Rep. Tom Price, an orthopedic surgeon from Georgia and President-elect Donald Trump's pick for HHS secretary, proposed legislation in 2015 to repeal the Affordable Care Act. His replacement would have granted physician groups considerable control in key areas of healthcare quality.
Those provisions are raising conflict-of-interest concerns among some critics, who are pointing to ties between Price and the healthcare industry. “These physician groups are advocacy organizations that exist to serve the interests of their members, which are physicians, and those interests are often financial in nature,” said Eric Campbell, a sociologist and professor of medicine at Harvard Medical School whose research includes physician conflicts of interest.
Title VII of the Empowering Patients First Act that Price introduced in May 2015 covers quality, including comparative-effectiveness and patient-centered outcomes research and performance-based quality measures.
Section 701 of the bill proposed that data from such research would not be used “to deny coverage of an item or service under a Federal healthcare program,” and it called for ensuring that such research, which compares the real-world effectiveness of different treatments, would also take into account precision medicine and individual responses to therapies.
But buried in Section 701 is also an attempt to slap restrictions on publishing that research. “Nothing the Federal Coordinating Council for Comparative Effectiveness Research finds can be released in final form until after consultation with and approved by relevant physician specialty organizations,” the bill said.
The 15-member Federal Council was created with funding from the 2009 American Recovery and Reinvestment Act, better known as the Obama stimulus, and was given $1.1 billion to fund and coordinate comparative-effectiveness research at HHS, the National Institutes of Health and the Agency for Healthcare Research and Quality. The council also reports annually to the president and Congress on its activities and makes recommendations for infrastructure, spending and improved research.
“I would have a major problem with physician organizations having any kind of role whatsoever in what results of research are reported publicly,” Campbell said.
The purpose of comparative-effectiveness research is to measure one treatment against another. In the past, groups with vested interests in one type of treatment have at times quarreled with the results of that research.
In 1993, AHRQ's precursor agency convened an expert panel that concluded surgery was no better than nonsurgical treatment for back pain. In response, the North American Spine Society approached Congress to defund the agency, which saw its budgets and authority sharply curtailed by the Newt Gingrich-led House. Other interested groups, including one company that made screws used in spinal fusions, lobbied hard against the agency or tried to prevent the guidelines from being published.
The surgeons feared that Medicare might stop reimbursing for back surgeries, the Washington Monthly reported in 2007.
Price's proposed legislation would have also granted physicians significant control over performance-based quality measures, which will have a much greater role in affecting physicians' Medicare payments under the Medicare Access and CHIP Reauthroization Act.
The HHS secretary would submit a proposal to Congress for a process to develop those measures, the bill said, and that proposal “shall be in concert and agreement with the Physician Consortium for Performance Improvement and shall only utilize measures agreed upon by each physician specialty organization.”
The Physician Consortium for Performance is a membership organization that includes specialty associations, government agencies, healthcare companies, at least one insurer, consultancies and state medical societies.
The current process for determining quality measures used in federal health programs already incorporates input from stakeholders. Committees made up of patients, providers and payers alike gather to evaluate measures, which ultimately the National Quality Forum recommends to HHS.
Soliciting input from physician organizations is fine, but “giving them final approval is problematic,” Campbell said. “Those organizations do not exist to ensure that the best medicine gets practiced, or that patients get the best care. They exist to serve the interests of physicians.”
Sen. Chuck Schumer (D-N.Y.) called Price's nomination akin to “asking the fox to guard the hen house.”
Dr. Steven Walsh, president of the Medical Association of Georgia, of which Price was once a member, strongly endorsed his nomination, describing Price's background in a way that suggested Price would prioritize physician interests.
“Dr. Price understands that there is a critical need to reduce the administrative burden that has been placed on today's physician,” Walsh said in a statement. “He knows that we need to reduce the amount of control the federal government and big health insurance companies have on our healthcare system.”
The American Medical Association, American Hospital Association and America's Essential Hospitals have all released statements supporting Price's nomination.