HHS Secretary Price’s Resignation Casts Doubt on New Initiatives

The resignation of HHS Secretary Tom Price, MD casts doubt on initiatives championed by the former orthopedic surgeon in altering the trajectory of the Patient Protection and Affordable Care Act.

Under intense criticism and amid growing frustration by President Donald Trump, U.S. Department of Health and Human Services (HHS) Secretary Tom Price, MD resigned on Friday, creating a new air of uncertainty regarding some of his earlier proposals.

Before Price delivered his resignation statement, earlier on Friday, media reports quoted the President as saying a decision would come later in the evening regarding whether he would fire Price over revelations of his using charter jets and military aircraft for official business. An investigation by POLITICO revealed that Price’s use of private aircraft for domestic and international flights cost taxpayers an estimated $1 million since May of this year.

Price is also under investigation by the HHS Office of Inspector General (OIG) for his travel.

HHS Deputy Assistant Secretary Don Wright, MD, MPH, has been appointed to serve as acting Secretary, according to the White House.

According to a post on the HHS website, Wright is also the Deputy Assistant Secretary for Health and Director of the Office of Disease Prevention and Health Promotion (ODPHP), a position he has held since January 2012. From 2007 to 2009, he was the HHS Principal Deputy Assistant Secretary for Health. During this time, he was appointed by President George W. Bush to serve as the alternate U.S. delegate to the World Health Organization Executive Board.

According to the HHS website, Dr. Wright is board-certified in both family medicine and preventive medicine. He is a fellow of the American College of Occupational and Environmental Medicine and the American Academy of Family Physicians.

Price’s resignation specifically casts doubt on one of the latest initiatives from the Centers for Medicare & Medicaid Services (CMS), which in early August of this year proposed canceling the expansion of the Advancing Care Coordination through Episode Payment Model. The proposal is scheduled to become effective on Jan. 1, 2018. This initiative was to start a bundled payment program in select areas for conditions or services including acute myocardial infarction, cardiac bypass surgery, and hip and femur fractures.

“One of Dr. Price’s first actions as HHS Secretary was to propose the cancellation of the expansion of the mandatory ‘bundled payment’ models for acute myocardial infarction, coronary artery bypass surgery, and hip fractures, and cut the size of the Comprehensive Care for Joint Replacement (CJR) mandatory program in half,” said Ronald Hirsch, MD, in an email to RACmonitor. “It was well-known that he did not support mandatory, value-based programs, preferring to ask providers to volunteer to test out new payment models.”

Hirsch said the Price resignation raises questions about how CMS will act.

“I suspect that when HHS proposed to cancel the programs, many of the hospitals who were in one of the bundles stopped all preparations, expecting the cancellation to be a done deal – so a reversal at this late date would have significant consequences for those hospitals,” Hirsch said. “But the proposal is still in the comment phase, so it may be wise to suggest that HHS go ahead with the cancellation or propose at least a one-year delay to allow time for preparation.”

Comments can be submitted online until Oct. 16 at this link: https://www.regulations.gov/document?D=CMS-2017-0120-0001