HHS Hires Deputy Health Technology Secretary, Raising More Questions about ONC’s Future

March 21, 2017
The U.S. Department of Health and Human Services (HHS) has hired former Louisiana Rep. John Fleming, M.D., as a deputy assistant secretary for health technology within the federal agency.

The U.S. Department of Health and Human Services (HHS) has hired former Louisiana Rep. John Fleming, M.D., as a deputy assistant secretary for health technology within the federal agency.

The position is a new one within HHS, and according to a report in NOLA.com, Fleming “described his role as a linchpin in finding ways to improve how physicians use technology to practice medicine.” The report noted that Fleming will report to HHS Secretary Tom Price, M.D., who was confirmed by the Senate last month. Fleming, who worked closely with Price in Congress, will not have to be confirmed by the Senate for this position, according to the report.

Fleming, 65, a Republican, served as the U.S. Representative for Louisiana's 4th congressional district from 2009 to 2017. He missed the runoff last fall in the Senate race to succeed David Vitter, ultimately losing the seat to John Kennedy, the Republican state treasurer at the time. He specializes in family medicine in Minden, La.

According to the NOLA.com report, Fleming said, “It's clear there's a lot of work to do, and they're anxious to get somebody in place and start activating this.” He added that “he sees his role as writing and championing policies that encourage more physicians to embrace technology, rather than view it as a mandated burden.”

Fleming, former co-chair of the GOP Doctors Caucus and Freedom Caucus, was part of a petition to the Centers for Medicare & Medicaid Services (CMS) last fall to make the MIPS (Merit-Based Incentive Payment System) payment path under MACRA far less complex for eligible Medicare doctors. Fleming and others noted at the time that “In order to be successful, MIPS must engage clinicians with a reporting system that is not overly burdensome, a scoring system that is simple and transparent, attainable thresholds, and a short enough quality/payment feedback loop to allow physicians to learn to and make necessary changes to avoid further penalty.”

It remains to be seen what this means for the future of the Office of the National Coordinator for Health IT (ONC), the health IT branch of the government that made most of its progress under the Obama Administration. ONC was not mentioned in Trump’s proposed federal budget last week, and as Healthcare Informatics reported at the time, “One informational source who is not inside the federal government but who has extensive contacts with the government, told Healthcare Informatics that OMB officials had prepared the budget without any consultation with anyone within CMS or ONC.”

To this end, a Politico Morning eHealth report today noted that Fleming actually thought he was interviewing for the National Coordinator position at ONC when he met with Price to discuss the deputy assistant secretary for health technology position at HHS. “I think it’s the same or a similar position,” Fleming told Politico, adding that ONC “may be reorganizing,” though that latter comment was pure speculation on his part, per the report. He further noted to Politico, “Health IT policymaking has always been scattered among several HHS agencies. CMS is in charge of setting meaningful use requirements and tech-heavy MACRA rules.”

In the end, the hiring of Fleming at HHS will add more uncertainty as to what’s in store for ONC. There has been talk in some circles that while ONC was created to spur the adoption of electronic health records (EHRs) in hospitals and physician practices across the U.S.—which it has done successfully—there are now major questions about the department’s future role. In a recent letter to Secretary Price, the Health IT Now Coalition said that Congress and the administration must “clarify what role and to what extent ONC should play in the overall regulation of health information technology, and how such a role would interact with other regulatory agencies.” The many health IT companies in the Coalition think that ONC has overstepped its authorities in certain cases, such as its oversight on EHRs and other health IT products.

What’s more, in one of its Top Ten Tech Trends for 2017, Healthcare Informatics closely examined how value-based care and health IT will move forward in the Trump administration. In that story, Farzad Mostashari, M.D., former National Coordinator for Health IT, noted that the agency’s annual budget “has been basically frozen” for the better part of the last decade.