During his keynote speech at the World Health Care Congress in Washington, D.C. this week, former HHS (the U.S. Department of Health and Human Services) Secretary Tom Price, M.D., spoke about the need “to fix a broken healthcare system.”
Price, a former Georgia Congressman and retired orthopedic surgeon, served as HHS Secretary for a brief period last year before resigning following an investigation about his use of private jets for official business. At the World Health Care Congress, he delivered the opening keynote on May 1, where he asserted that “We have a broken healthcare system and have not yet fixed it.”
Adding some context, Price stated that there is not one healthcare system that exists today, but rather there are multiple systems with silos. He offered several examples of this, such as: Medicare for seniors, Medicaid for folks on the lower end of the economic spectrum, employer-sponsored health plans, the insurance exchange system, a system for the VA (Department of Veterans Affairs), and the Indian Health Service, just to name some.
“Each one of them has their own set of rules for financing and delivery. Some overlap and some reflect [the concepts of] others,” he said. “But it’s a hodgepodge of systems and we wonder why it’s a mess.” He then added that “if we can just harmonize the mechanisms of the systems we have, imagine the efficiencies we can gain, [which will] hopefully [lead to] better experiences for patients.”
Thoughts on Bundles
It’s no secret that Price, throughout his time in Congress and during his tenure as HHS Secretary, made clear that he was no fan of certain mandatory bundled payment models. Notably, in 2016, Price and several other members of Congress penned a letter stating that three proposed mandatory models at the time [including the Comprehensive Care for Joint Replacement (CJR) bundled payment model for hip and knee replacements] demonstrate that CMMI [the Center for Medicare and Medicaid Innovation] has “exceeded its authority, failed to engage stakeholders and has upset the balance of power between the legislative and executive branches.” CMS then announced in November 2017, two months after Price resigned as Secretary, that it would be cancelling mandatory hip fracture and cardiac bundled payment models.
Price was asked today about why he wanted to slow down the mandatory bundled payment model movement, especially for joint replacements, to which he said, “We heard from physicians across the U.S. that they either didn’t feel they were ready for it or that it wasn’t resulting in quality care for patients.” He further noted, “When we looked at it—and I had concerns about this program when I was a legislator—we recognized that it was a broad swath of patients—65 to 68 percent—across the nation in geographic areas who would be subjected to this program, which was a requirement for physicians to go through with lower extremity joint replacements.”
But Price said that this payment model “had not proven that it worked any better than the first system.” He continued, “And when we, as a society, have clinical trials, we require informed consent. We require both patients and physicians to be able to say, ‘yes this makes sense or no, I don’t think that’s right for me and my patient.’ When you don’t [enable] that for a majority of society, that’s no longer a pilot or demonstration. That is the federal government making decisions about what kind of care must be provided to individuals, and we felt that was a step too far. So we tried to narrow the focus and the geographic area. And if [the model] was so wonderful and grand, then it would rise to the top [anyway],” Price contended.
Further speaking to the topic of bundled payment models and quality, Price noted that it is important to look at alternative payment models, “because there has to be alternative ways to finance the delivery of healthcare.” He added, “But I do think we have to stop and look at the value of things. The equation for value is that value equals quality over cost, and the challenge that the federal government has, and that any government has, is that what is quality healthcare for one individual with a particular diagnosis, and quality for another individual with that same diagnosis, might be markedly different, particularly if that second patient has comorbidities. Individuals are unique.”
Bundling, [which] provides a single payment for a service by a primary care physician or specialist, “shifts risk to providers,” he continued. “So it’s an exciting time. The winners in this area are those who will make it so that the doctors and the other folks providing care are able to utilize and navigate those issues with the least burden,” Price asserted.
The former HHS Secretary also had a few comments related to health IT, hinting at doctors’ frustrations with EHRs (electronic health records), emphasizing, “Physician burnout is real. The average retirement age for doctors is getting [younger]. So many physicians feel like they’ve been turned into data entry clerks. It’s important that we recognize this and come up with positive solutions.”
And on health data exchange, Price said, “We’re really close from a technological standpoint—not a federal government standpoint—to truly having interoperability of health records, and it’s so important that this work, because it’s [necessary] for individual patients to be able to make responsible decisions.”
Price Discusses Policy
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