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
Price went on to talk about the ACA (Affordable Care Act) repeal/replace debate last year that dominated much of 2017, calling it “the height of political frustration.” He said that two core points in the debate were what created an ideological split amongst healthcare policymakers: the individual coverage mandate and Medicaid expansion. “If we could have moved those [two issues] to the side, there was a feeling we could find common ground and move forward. But we weren’t able to do that,” Price admitted.
Price believes that if there is common political ground in the sector, it is around the key principles of healthcare: having a system that is accessible, affordable and which provides the highest quality of care for everyone. Price noted that he would add three additional principles that he believes in: having a system that is responsive to patients’ needs; incentivizing innovation; and creating choices for patients.
Nonetheless, too many challenges still present themselves, Price said, noting regulation barriers. “We all know that we need regulation in healthcare, but it has to be at a level that doesn’t stifle innovation. If there is an oppressive system of regulation, the likelihood is that innovation falls away,” he contended.
Price offered Edward Lifesciences as an example, a California-based medical equipment company specializing in artificial heart valves and hemodynamic monitoring. The company, he said, has done “cutting-edge work in heart valve pathology.” About a decade ago, Price explained, Edward Lifesciences came up with an inventive solution for aortic valve replacement, and this technology, which took them more than six years to get approved in the U.S., had been used and approved in 46 other nations before the United States.
“So this means that people in those 46 countries were able to see the benefits of this incredible technology and innovation done in the U.S. before our citizens could. That shouts that something is wrong,” he said, noting that Scott Gottlieb, M.D., FDA commissioner, is trying to remove some of these barriers for innovation while at the same time ensuring that the technology is safe.
In the end, Price again hammered home the point that consumers must have options, which aligns with what current health officials in the Trump administration firmly believe. “Options, choices, and voluntary programs [are what’s important] so that people can figure out what’s best for them,” he said.