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Health And Human Services Department Grappling With How Doctors Should Be Paid


President Trump announced today that he's nominating Alex Azar to be secretary of Health and Human Services. Azar is a former pharmaceutical executive, and he worked in HHS under President George W. Bush. We hear more about Azar elsewhere in the program.

And now we're going to look at one of the big issues that HHS is grappling with - the question of how doctors should be paid. Should they be paid based on the quality of their care, or for every appointment and procedure regardless of the quality? The Obama administration pushed hard to implement payment models based on merit in hopes of reducing costs, and the Trump administration has begun to reverse those changes.

Well, joining me now is Abby Goodnough, health care reporter for The New York Times. Thanks for coming in.

ABBY GOODNOUGH: Thanks for having me.

SIEGEL: And first, broadly, what's the change we're witnessing under the Trump administration?

GOODNOUGH: Well, what we're seeing is a real slowing down and putting on the brakes of what the Obama administration had tried to do and what everybody agrees needs to be done, which is move away from that so-called fee-for-service model where doctors are paid for every single thing they do to one that's based on their outcomes, how well their patients do after they get treated.

SIEGEL: So if you could just wade into the weeds of health care policy for a moment, what's an example of care where we might see this, that - where we might see these changes at work?

GOODNOUGH: We're really talking about all levels of care from primary care and how well you're doing treating patients with diabetes and high blood pressure over time to complicated orthopedic surgeries, cardiac surgeries where, you know, you need to measure how well somebody does after the surgery.

SIEGEL: So let's take, say, hip or knee replacements that are done for Medicare patients. What might be the difference? What did Obamacare do to change that? And what might Trump back away from doing?

GOODNOUGH: What the Obama administration did was it started this big experiment to require a bunch of hospitals and doctors to get paid a single amount by Medicare for every hip replacement and knee replacement operation and for any care that the patient needed for 90 days afterward, including if they needed rehab in a nursing home, which is often one of the biggest expenses. And they set a target price. And doctors who came in under that price would get a bonus, and doctors who came in over that price could get a penalty.

SIEGEL: And that was the Obamacare system.

GOODNOUGH: That's correct.

SIEGEL: Now, how would that change if these changes are adopted?

GOODNOUGH: So what Trump's first HHS secretary, Tom Price, did was come in and cancel one of those programs and sharply scale back another one and said, we need to make these voluntary. We don't want to push doctors into these. We don't want to require them to do it. And we need to take more time to see if it's actually worth it.

SIEGEL: Doctors' groups support that approach?

GOODNOUGH: Doctors' groups generally did support the approach. They did not like being forced into experimental payment programs. But the Obama administration's argument was if you don't make it mandatory for everyone, then a lot of people are going to go really slowly and you're never going to have enough people in it to see if it really works.

SIEGEL: Former Secretary Price is an orthopedic surgeon. And when we talk about hips and knees, we're talking about the bread and butter of a very well-paid specialty in U.S. health care. Are there people saying, you're going too easy on these guys, you should be - we should be roping in what they're charging for a new knee?

GOODNOUGH: Absolutely. I think that there are people who are really concerned and some groups who are really big on payment reform who are really concerned that Price coming in and putting the brakes on some of these programs and canceling some completely was a sign that he was just going to be protecting doctors' incomes and not wanting to move forward with ways to save money and make them think more about the quality of care they're providing.

SIEGEL: Do you know if the nomination of Alex Azar to be secretary of Health and Human Services would have any impact on this or other health care policy questions?

GOODNOUGH: We don't yet. We certainly know that Seema Verma, who is running the Medicaid and Medicare agency for Trump, has showed a commitment to slowing down some of these experiments and giving doctors more of a voice. It's a question mark about Azar. And everybody, doctors' groups in particular, will be watching to see where he comes down on it.

SIEGEL: That's reporter Abby Goodnough of The New York Times. Thanks.

GOODNOUGH: Thank you. Transcript provided by NPR, Copyright NPR.