Tom Price leads the charge to re­shape health­care

Modern Healthcare - - PHYSICIANS - By Har­ris Meyer

In March, new HHS Sec­re­tary Dr. Tom Price said no Amer­i­cans would be hurt fi­nan­cially by the House Repub­li­can bill to re­peal and re­place the Af­ford­able Care Act. He pre­dicted the num­ber of peo­ple with in­surance would in­crease. A few days later, dur­ing a CNN town hall event, Price de­fended the bill, which would phase out en­hanced fed­eral fund­ing for the ACA’s Med­i­caid ex­pan­sion. He was con­fronted by Brian Kline, a Penn­syl­va­nia can­cer sur­vivor, who told Price the ex­pan­sion “saved my life and saved me from med­i­cal bankruptcy.” Kline then asked Price: “Why do you want to take away my Med­i­caid ex­pan­sion?”

The sec­re­tary re­sponded that “we don’t want to take care away from any­body” but that Med­i­caid has “real prob­lems” and the ad­min­is­tra­tion wants to give peo­ple cur­rently on Med­i­caid bet­ter cov­er­age op­tions.

Price, a for­mer or­tho­pe­dic sur­geon and seven-term con­gress­man from the At­lanta area, has not shied from con­tro­versy in his first few months as HHS sec­re­tary, af­ter be­ing con­firmed by a 52-47 Se­nate vote in Fe­bru­ary fol­low­ing weeks of bit­ter de­bate. Democrats op­posed Price’s nom­i­na­tion partly on the grounds that as a con­gress­man he had traded health­care stocks while push­ing leg­is­la­tion that could boost those com­pa­nies’ share prices.

De­spite his tra­vails, Price’s lead­er­ship in shep­herd­ing the ACA re­peal-and-re­place bill through the House last month—and his ex­pected role in over­see­ing the health in­surance mar­ket, value-based pay­ment in­no­va­tions and Medi­care physi­cian pay­ment re­form—earned him the top spot on Mod­ern Health­care’s rank­ing of the 50 Most In­flu­en­tial Physi­cian Ex­ec­u­tives for 2017, his first time on the list.

“He got a bill through the House, and it didn’t look good be­fore that,” said Tom Scully, who headed the CMS un­der Pres­i­dent Ge­orge W. Bush and now is a part­ner at the in­vest­ment firm Welsh, Car­son, An­der­son & Stowe. “A lot of peo­ple don’t like the poli­cies, but he’s done a pretty good job on the poli­cies he’s been asked to carry out.”

One big chal­lenge so far has been the Trump ad­min­is­tra­tion’s slow pace in fill­ing key po­si­tions at HHS and its sub­sidiary agen­cies, mak­ing Price’s job even tougher.

“They’ve done a pretty good job of get­ting peo­ple on­board, but they still have big po­si­tions to fill,” said Bill Pierce, an HHS of­fi­cial in the Ge­orge W. Bush ad­min­is­tra­tion who’s now a com­mu­ni­ca­tions strate­gist at APCO World­wide.

Ear­lier this month, Price took flak from con­gres­sional Democrats for de­fend­ing Pres­i­dent Don­ald Trump’s bud­get pro­posal to cut hun­dreds of bil­lions of dol­lars from med­i­cal re­search, Med­i­caid, the Chil­dren’s Health In­surance Pro­gram and pub­lic health ef­forts. He coun­tered that many fed­eral pro­grams “fail the very peo­ple they are meant to help.”

Some ob­servers crit­i­cize Price for not push­ing to en­sure fund­ing for the ACA’s cost-shar­ing re­duc­tion pay­ments for lower-in­come ex­change plan en­rollees. In­sur­ers com­plain the ad­min­is­tra­tion’s re­fusal to com­mit to con­tin­u­ing those pay­ments is forc­ing them to pull back from sell­ing plans on the ex­changes in 2018. “Price is part of the team that’s caus­ing a sub­stan­tial amount of mar­ket dis­rup­tion,” said for­mer Clin­ton ad­min­is­tra­tion of­fi­cial Dan Men­del­son, now CEO of Avalere Health. Price was not avail­able for an in­ter­view. Price hasn’t mod­er­ated his strong con­ser­va­tive views from his years in the House, tire­lessly tweet­ing out the ar­gu­ment that the ACA and ex­ces­sive fed­eral in­volve­ment in health­care are hurt­ing con­sumers, show­cas­ing in­di­vid­ual ex­am­ples.

On June 9, he pushed out a video clip of Mol­lie Hoskins Scar­brough, owner of Hoskins Drug Store in Clin­ton, Tenn., who said that nar­row net­works are hurt­ing her small busi­ness. “Un­der Oba­macare, cov­er­age ≠ care. An­other bro­ken prom­ise . . . one that’s hit­ting Mol­lie’s #small­biz & oth­ers like it. Time to #Re­pealAndRe­place,” Price tweeted.

