DW blog: The First 100 Days

100days-homepage.jpg

AADA meets with Tom Price to discuss regulatory relief

April 17, 2017
American Academy of Dermatology Association (AADA) staff met with Tom Price, MD, secretary of the U.S. Department of Health and Human Services (HHS), to discuss reducing the regulatory burden on physicians. The Secretary of HHS has the authority over the Medicare Physician Fee Schedule (MPFS) and has also been granted authority by President Trump, via Executive Order, to take steps to minimize the fiscal and regulatory burden of the Affordable Care Act (ACA). The AADA ― along with staff from six other specialties ― requested that Sec. Price propose ACA regulatory relief within the proposed 2018 MFPS ― expected to be released by the Centers for Medicare and Medicaid Services (CMS) in July.

Tom Price MeetingSpecifically, the coalition expressed concerns that the methodology used to calculate the Value Based Modifier (VBM) is flawed, and, therefore, requested that the fee schedule establish a Value Based Modifier (VBM) of zero for 2018. CMS has estimated that more than 60 percent of practices (mostly small and solo) and 36 percent of physicians will incur penalties of either 2 or 4 percent in 2017. 

The coalition also requested that the agency adopt broader hardship exemptions for the Meaningful Use program. Additionally, the group called on HHS to adjust the requirements under the Physician Quality Reporting System (PQRS), specifically by reducing the number of measures that physicians must report.

Dr. Price and his staff were very receptive to the coalition’s requests and stated that they would share the information with CMS. In the past, Dr. Price has also expressed concerns over the administrative load placed on physicians, and stated that he is committed to decreasing over-burdensome regulations.


White House names HHS deputy secretary

April 11, 2017
The Trump Administration has nominated Stephen Parente to serve as the assistant secretary of planning and evaluation at the U.S. Department of Health and Human Services (HHS). He will be the principal advisor to HHS Secretary Tom Price, MD. Parente is a health care economist and currently works as a professor at the University of Minnesota.


HHS gets new health IT coordinator

March 31, 2017
Donald Rucker, MD, will head up the U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator (ONC) for Health Information Technology. The health IT ONC helps guide health information technology initiatives, such as the CMS EHR Incentive Program. Dr. Rucker was an emergency physician before serving as chief medical officer of Siemens. He currently works at Ohio State University as an adjunct professor in the biomedical informatics department.


HHS hires health IT lead

March 22, 2017
Former U.S. Rep. John Fleming, MD, (R-La.) has been hired to serve under HHS Secretary Tom Price, MD, as deputy assistant secretary for health technology. According to news reports, Dr. Fleming supports the widespread use of health information technology and says he will work to improve health IT interoperability. During his time on Capitol Hill, he spoke out against the Medicare Access and CHIP Reauthorization Act (MACRA), citing concerns about the administrative burden that the law would have on physicians.


President Trump picks HHS deputy secretary

March 15, 2017
President Trump has announced his intent to nominate Eric D. Hargan, JD, to serve as deputy secretary of the U.S. Department of Health and Human Services (HHS). Hargan is a shareholder of Greenberg Traurig, LLP, in its Health and FDA Business practice. He previously served as deputy general counsel, principal associate deputy secretary, and acting deputy secretary of HHS under the George W. Bush Administration. Hargan’s nomination will require a Senate confirmation.


Senate confirms White House pick for CMS lead

March 13, 2017
The Senate has voted 55 to 43 to confirm Seema Verma as administrator of the Centers for Medicare and Medicaid Services.


President Trump pick for CMS administrator moves forward

March 2, 2017
The Senate Finance Committee has voted 13-12 to approve Seema Verma as the next CMS administrator. Verma’s nomination will now go to the full Senate for a vote.


Senate Finance Committee postpones vote on CMS administrator

March 1, 2017
The Senate Finance Committee has postponed a vote on President Trump's pick for CMS administrator. The Committee took a preliminary vote of 15-11 with proxy votes to approve Seema Verma. However, because the vote was only 9-9 without proxy votes, the Committee will have to vote again. Per the Committee's rules, proxy votes do not count.

Verma helped create and update the Healthy Indiana Plan ― Indiana's consumer-directed Medicaid program ― under Gov. Mitch Daniels and Vice President Mike Pence when he served as governor of Indiana. Prior to her role at SVC, Verma served as vice president of planning for the Health and Hospital Corporation of Marion County in Indiana and director for the Association of State and Territorial Health Officials in Washington, D.C.


