Trump Picks Rep. Tom Price, MD, to Lead HHS

November 28, 2016

President-Elect Donald Trump has chosen Rep. Tom Price, MD (R-GA), an orthopaedic surgeon, to head the US Department of Health and Human Services (HHS) and help his coming administration repeal and replace the Affordable Care Act (ACA), a burning cause for the congressman, according to media reports tonight.

As a physician-legislator who has decried the "government takeover of healthcare," Dr Price would make a good fit with a new Republican administration seeking a smaller role for government in general. He would play a major role in determining how Medicare and Medicaid reimburse physicians.

If confirmed by the Senate next year, Dr Price would be the first physician to head HHS since Louis Sullivan, MD, during the George H. W. Bush administration.

Dr Price was first elected to the House by Georgia's 6th congressional district in suburban Atlanta in 2004. In 2014, he became the chair of the powerful House Budget Committee. He belongs to the GOP Doctors Caucus, a group of clinicians in the House that has vigorously opposed the ACA.

All in all, Dr Price owns a strong resume for an HHS secretary, said Jack Lewin, MD, president and chief executive officer of the Cardiovascular Research Foundation.

"He's had a lot of experience with Congress," Dr Lewin told Medscape Medical News. "He understands medicine and physicians. He's well versed on the issues that have to be addressed.

"He would be capable of succeeding in the job."

Dr Lewin, a former chief executive officer for the American College of Cardiology, predicts that organized medicine will look favorably on Dr Price's nomination. "He's been a friend of organized medicine," said Dr Lewin. "He definitely would be an advocate for physicians, and patients as well."

Dr Price would come prepared to help fulfill Trump's campaign promise to repeal and replace the ACA. In 2009, he sponsored the Empowering Patients First Act, a conservative alternative to nascent ACA legislation at that time. He introduced an expanded version of the bill as recently as 2015 that would allow individuals to opt out of Medicare, Medicaid, TRICARE, and Veterans Affairs benefits and purchase a private health plan using refundable tax credits. The bill also would expand the use of health savings accounts, provide grants for high-risk insurance pools operated by individual states, allow the sale of health insurance across state lines, and enact tort reforms such as shielding physicians from liability if they adhered to clinical guidelines.

This blueprint for conservative healthcare reform resembles the plan offered by House Speaker Paul Ryan (R-WI). Among other things, Ryan wants to let Medicare beneficiaries buy a private health plan of their choice with an adjustable subsidy, or what he calls a premium support payment.

Nurse Practitioners and States' Rights

Trump's choice for HHS has taken other stands on healthcare consistent with a small-government philosophy.

Dr Price and other members of the GOP Doctors Caucus, for example, protested the launch of Medicare's first mandatory, as opposed to voluntary, demonstration project for an alternative payment model, which had to do with joint replacement. His group also objected to a proposal, eventually put on hold, that would have imposed Medicare penalties on physicians who conduct routine prostate-specific antigen screenings for prostate cancer. "We find it unsettling that [the Centers for Medicare & Medicaid Services] is interjecting itself in the ongoing scientific debate regarding the appropriate role of [prostate-specific antigen] in prostate cancer screening," they wrote.

The GOP Doctors Caucus has aligned itself with organized medicine in restricting the role of nonphysician clinicians, viewed by many as the answer to a physician shortage. Dr Price signed a caucus letter to the Department of Veterans Affairs in opposition to a Veterans Health Administration plan to let its advanced-practice registered nurses work independently, without physician supervision. The GOP Doctors Caucus wrote that the Veterans Health Administration proposal "is a misguided injustice to our nation's veterans," noting that fewer than half of the states allow full scope of practice for advanced-practice registered nurses.

"We expect the [Department of Veterans Affairs] to refrain from trampling on states' rights," the letter stated.

Legislation sponsored or supported by Dr Price also holds clues to what his possible agenda at HHS might be if he is confirmed. He cosponsored an unsuccessful bill that would have prohibited HHS from requiring physicians to use the International Classification of Diseases, Tenth Revision, diagnostic codes, which debuted in November 2015. In 2011, he introduced legislation that would allow all physicians in Medicare to contract with patients on a fee and then balance-bill them for the amount above the program's allowable charge. This reform was needed, Dr Price said at the time, to make up for paltry Medicare rates that threaten to drive physicians out of the program and leave seniors bereft of care. Critics, however, said that the legislation would have increased out-of-pocket spending for seniors. The bill later became part of Dr Price's Empowering Patients First Act.

Balanced billing is a function of fee-for-service reimbursement, but not so much the pay-for-value arrangements that are supplanting it. As his balance-billing legislation might suggest, Dr Price has been "a strong advocate for traditional payment," said organized medicine veteran Dr Lewin. However, Dr Price voted for the Medicare Access and CHIP Reauthorization Act, which shifts Medicare from fee-for-service to pay-for-value.

Possible flashpoints in his Senate confirmation, as far as Democrats are concerned, are Dr Price's opposition to abortion and his votes against legislation that would protect lesbian, gay, bisexual, and transgender individuals from discrimination. Those stances put him at odds with some medical societies.

Disagreement comes with politics, but Dr Price himself is not disagreeable, said Dr Lewin. "He's considerate on a personal level," said Dr Lewin. "He's a pleasant man in terms of personality and style...and a persuasive individual."

Donald Palmisano, Jr, executive director of the Medical Association of Georgia, describes Dr Price as approachable and accessible to political friends and foes alike.

"He listens to all sides of an argument before coming to a decision," Palmisano told Medscape Medical News. "When he's talking to an opponent, he'll say, 'Tell me why you believe this.' "

Follow Robert Lowes on Twitter @LowesRobert


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