President-elect Donald Trump has nominated Mehmet Oz, MD, as CMS administrator, and six leaders joined Becker's to discuss what this could mean for physicians.
Question: What could President-elect Donald Trump's nomination of Dr. Mehmet Oz as the leader of CMS mean for physicians?
Editor's note: These responses were edited lightly for clarity.
Marc Comaratta, MD. President and Managing Partner of Montana Retina Consultants (Bozeman): It's difficult to say what the appointment of Dr. Oz for CMS means for physicians. He was clearly picked because of the incoming president's fondness for Republican television personalities. Beyond that, it has been some time since he has been a practicing physician. Does he know the current state of physician reimbursement and regulatory burdens? One would think he still has friends and associates who are physicians who could bring him up to speed. Even if he were aware of today's environment, what power would he have to actually change policy? After all, it is Congress that ultimately determines how much money to allocate to CMS, and it is likely Congress that would have to rewrite the laws to modify or eliminate burdens such as the merit-based incentive program.
Further, it is the stated goal of Project 2025 to involuntarily move every Medicare beneficiary to Medicare Advantage plans, in which case CMS would be reduced to being a mostly feckless overseer of privatized Medicare. Despite the incoming president's attempt to put daylight between himself and the project's authors, his recent hiring decisions for the new administration suggest that Project 2025 participants will play a major role in shaping policy on any number of fronts. I suspect that whether the president-elect was planning on it or not, Dr. Oz has been hired as a genial figurehead to sell America on the privatization of Medicare that began with another Republican administration, that of George W. Bush. The American people, doctors, the debt and the deficit would soon learn that the complete privatization of a nearly unanimously popular social program would not end well for anyone but the insurance companies' C-suites.
Mark Dawson, MD. Senior Partner at Acadiana Family Medical Associates (Rayne, La.): It is helpful that he is a physician, but I am concerned that he does not put much faith in clinical studies. His stance on COVID-19 was too far from mainstream medicine.
Surinder Devgun, MD. Managing Partner of Rochester (N.Y.) Gastroenterology Associates: Unfortunately I am not familiar enough with his (Dr. Oz's) viewpoints and policies to make much of an informed assessment. However, he will be serving at the whim of President Trump and will likely follow his lead in implementing policy. Thus, I would anticipate efforts to reduce drug costs and perhaps some delay implementing the Biden administration's goals to place beneficiaries with accountable care organizations by 2030, thereby prolonging fee-for-service models for the foreseeable future.
David Kaye, MD. Spine Surgeon at Rothman Orthopaedics (Philadelphia): The effect of Dr. Oz's appointment as the head of CMS under the incoming Trump administration on physicians generally, and on surgeons in particular, may be mixed. Dr. Oz has expressed strong support for expanding privatized healthcare models like Medicare Advantage, which he believes may provide affordable and comprehensive care while controlling costs. Unfortunately, as we have increasingly seen over the past few years, Medicare Advantage plans have at times been unnecessarily onerous on physicians and their staff, especially with continued denials and difficulty with pre-authorizations. This has added more financial challenge to already stressed practices and hospitals, and the response has been for some systems to stop accepting some of these plans. Without addressing some of these shortcomings, more widespread implementation and acceptance of Medicare Advantage may prove challenging.
On the other hand, Medicare reimbursements have been continually declining with reported inflation adjusted decreases in reimbursements of over the past 20 years of over 30%. Last year, CMS cut the conversion factor by 3.4%, with another anticipated cut in 2025 and a planned further reimbursement cut of 2.9%. As a former well-regarded surgeon, Dr. Oz may be particularly sensitive to these declines and may finally stem the tide, which would be welcome by all physicians.
Udaya Padakandla, MD. Immediate Past President of the Texas Society of Anesthesiologists: Dr. Oz is a very accomplished cardiothoracic surgeon who rose to the status of professor emeritus at Columbia University in New York. He was involved in developing procedures for various cardiac surgical devices and several patents as well. That certainly makes him a strong candidate for a leadership position at CMS. However, his investments and business positions show a preference to health insurance and pharmaceutical business. On the other hand, I cannot find any references to Dr. Oz's positions on physicians, physician pay, physicians' rights or advocacy for patient-physician relationships.
My wish list for him would be that he will be a strong physician advocate, standing up for restoring a leadership position for physicians in healthcare and in health policy. I would also hope that he will place patients and physicians above the fray of politics and profit-taking businesses, including insurance companies, hospitals and pharmaceuticals. I would hesitate to pre-judge Dr. Oz by jumping to conclusions. I would like to wait to see what disclosures he will make during the run-up to his Senate confirmation.
John Swicegood, MD. Anesthesiologist in Fort Smith, Ark.: As I understand it, Dr. Oz is a proponent of Medicare Advantage plans. In any other world, these plans would be subject to the Racketeer Influenced and Corrupt Organizations Act, racketeering and false advertising. There's a reason physicians and hospitals across the country are dropping these plans due to nonpayment on legitimate claims. I have serious doubts expanding these disadvantageous plans will help patient access and value.
The cartel of Medicare/Medicaid/hospital/insurance companies/Big Pharma will be an extraordinary challenge for anyone to reform. Dr. Oz has proposed a capitation model for healthcare doing away with fee for service. Given the current vertical alignment of employee physician arrangements, I suspect reimbursement to fall further as the cartel will extract the lion's share of payment before a physician ever sees it. Currently, CMS continues to micromanage physicians while expanding documentation to point of infinity. Just this burden explains a great deal of physician burnout and early attrition. Falling reimbursement, hospitals manipulating care, longer work hours; this and numerous other burdens will push many physicians out of practice. Will anyone or anything return healthcare back to physicians? This remains to be seen.