Senate confirms Tom Price for HHS Secretary

Feb. 10, 2017
The U.S. Senate has voted (52-47) to confirm Dr. Tom Price as Secretary of the U.S. Department of Health and Human Services (HHS) under President Donald Trump. Dr. Price, an orthopedic surgeon, previously served as congressman for Georgia’s 6th district and as House Budget Committee chair and would be the first physician to serve as secretary of HHS in nearly 25 years. Dr. Price has worked on issues affecting dermatology, such as Medicare payment reform, shortening EHR reporting periods, and ensuring that the MACRA transition included opportunities for physicians to avoid penalties. Dr. Price has also demonstrated a commitment to decreasing over-burdensome regulations associated with EHR, MACRA, and quality reporting.

In other confirmation news, the Senate Finance Committee will hold a confirmation hearing for Seema Verma, President Trump's pick for CMS administrator, next week.


Senate Committee approves Dr. Price

Feb. 1, 2017
The Senate Finance Committee has approved the nomination of Tom Price, MD, to serve as secretary of HHS. Dr. Price's nomination will now go to the full Senate for a vote.

A vote on Dr. Price's approval was delayed yesterday in the Senate Finance Committee after committee Democrats boycotted the vote. The Committee rules require that at least one Democratic member must be present for the Committee to proceed. However, today Committee Republicans agreed by unanimous consent to temporarily change the committee’s rules, thereby allowing the committee to vote in favor of approving Dr. Price.


Senate Finance Committee schedules vote on Dr. Price nomination

Jan. 30, 2017
The Senate Finance Committee has scheduled an Open Executive Session for Tuesday, Jan. 31 at 10:00 a.m. eastern to discuss and potentially vote on the nomination of Dr. Tom Price as secretary of the U.S. Department of Health and Human Services.

Dr. Price, an orthopedic surgeon, previously served as congressman for Georgia’s 6th district and as House Budget Committee chair and would be the first physician to serve as secretary of HHS in nearly 25 years.


Dr. Price discusses ACA, regulatory burdens, transparency, and drug prices in nomination hearing

Jan. 24, 2017
Rep. Tom Price, MD (R-Ga.) ― President Trump’s pick for secretary of the Department of Health and Human Services (HHS) ― sat before the Senate Finance Committee, which will determine if his nomination proceeds to a confirmation vote, and answered questions about several health care issues.

Affordable Care Act
Sen. Ron Wyden (D-Ore.), ranking member of the Senate Finance Committee, referenced President Trump’s executive order that directs the secretary of HHS to work toward the swift repeal of the ACA. Sen. Wyden asked Dr. Price if he could assure that no one citizen will be worse off if the ACA is repealed? Dr. Price committed to working with Congress to ensure access to high-quality care. Piggybacking off of Sen. Wyden’s question, Sen. Sherrod Brown (D-Ohio) asked if Dr. Price would enforce the ACA’s ban on discriminating against patients with pre-existing conditions or patients with illnesses that are expensive to treat. Dr. Price responded, “Nobody ought to lose their insurance because they get a bad diagnosis.”

Sen. Pat Roberts (R-Kan.) asked what tools Dr. Price will utilize to provide stability and improve the individual insurance markets to make them more appealing so that insurance carriers will want to come back? Dr. Price stated, “This law isn’t working. It’s not working for patients. One of the goals I have is to lower the temperature in this debate.” He indicated that government should assure carriers that the replacement plan will be more attractive to insurers.

When asked by Sen. Richard Burr (R-N.C.) what his overall goals are for an ACA replacement plan, Dr. Price reiterated his desire to provide accessible and affordable coverage for high quality care while offering patients choices.

CMMI
Sen. Orrin Hatch (R-Utah), chair of the Senate Finance Committee, asked Dr. Price about his thoughts on the Center for Medicare and Medicaid Innovation (CMMI) ― the agency under CMS that develops and tests value-based payment models. “Innovation is so incredibly important to health care and the vibrant quality of health care that we need to be able to provide to our citizens,” Dr. Price said. “One of the roles that we as policymakers have is to incentivize innovation. The Center for Medicare and Medicaid Innovation is a vehicle that might do just that. I think, however, that CMMI has gotten off track a bit. I think that what it has done is defined areas where it has mandatorily dictated to physicians and other providers in this country in certain areas how they must practice. I’m a strong supporter of innovation but I hope that we can move CMMI in a direction that actually makes sense for patients.”

