program administered by the Centers for Medicare and Medicaid Services (CMS) made up of twenty “advanced care collaboratives” of affiliated health care providers and community-based social service organizations. Collaboratives would receive a planning grant to assess the needs of the population of patients it would serve; to purchase or upgrade health information technology to facilitate better coordination of care between providers; and to support education and training on documenting and communicating beneficiary treatment preferences and goals.

Once planning is complete, collaboratives would enter a three-year payment agreement with Medicare to provide coordinated, high-quality care for their target patient population. Under the terms of the pilot program, CMS would waive regulations to promote innovative care for patients with advanced illness.

Waivers would be granted to allow Medicare patients to receive hospice care and curative treatment at the same time. Currently CMS’s regulations force patients to choose one or the other for their terminal illness. Patients would be able to also receive Medicare coverage in a skilled nursing home without a consecutive three-day inpatient hospital stay. Under current Medicare rules, patients are often charged for skilled nursing care after they leave an inpatient hospital stay because they were hospitalized for observation rather than admitted to the hospital.

Whitehouse’s legislative proposal would also allow Medicare patients to receive home health services without the requirement that they be homebound. Under current rules, a patient’s condition must have progressed such that there “exists a normal inability to leave home,” denying these services to those who are seriously ill but still mobile. Finally, it would also allow nurse practitioners to sign home health and hospice care plans and certify patients for the hospice benefit. Right now, only doctors can do so, even though nurse practitioners are often the ones administering home health and hospice care. This forms another barrier for patients seeking these services, especially in underserved and rural areas.

According to Tom Koutsoumpas, Co-Chair of the Coalition to Transform Advanced Care’s (C-TAC) Board of Directors, Whitehouse’s legislative proposal is “a critical step forward to achieving high-quality, coordinated care for those with advanced illness. This legislation allows for important innovations in care delivery and removes obstacles to support patients throughout the care continuum.”

Job Hunting No Easy Chore as You Grow Older

Published in the Pawtucket Times, November 29, 2013

Last Friday, the U.S. Bureau of Labor Statistics brought bad news to over 57,000 job-less Rhode Islanders. According to the federal agency, Rhode Island’s unemployment rate of 9.2 percent is the nation’s second highest, followed by Nevada’s rate that is one percent higher. Compare this to 7.3 percent, the national jobless rate for that month.

When hearing about the Ocean State’s national distinction of having one of the highest unemployment rates among fifty states, Henry Rosenthal, an Oak Hill, Pawtucket resident since 1955, who has been unemployed for 16 months, called it a “real disgrace. The dismal statistics released only confirmed what the older job hunter personally knows from sending out hundreds of resumes, it’s an extremely tough job market.

Older Job Seeker Can’t Find Work

But, to make matters worse, 63-year-old Rosenthal, and other aging baby boomers, will bluntly tell you that age discrimination is derailing their efforts of finding meaningful work that pays a decent wage and benefits.

Even if you totally believe that your age keeps you from getting a job, it is not always easy to sue because it is tough to prove, says Rosenthal.

In April 2012, his Dallas-based employer downsized, which led to Rosenthal losing his sales job of selling loan origination software to banks. Throughout his 45 year employment career, he had a very stable employment record. He only recalls two other jobs that were lost due to his lack of seniority when corporate mergers occurred.

Rosenthal, a graduate of Temple University, had always been able to find a new position quickly when losing a job because of his “skill set and previous work experience,” he says.

But today things are different.

Rhode Island’s puttering economy has kept Rosenthal from easily landing a new position. In the few times he was able to get his foot in the door for an interview, he was told afterwards that he was “perfectly qualified” for the position, in some instances even over-qualified, but ultimately he received no job offer.

“I honestly believe that jobs have not been offered to me because of age,” charges Rosenthal, who believes that ”younger people who oversee the hiring tend to be intimated with the older job applicants and feel threatened.”

Although it is against federal law [The Age Discrimination in Employment Act of 1967] to ask applicants how old they are, “it’s easy to figure out how old a person is,” notes Rosenthal. “By asking when you graduated high school and college a company can figure out your age,” he says.

It’s About Who You Know

During his ongoing job search, Rosenthal quickly realized that in many cases it might just take a personal relationship in a company to get an interview. With all of his previous employers based either across the nation or located all over the world, he has very few contacts with the local business community, he notes.

“Unless you get a direct reference or have a personal connection with a potential employer, they just might hire a younger applicant because they can pay less money or think they won’t take time off because of health issues,” he quips.

