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Price Likely to End Mandatory Medicare Payment Test

By Kerry Young, CQ Roll Call

November 29, 2016 -- Rep. Tom Price likely would end compulsory participation in Medicare's programs that test alternative forms of payment if he serves as secretary of the Department of Health and Human Services (HHS), the head of government relations for a trade group predicted Tuesday.

President-elect Donald Trump on Tuesday announced his plan to tap the Georgia Republican to lead federal health programs. As House Budget Chairman, Price in September held a hearing delving into a potential repeal of the Center for Medicare and Medicaid Innovation (CMMI). That center, created by the 2010 health law, has served as the Obama administration's chief vehicle for testing new approaches to pay for care. Price has been among the sharpest critics in Congress of CMMI and its programs, which include a controversial proposed test of payment for drugs given in doctors' offices.

The future of the Innovation Center with Republicans in full control of Congress and the White House is in doubt, said Clifton Porter II, senior vice president for government relations at the American Health Care Association, on a call with reporters Tuesday. Republicans may seek to end that program, although they still may continue with its principal aim of testing alternative ways to pay for care to people enrolled in Medicare. Some lawmakers in both parties want to move traditional Medicare away from its longstanding fee-for-service model, which some policy analysts say results often in poor quality of care and needless duplication of costly services and tests.

Price has criticized the mandatory nature of certain CMMI programs, including the Comprehensive Care for Joint Replacement model that began earlier this year. That program compels most hospitals in 67 regions of the country to participate in tests that may raise or shave their Medicare pay based on how well people fare after hip and knee replacements.

Price, himself an orthopedic surgeon, introduced a bill (HR 4848) in March seeking to delay implementation of this test. CMS also has proposed a cardiac care model that would involve hospitals in 98 regions of the country, with similar mandatory participation requirements. Price likely would only use voluntary participation in future programs, Porter said.

"If I look at Mr. Price's record, it would be something that he would probably have eyes to change," Porter said on the call. "If folks want to get involved with ideas and concepts like this, they'll have the option."

Price has said he was drawn to politics because he felt lawmakers wielded too much power over his actions as a doctor. Price grew up in Michigan, the son of a dairy farmer who decided to attend medical school at age 36 to become an emergency room doctor. He moved to Atlanta for a residency in orthopedic surgery at Emory University and eventually settled nearby with his anesthesiologist wife.

"His role as an orthopedic surgeon actually delivering care and understanding the rehabilitation process, I think, is going to add some insight" to his approach if confirmed as HHS secretary, Porter said.

In tapping Price, Trump has chosen a lawmaker already deeply schooled in the operations of Medicare. Price has proven to be both a partisan standard bearer and a pragmatic dealmaker when it comes to health policy. As House Budget chairman, he's been the point man for efforts to repeal President Barack Obama's signature domestic achievement, the 2010 health law. Yet he also worked behind the scenes last year with the Centers for Medicare and Medicaid Services and congressional Democrats and Republicans on a successful last-minute bill that spared many doctors from facing penalties for failing to meet federal standards for demonstrating use of electronic health records.

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