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    Grading the Trump administration's healthcare initiatives


    Tom Price: C

    Tom Price, a former orthopedic surgeon, was brought in as head of the Department of Health and Human Services. The move was applauded by most rank-and-file physicians because he spoke the language of physicians suffering under the weight of the prior administrations good intentions. In his Senate confirmation hearing, he bemoaned the rules and regulations related to Meaningful Use that had pushed physicians into retirement, but did nothing to increase value to patients. He signaled a lighter touch may be on the horizon when it came to EHRs by noting that the major role of the federal government was to ensure interoperability rather than micromanaging the collection of useless data points from data entry clerks formerly known as doctors.


    RELATED READING: Trump administration promotes patient ownership of health data


    Unfortunately, the former Senator was gone before he could affect any change, felled by the stellar journalists at Politico who uncovered evidence of travel via a charter plane for personal matters. I must profess to being incredibly annoyed at the development. The penalty seemed entirely too great given how hopeful I was at having a physician voice speaking to physician concerns at the head of the policy making table. Regardless, the reign of Price was an ineffectual one.

    Seema Verma: B-

    Appointing Seema Verma to head the Center for Medicare and Medicaid Service was another move applauded by many in the trenches. Little known to most, she had garnered attention locally in Indiana with an innovative approach to the state’s Medicaid program. She seemed to understand that poor access in Medicaid patients was driven in large part by inordinately poor reimbursement for a population that can be very complex to manage.  A key component to Indiana Medicaid was using tobacco tax dollars to raise Medicaid rates to at least be equal to Medicare rates—a move that made her popular among physicians whose charge it was to take care of these patients.

    Unfortunately, it is the charge of the director of CMS to administer, rather than make, new laws. There has been little of substance to report from Verma other than some nice words about putting patients before paperwork. She has also been remarkably ineffective in making a case for what she believes in publicly.   Those of us who believe that the solutions in healthcare lie with physician-patient partnerships that take a wide berth around third party payers, need an effective and vocal salesperson. While there are glimmers of what could be as a recent fiery address at the HIMSS conference attests to, Verma, has unfortunately mostly relegated herself to staid positions that inch the ball forward.

    Evidence of this can be seen in her approach to the framework of value-based care that is mostly indistinguishable from its predecessors. There are some more exclusions for low-volume providers, but the meaningless system that transfers healthcare dollars from those unable to comply with regulations to those that can comply with regulations, is largely in place.  It is still early, but a lack of bold action has marked the Verma reign so far.

    Next: Scott Gottlieb

    Anish Koka
    Anish Koka is a cardiologist in private practice in Philadelphia trying not to read the writing on the wall. Follow him on twitter ...


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    • [email protected]
      As a full time pastor and retired physician; I feel that a response from a different set ot trench workers is needed. People in my my area are suffering from the recent healthcare policies. The hard working people in rural Southeast Oklahoma are struggling to get quality healthcare vs. surviving. Many of these people are Trump supporters it is unfortunate that the current Administration policies will not support them. As you continue to give grades I will continue to work to find quality healthcare to for all people regardless of their political affiliation. Charles A. Woodridge MD, M. Div
    • [email protected]
      Thank you, Dr. Koka, for a measured and thoughtful assessment. Of particular note, your thoughts on value-based reimbursement, EMRs, and avoidance of third-party intermediation were particularly enlightening. I would agree that the demise of Tom Price so early in the process was disheartening and that the response from 'the Resistance" was dramatically overblown. I wish Seema Verma much success but am in agreement that the built-in inertia with Medicare and Medicaid may be too much to overcome in a relatively short timeframe. A bright spot in this whole issue is how alternative practice and reimbursement models, like Direct Primary Care, may have a positive impact on improving both quality and cost of care. Time will tell.

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