He told Democrats ear­lier this month that he stood by his pre­vi­ous state­ment that “there are no cuts to the Med­i­caid pro­gram” in the House bill to re­peal the ACA, even though the Con­gres­sional Bud­get Of­fice pro­jected that the bill would cut Med­i­caid spend­ing by $834 bil­lion over 10 years and re­duce en­roll­ment by 14 mil­lion peo­ple.

“That’s ab­so­lute non­sense,” said Ron Pol­lack, chair­man emer­i­tus of Fam­i­lies USA, who helped build sup­port for pas­sage of the ACA in 2010. “He ap­pears to have no mis­giv- ings about say­ing things that are bla­tantly un­true. That is an ex­tra­or­di­nary thing for an HHS sec­re­tary.”

“He’s flack­ing for an ad­min­is­tra­tion that wants to cut peo­ple off the health­care rolls,” said Kline, the can­cer sur­vivor and a for­mer Demo­cratic cam­paign staffer. “Physi­cians should be help­ing peo­ple, not be­com­ing spin doc­tors.”

Health­care in­dus­try lead­ers will be watch­ing closely to see how Price and Seema Verma, the new CMS ad­min­is­tra­tor, pro­ceed in han­dling pay­ment and de­liv­ery re­forms launched by the Cen­ter for Medi­care and Med­i­caid In­no­va­tion. As a con­gress­man, Price was sharply crit­i­cal of some of CMMI’s Medi­care demon­stra­tions, par­tic­u­larly the manda­tory bun­dled-pay­ment pro­gram for joint re­place­ments that the CMS rolled out in 67 mar­kets last year.

In March, the CMS de­layed im­ple­men­ta­tion of a manda­tory bun­dled-pay­ment pro­gram for car­diac care, sug­gest­ing it was mulling whether to fur­ther de­lay or drop all manda­tory bun­dled-pay­ment ini­tia­tives. The move raised ques­tions about whether the CMS would con­tinue to lead the na­tion’s value-based pay­ment re­form ef­forts.

“Price has al­ways been con­cerned about some of the bun­dles,” Scully said. “But I hope value-based pay­ment speeds up. My guess is he’ll move in that di­rec­tion be­cause struc­turally it’s the right way to go.”

“He ap­pears to be al­low­ing the ef­forts of CMMI to pro­ceed,” Men­del­son said. “That’s dif­fer­ent from where he stood in the past, when he was re­ally rep­re­sent­ing the per­spec­tive of physi­cians. He’s now tak­ing a more bal­anced look.”

On Med­i­caid, health­care ex­ec­u­tives and state pol­i­cy­mak­ers ex­pect Price and Verma to grant states greater lee­way in run­ning their pro­grams, in­clud­ing al­low­ing states to im­pose pre­mi­ums, work re­quire­ments, ben­e­fit cut­offs for pre­mium non­pay­ment and ben­e­fit time lim­its.

Price has long fa­vored con­vert­ing Medi­care into a de­fined-con­tri­bu­tion, pre­mium-sup­port model. Ex­perts doubt, how­ever, that he or con­gres­sional Repub­li­cans will be able to move for­ward on that po­lit­i­cally, at least this year. But he may try to re­vamp the pro­gram in smaller pieces.

Some fret Price will push pay­ment poli­cies that fa­vor cer­tain in­dus­try groups, such as med­i­cal spe­cial­ists and drug or equip­ment man­u­fac­tur­ers, or that pro­mote pri­va­ti­za­tion of Medi­care. “I’ll be watch­ing whether he sub­verts pro­gram in­tegrity,” Men­del­son said.

The more im­me­di­ate task fac­ing Price is how to keep the in­di­vid­ual in­surance mar­ket func­tion­ing in 2018 as a grow­ing num­ber of in­sur­ers bow out due to uncer­tainty about the fate of the ACA and its cost-shar­ing re­duc­tion pay­ments.

“As a re­sult of the ad­min­is­tra­tion’s de­ci­sions so far, it’s quite likely there will be some re­gions with no mar­ket­place plans,” Men­del­son said. Price will “have to fig­ure out how to pro­vide cov­er­age for peo­ple in those mar­kets.”

What­ever he hopes to achieve, Price faces a far rock­ier po­lit­i­cal en­vi­ron­ment than other new HHS sec­re­taries. “Tom Price is a well-liked per­son who wants to work with peo­ple, but he finds him­self in an ex­tra­or­di­nary time of po­lit­i­cal up­heaval,” Pierce said. “The Repub­li­can Party has made an in­escapable com­mit­ment to re­peal and re­place the ACA. Whether that’s right or wrong, he’s in this po­si­tion where that’s the or­der of the day.”


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