According to Medscape (registration required) and other media reports, President-Elect Donald Trump has tapped Rep. Tom Price, MD (R-GA) to be the next secretary of the US Department of Health and Human Services (HHS).
Dr. Price, an orthopaedic surgeon, became chair of the House Budget Committee in 2014, and he is a member of the GOP Doctors Caucus, which has vigorously opposed the Affordable Care Act (ACA). Dr. Price has introduced ACA-replacement legislation called the Empowering Patients First Act. Among other things, Dr. Price’s legislation would allow Medicare-eligible people to opt out of the program and purchase private health insurance using tax credits. In the bill’s latest form, people between 18 and 35 years of age would also be eligible to receive $1200 in tax credits to buy health coverage on the individual market.
Dr. Price has taken other stands on health care policy that are consistent with a small-government approach, although he did vote for the Medicare Access and CHIP Reauthorization Act (MACRA), which gradually shifts Medicare from a fee-for-service to pay-for-value system.
HHS Secretary nominees face a confirmation vote in the Senate, but by all accounts, Dr. Price’s personality will not get in the way of that. Donald Palmisano, Jr., executive director of the Medical Association of Georgia, told Medscape that Dr. Price is “approachable and accessible to political friends and foes alike.”
With the clock ticking toward an October 1, 2015 compliance deadline for ICD-10, Tennessee Rep. Diane Black recently introduced a bill, HR 2247, that would require a transition period for the changeover from ICD-9 codes. Rep. Black’s bill would not stall the October 1 compliance date, but it would require the U.S. Department of Health and Human Services (HHS) to provide transparent end-to-end testing of the new system to certify that it’s fully functional. According to the legislation, during the testing period and for 18 months following HHS certification, the Centers for Medicare and Medicaid Services (CMS) would be prohibited from denying claims “due solely to the use of an unspecified or inaccurate code.” Essentially, that means CMS would have to accept, process, and pay claims that are submitted with either ICD-9 or ICD-10 codes.
Two weeks prior to the filing of Rep. Black’s legislation, Texas Rep. Ted Poe introduced HR 2126, which would simply prohibit HHS from replacing ICD-9 until the Comptroller General completes a study “to identify steps that can be taken to mitigate the disruption on health care providers resulting from a replacement of ICD-9.” Both pieces of legislation have been referred to the House Committee on Energy and Commerce and the House Committee on Ways and Means.
The proposed fiscal 2016 budget for the US Department of Health and Human Services (HHS) includes a change to existing exceptions in the physician self-referral (Stark) law that could affect some orthopaedic practices. Beginning in 2017, HHS would prohibit many in-office referrals for “therapy services, advanced imaging, and anatomic pathology services.” (See pages 68 and 76 of the budget, specifically.) Such services are currently allowed to enhance patient convenience, but HHS claims that they “are rarely furnished on the same day as the related physician visit.” The HHS budget also points to “evidence that suggests that this exception may have resulted in overutilization and rapid growth of certain services,” and it estimates that implementing this restriction would save more than $6 billion over 10 years.
In a blog post from the law firm of Duane Morris, attorney Matthew Jones says, “While the current political climate in Washington leaves the fate of HHS’s proposed budget far from certain, physicians must once again be on the alert for increased limitations on their ability to provide in-office ancillary services.”