Representative Tom Price (R., GA) is Donald Trump’s pick for Secretary of Health and Human Services [HHS]. In this position, he will be in charge of the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and many more agencies related to our health and our medical care.
The largest controversy during his Senate confirmation hearings has centered on some allegations that he had conflicts of interest involving the drug manufacturing and medical device industries during his time in Congress.
But there is a position Dr. Price has about the importance of the patient perspective that he included in his own proposed replacement for Obamacare that would be equally of interest to the public if it was getting any attention- which it is not.
Dr. Tom Price is an Orthopedic Surgeon who has represented Georgia’s 6th Congressional District since 2005.
Let me start by saying I have no knowledge about how Dr. Price treated patients when he was in practice. I do not know how compassionate, caring or attentive he may have been on a one-on-one interaction, and I have not seen any reports, articles or quotes from past patients that would add any perspective on how patient-centric he may have been as a surgeon.
He did, however, release his proposal for a replacement to Obamacare in May, entitled the Empowering Patients First Act. Reviewing his proposed law, however, leaves me with the impression that the intention is to protect physician income- not empower patients. *
The most glaring example of my assertion is this:
Effectiveness or Patient Centered Outcomes Research;
- The Secretary of HHS is prohibited from using comparative effectiveness or patient-centered outcomes research to deny coverage of an item or service under a Federal health care program.
[redacted, emphasis added]
To understand the implications of this language, I need to briefly explain what the reference to “Patient-Centered Outcomes Research” means.
The Patient Voice in Determining Best Practices in Medical Care
A large part of the Affordable Care Act (Obamacare) was to improve outcomes for patients individually and nationally through research-driven standardization of medical care. An important component of that goal was the creation of the Patient-Centered Outcomes Research Institute (PCORI, pronounced PICK-or-e).
The purpose of PCORI is to significantly impact how physicians treat chronic disease and how patients participate in their own medical decision-making. The organizing theme is that not all treatments are effective, and not all patients are appropriate for all treatments. Since its inception, PCORI has been adding to the lengthy history and breadth of comparative effectiveness research in America, but from a uniquely patient-focused perspective.
Patient-centered comparative research, as defined by PCORI, focuses on four patient questions:
1. “Given my personal characteristics, conditions, and preferences, what should I expect will happen to me?”
2. “What are my options, and what are the potential benefits and harms of those options?”
3. “What can I do to improve the outcomes that are most important to me?”
4. “How can clinicians—and the care delivery systems they work in—help me make the best decisions about my health and health care?”
Patients are purposefully incorporated throughout all functions of PCORI. They are asked to help select which research projects will receive funding, design how the research will be conducted, and choose platforms for communicating the research findings that will be available to various patient groups.
Although most Americans are unaware of PCORI- I assume that the questions above resonate with many- if not most- Americans encountering the health care system. I also believe that knowing the patient perspective is reflected in determining what treatments are endorsed (and paid for) by Medicare and other federal programs is a comfort.
But not according to Dr. Price. If CMS is prevented by law from considering any PCORI recommendations (or any other comparative research for that matter), what is the point?
Conclusion
Patients have always been central to our medical care and health care system– and the concept “Patient-Centered Care” has been the touchstone for all health care law and policy since the pivotal IOM report “Crossing the Quality Chasm” in 2001.
Examples of the importance of patients in health policy include:
– protecting patient privacy (HIPAA, 1995);
– patient satisfaction scores under Value Based Purchasing (which began in 2006);
– the requirement for patient portals (HITECH Act, 2009), and;
– the Affordable Care Act & the creation of PCORI (2010).
To have a person put in charge of HHS with such antithetical point of view of the role of the patient strikes me like a blow to everything we hold important as patients, and something the public- if not our Senators- would be concerned about if they knew.
*I will get back to other unusually strong pro-physician aspects of the Empowering Patients First Act in future Fontenotes
Want to Know More?
- If you would like to know more about Dr. Price’s Empowering Patients First Act, but do not want to slog through all 242 pages- an 11-page summary is available here.
- If you would like to know more about PCORI, there is an excellent 15-minute video “PCORI 101” with a brief description of the Institute on their website.
- I published a more complete, fully referenced paper on PCORI and comparative research in the Physician Executive Journal in July, 2013. A copy is available on my website here.