Tom Price takes aim at the inefficiencies of meaningful use, questions how to pay for precision medicine
Rep. Tom Price, MD, the Georgia Republican tapped by President-elect Donald Trump to be the next U.S. Secretary of Health and Human Services, spent four hours testifying before the Senate Health, Education, Labor and Pension Committee on Jan. 18.
Most of the hearing focused on the expected topics: the future of the Affordable Care Act, the scope of Medicare and Medicaid, Price's questionable investments in medical device and drug companies.
But toward the end of the testimony, Republican Louisiana Senator Bill Cassidy, MD, asked Price to weigh in on health information technology.
"Franken calls me a Luddite, because I am skeptical about electronic health records and their negative impact upon productivity," said Cassidy, referring to fellow HELP Committee member Al Franken, D-Minnesota.
"I see that MD Anderson just laid off 5 percent of their staff," said Cassidy. "They're blaming it upon financial losses based on decreased productivity, again directly attributable to the implementation of their EHR."
He asked Price: "What can we do about this time and productivity sump that has become the electronic health record and meaningful use? Keeping that which is positive, but hopefully doing something better for the patient and the physician."
"Electronic health records are so important because, from an innovation standpoint they allow the patient to have their health history with them at all times and be able to allow whatever physician or provider to have access to that," Price responded. "We in the federal government have a role in that, but that role ought to be interoperability: to make sure the different systems can talk to each other so it inures to the benefit of the patient.”
With regard to the EHR Incentive Program, "I've had more than one physician tell me that the final rules and regulations related to meaningful use were the final straw for them," said Price. "And they quit. And they've got no more gray hair than you or I have. And when that happens we lose incredible intellectual capital in our society."
Said Cassidy: "I often find an orthopedic surgeon asking someone about their smoking history is not really a good use of an orthopedic surgeon's time. Not that it isn't important, but he's not the person that would institute the cessation program."
"I think what's absolutely imperative is to find out what things ought to be determined and checked, the metrics that are used – that they actually correlate with the quality of care that's being provided as opposed to so many things that are required right now of the physician or the provider that make is so they're wasting their time documenting these things so that it sits in some matrix somewhere but doesn't result in a higher quality of care or outcomes for that patient," said Price.
Sen. Cassidy then turned the conversation to the future of medicine and the economics of "expensive medicines used only by a few," such as gene therapy that could combat antibiotic resistant bacteria. How should that be paid for "in the era of personalized medicine, where it might be an n = 1 or an n = 1000 – still very small but the cure could be a million"?
"We're entering a brave new world that is so exciting from a scientific standpoint," said Price. "To be able to provide this sort of personalized healthcare to folks, we'll be able to cure things that we never dreamed about curing. The challenges of how we afford to be able to make that available to our society are real, and I think we need to get the best minds together to make that happen, and I look forward to working with you to do so.
"Incentivization from an FDA standpoint is incredibly important," Price continued, "to make sure that if companies come up with things that are able to cure diseases, that they are appropriately compensated for it."
As the hearing drew to a close, HELP Committee Chair Lamar Alexander, R-Tennessee, thanked Price for undergoing what he said was "the most extensive questioning of any Secretary of Health and Human Services since 1993." And he took one more swipe at meaningful use.
"At Vanderbilt, which was an early adopter of electronic healthcare records, they said Stage 1 was helpful, Stage 2 they could deal with and Stage 3 was terrifying," said Alexander.
"I had hoped we could delay Stage 3," Alexander added. "I thought it could be as simple as saying to the physicians and providers of the world, 'Look, if you're a physician and you're spending 50 percent of your time filling out forms, then either you're doing something wrong or we're doing something wrong. And let's work together over the next couple years to get that down to a manageable level and create an environment where physicians and providers can spend their time talking instead of typing.
"You've got a bipartisan consensus here to work on that," he told Price. "At least we did last year when we passed the (21st Century) Cures bill. I invite you to work with us, if you're confirmed, to complete that."