“Research findings will tell you that older workers are more responsible and loyal than their younger colleagues, and have a better work ethic, too,” Rosenthal is quick to say. Don’t believe that older workers take more time off then younger employees, he adds.

As Thanksgiving approaches, Rosenthal keeps plugging along sending out resumes hoping to reel in that full-time job. With being two years shy of age 65, he says, “I am just not interested in retiring because I don’t have enough hobbies or interests to keep me busy.”

Like many other long-term unemployed Rhode Islanders, Rosenthal just tries to keep the faith, realizing that “sooner or later something will turn up. To survive, “you don’t look backward you just look forward.”

What Some Polls Say

It seems that Rosenthal is not alone in his belief that age can make a job search more challenging to find full-time employment. According to an Associated Press-NORC Center poll results, detailed in “Working Longer: Older Americans’ Attitudes on Work and Retirement,” 55 percent of those 50 and over who searched for employment in the past five years viewed their search as difficult, and 43 percent thought employers were concerned about their age.

The poll found that 69 percent of the older job seekers reported few available jobs 63 percent say the jobs did not pay well, nor did they offer good benefits (53 percent). Around one-third of the respondents were told they were over qualified [like Rosenthal].

But the October 2013 poll also revealed that some employers do value older workers. Forty three percent of the older respondents seeking employment in the last five years say they encountered a high demand for their skills, and 31 percent say there was a high demand for their experiences.

According to the poll’s findings, “unemployed people aged 45 to 54 were out of work 45 weeks on average, those 55 to 64 were jobless for 57 weeks and those 65 and older an average of 51 weeks.”

Meanwhile, an AARP poll also released last month, found age discrimination “rampant” in New York City for those age 50 and over. The researchers found that when an aging baby boomer loses a job it may take them about 4 months longer than younger job seekers to find another one.

Forty eight percent of the survey respondents claim they either personally experienced age discrimination or witnessed it directed at a family member or friend who has turned fifty years old. Almost half of these respondents either personally or witnessed a person not being hired because of their age.

Increasing Your Odds of Finding Work

Kathy Aguiar, principal employment and training interviewer at West Warwick-based Network Rhode Island Career Center. agrees with Rosenthal’s personal observations and the above cited poll results that indicate that older job seekers can be blocked from gaining meaningful employment by age discrimination. However, Aguiar, who has 25 years of assisting Rhode Island’s unemployed get work, tells me that there are job hunting skills and techniques that you can use to increase your odds in finding that job.

“It’s not the 1980s and with a 9.3 percent unemployment rate you must change with the times,” urges Aguiar, stressing that the 80s way of writing a resume is totally outdated today.

If your resume is not formatted correctly, computer systems, called Applicant Tracking Systems, won’t identify you as a potential candidate, says Aguiar, who says that “75 percent of the applicants applying by internet will be thrown out of the selection process because of this problem.”

Applicant Tracking Systems will skip over employment history if you put that information under “career development” instead of “work experience,” on your resume, adds Aguiar. “Always put the company’s name first, followed by job title, and employment dates.”

Aguiar warns applicants not to save resumes as PDF files because Applicant Tracking Systems cannot read this documents. Save it on a word file, she recommends.

Today, one resume does not fit all, notes Aguiar. Especially in Rhode Island you have to target your resume to the position you are seeking. You have to revise your resume to the position you are seeking. .

A well-written resume combined with using Social Media, including Linkedin, Facebook, and Twitter, and good networking skills can lead to a successful job search, adds Aguiar.

Finally, one of the best ways to get an interview and ultimately becoming gainfully employed is by finding someone within a company to be a personal reference. “Who you know is still important, especially in Rhode Island.” You may even get extra points when your resume is reviewed because of the internal reference, she says.

National polls tell us that ageism is running rampant in the employment sector. You can not deny its existence when you continue to hear stories from those age 50 and over unemployed family members, friends, neighbors, and acquaintances, who tell you about their frustrating and very challenging experiences of seeking gainful employment.

Only in this country do we not value the wisdom and knowledge that our elders provide us. It is time for a change in our thinking and attitudes.

If an employer is worried about his bottom line, just consider hiring an older worker. You will most certainly will get the bang for your buck by bringing in an aging baby boomer who is loyal, dependable, and brings a skill set and life experience that most certainly will benefit your company. To me, it’s a no brainer.

Herb Weiss LRI ’12, is a Pawtucket-based writer who covers aging, health care and medical issues. He can be reached at hweissri@aol.com