Regulatory burdens
Sen. Roberts referenced various regulations, such as meaningful use, that have caused undue burdens on providers and asked Dr. Price how he will work to alleviate the burden. In response, Dr. Price agreed stating that, “The regulatory scheme that we’ve put in place is choking the individuals that are actually trying to provide care. So much so that you have physicians and other providers who are leaving the practice. The meaningful use project makes it that much more difficult. We’ve turned physicians into data entry clerks.” Dr. Price went on to say that recognizing the problem is the first step and then government must take a second look at the consequences of what it has done.

Transparency: Quality and cost
Sen. Pat Toomey (R-Pa.) asked Dr. Price about his opinions on transparency in health care, to which Dr. Price stated firmly that quality and cost information regarding care should be available to patients. “Outcomes are important and we need to be measuring what makes sense from a quality standpoint and allow patients and others to see what those outcomes are,” Dr. Price said. “But it’s transparency in pricing as well. If you’re an individual and want to know what something costs, it’s virtually impossible to find out what that is. If we want to make the system patient-friendly, not insurance-friendly or government-friendly, then we would make that a priority.”

Drug pricing
With regard to access to medications, Sen. Wyden asked Dr. Price if he would be willing to follow President Trump’s recommendation and allow federal health care plans the authority to negotiate drug prices. In response, Dr. Price said, “Right now the PBMs [pharmacy benefits managers] are doing that negotiation. It’s important to have the conversation and look at whether or not there’s a better way to do that. If there is, then I’m certainly open to it.”

In addition to a litany of questions on various health care related issues, several members of the committee reiterated concerns about the ethics of Dr. Price’s investments in various health-related companies while supporting bills that could have benefited these companies. The Senate Finance Committee will vote on Dr. Price’s nomination within the next several weeks.


Dr. Price faces Senate HELP committee in nomination hearing

Jan. 18, 2017
The Senate Health, Education, Labor and Pensions (HELP) Committee held a nomination hearing for Rep. Tom Price, MD (R-Ga.) ― President-elect Donald Trump’s pick for secretary of the Department of Health and Human Services. The American Academy of Dermatology Association attended the hearing. Among several health care related issues that were addressed during the hearing, most notably Dr. Price was asked about his thoughts on a replacement for the Affordable Care Act (ACA), access to drugs, and regulatory burdens on physicians. Additionally, Dr. Price addressed concerns about his financial ties to a medical device company.

ACA replacement
When asked by Committee Chair Sen. Lamar Alexander (R-Tenn.) about Dr. Price’s goal for an ACA replacement plan, Dr. Price stated that health care needs to be affordable, accessible, high quality, and responsive to patients, offer incentives for innovation, and ensure choices are made by and preserved for patients. When asked about the timing of repeal and replace, he stated, “I think that one of the important things that we need to convey to the American people is that nobody is interested in pulling the rug out from anybody.” Dr. Price also expressed an interest in implementing high-risk pools and expanding the use of health savings accounts in a replacement plan to cover general health services.

Medicare drug price negotiations
Sen. Bernie Sanders (I-Vt.) asked Dr. Price if he would join him and Democrats in efforts to allow Medicare to negotiate drug prices and allows drugs to be imported from Canada. Without confirming his position on government price negotiations or importation, Dr. Price stated that the cost of drugs is a high priority for all Americans and he committed to working with Congress in addressing the drug pricing issue.

Regulatory burdens
Sen. Bill Cassidy (R-La.) asked Dr. Price for his thoughts on what the government can do to address the regulatory burden that physicians are experiencing with electronic health record (EHR) requirements, such as Meaningful Use. Dr. Price said that EHRs are important from an innovative standpoint because they allow patients access to their medical history. However, he said that the federal government’s role is to ensure interoperability between EHR systems. Additionally, he indicated that the government should work more closely with providers in determining the metrics that should be measured through these systems to improve quality. “If we truly worked with the providers and asked them what we should measure, I suspect that there are some very specific things we could use.”

Government authority in health care
Sen. Pat Roberts (R-Kan.) expressed his concerns about the increased authority of the Independent Payment Advisory Board (IPAB), the Centers for Medicare and Medicaid Innovation (CMMI), the U.S. Preventative Services Task Force (USPSTF), and the Patient-Centered Outcomes Research Institute (PCORI). Dr. Price stated his concerns about CMMI, indicating that the patient should be at the center of care and that health care treatments should not be dictated by government.

