Dr. Tom Price, who is an orthopaedic surgeon and Republican member of the U. S. House of Representatives, has been nominated to head the Department of Health & Human Services (HHS) which includes CMS.
If confirmed, Dr. Price will be the first orthopaedic surgeon to head HHS and the first physician to head HHS in more than 20 years. As HHS Secretary, Dr. Price will have a great deal of control over CMS-related regulatory matters, including the BPCI, CJR and MIPS programs. He is also expected to have a great deal of input as to whether and how the ACA is repealed and replaced.
The purpose of this message is to give you a brief description of Dr. Price’s background and some of his positions that might have an impact on orthopaedic and other physician groups.
Dr. Price graduated from the University of Michigan’s medical school in 1980 and practiced as an orthopaedic surgeon in the Atlanta area for about 20 years. He was a partner and founding board member of Resurgens Orthopaedics until he was elected to Congress in 2004. Resurgens is the largest orthopaedic group in Georgia with nearly 100 physicians covering the metro Atlanta area-so Dr. Price is very familiar with large orthopaedic groups and their concerns.
Dr. Price has a long history of working with AAOS which released the following statement in support of his HHS nomination.
Dr. Price has decades of leadership on health care policy issues and firsthand experience caring for patients for nearly twenty years. He has worked closely with AAOS on issues including repeal of the Medicare sustainable growth rate formula, oversight of mandatory bundled payment models, increasing flexibility within electronic health record programs, defending important in-office ancillary services, and protecting the patient-physician relationship. He has been an indispensable voice within the House Republican Doctors Caucus, making significant contributions to health policy reform and furthering the interests of patients. And he has been one of the most important champions in improving the care of patients in the specialty, rural, and small or solo practice settings.
The following are some of Dr. Price’s policy positions that directly relate to orthopaedic and other physician groups:
- Strongly opposed to the mandatory nature of the Comprehensive Care Joint Replacement (CJR) program. (See Dr. Price’s attached letter to CMS.) This position might benefit orthopaedic groups because hospitals manage the CJR bundle whereas physicians manage the BPCI bundle as part of that optional program.
- Strongly in favor of tort reform to raise the burden of proving negligence and limiting awards in medical malpractice cases.
- Favors allowing health insurers to sell across state lines
- Opposed to CMS using comparative effectiveness or patient-centered outcomes research to deny or limit coverage
- Favors making in more difficult for CMS to require reporting and use of performance-based qualify measures. This may result in a delay and/or modification of the CMS’s Merit-Based Incentive Payment System (MIPS) which is set to begin in 2017
- Favors a federal antitrust waiver that would allow otherwise unaffiliated physicians and other providers to collectively negotiate payment rates with insurance companies.
Many of these positions are reflected in the Empowering Patients First Act (HR 2300) which is a bill that Dr. Price introduced to replace the ACA. I have attached a section-by-section overview of this bill.
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