Questions on ethics
Committee Ranking Member Sen. Patty Murray (D-Wash.) and Sen. Elizabeth Warren (D-Mass.) questioned the ethics of Dr. Price’s ties to a medical device company. Recently, information has been released about Dr. Price’s personal investments and potential ties to his legislative actions. According to House records, in 2016 Dr. Price bought between $1,001 to $15,000 worth of shares in Zimmer Biomet ― a knee and hip implant manufacturer. Shortly after the purchase, Dr. Price introduced the HIP Act that would have delayed a CMS regulation that would hurt Zimmer Biomet financially. Zimmer Biomet's PAC also donated to Dr. Price's reelection campaign.

When questioned at the hearing, Dr. Price indicated that the trade in Zimmer Biomet shares in his broker-direct account was handled by a broker and also denied knowledge of nonpublic information when trading certain stocks. Sen. Orrin Hatch (R-Utah) asked, “Can you confirm that you have always followed the law relating to trading in stocks while serving as a member of Congress?” Dr. Price responded, “Everything that we have done has been above board, transparent, ethical, and legal. The Office of Government Ethics has looked at our holdings and given advice on what needs to be done in terms of divesting from certain stock holdings to make certain that there are no conflicts of interest. We have read those, agreed to those, and signed those. That document is online for everybody to see.” View Dr. Price’s public financial disclosure report and his ethics agreement.

The HELP Committee hearing is considered a courtesy hearing. A formal hearing before the Senate Finance Committee ― the committee that will vote on Dr. Price’s nomination ― is scheduled for Jan. 24.


Tentative hearing scheduled for Dr. Price nomination

Jan. 3, 2017
The Senate Health, Education, Labor and Pensions Committee has set a tentative date for a hearing for Rep. Tom Price, MD (R-Ga.) ― President-elect Donald Trump’s pick for Secretary of the U.S. Department of Health and Human Services ― on Jan. 18. However, the hearing date will not be officially announced until one week before it is definitively scheduled to occur. This is would be a courtesy hearing, as it is the Senate Finance Committee that will ultimately vote on the nomination.

The American Academy of Dermatology Association (AADA) has had a long-standing relationship with Dr. Price, who was a featured speaker at the AADA's 2012 Legislative Conference. The AADA has worked with him on issues such as Medicare payment reform, shortening EHR reporting periods, and ensuring that the MACRA transition included opportunities for physicians to avoid penalties.

Similarly, Seema Verma, President-elect Trump’s choice for CMS administrator, can anticipate a confirmation hearing in the near future. Although a date for her hearing has not been publicly floated, the Senate Finance Committee indicates that it has received three years of tax returns and completed questionnaires from both Dr. Price and Verma.


President-elect Trump picks Dr. Price for HHS

Nov. 30, 2016
President-elect Donald Trump has nominated House Budget Committee Chair, Rep. Tom Price, MD (R-Ga.), to serve as Secretary of the U.S. Department of Health and Human Services.

Dr. Price, an orthopedic surgeon, has been a staunch supporter of the full repeal of the Affordable Care Act (ACA) ― he introduced the Empowering Patients First Act in 2015 which would fully repeal and replace the ACA with a system that includes individual health pools and expanded health savings accounts, and would have given physician groups control over performance-based quality measures. As a physician, Dr. Price has indicated that he understands the administrative burdens placed on the physician community and has expressed concerns over the burdens of electronic health records and Meaningful Use ― indeed, he was instrumental in the passage of a blanket hardship exemption from MU requirements in 2015. He also supports allowing physicians to balance bill their Medicare patients, repealing the Independent Payment Advisory Board (IPAB), allowing the use of in-office compounded drugs, preserving the In-Office Ancillary Services Exception to the Stark Law, and ensuring that step therapy protocols do not impede patient access to necessary treatment. 

The American Academy of Dermatology Association (AADA) has had a long-standing relationship with Dr. Price, who was a featured speaker at the AADA's 2012 Legislative Conference. The AADA has worked with him on issues such as Medicare payment reform, shortening EHR reporting periods, and ensuring that the MACRA transition included opportunities for physicians to avoid penalties.

President-elect Trump’s nominations will require a simple majority vote in the Senate. Hearings on his nominations will likely take place in early January. The AMA and other medical organizations have announced their strong support for Dr. Price's nomination.