Wednesday, July 31, 2019

CMS/HHS References to President Trump's Leadership

Recently, I ran across a number of HHS/CMS press releases or quotations specifically praising President Trump's vision and leadership, and I wondered how this compared to the Obama era.

See for example:
“Hospitals would be required to post all their payer-specific negotiated rates, which are the prices actually paid by insurers,” CMS Administrator Seema Verma said on a conference call with reporters. “Hospital pricing has been a mystery, but thanks to the leadership of President Trump, those days are over.”
At: MedCityNews, July 29, 2019, here.

Similarly, in a recent speech to the National Kidney Foundation, Secr. Azar remarked, "President Trump has the kind of ambition we need to deliver much better [health] care for Americans, even if it means bold change."

Similarly, in an August 2019 press released regarding a National Coverage Determination on CAR-T therapy, "The Centers for Medicare & Medicaid Services (CMS), under the leadership of President Trump and Secretary Azar, finalized the decision to cover FDA-approved Chimeric Antigen Receptor T-cell, or “CAR T-cell” therapy, which is a form of cancer treatment..."  (Here; my regular business blog on this news, here.)

Once in a while this may be OK, but if it ever becomes mandatory in each press release, it would be a little eerie (sort of like, "Thanks to Comrade Stalin's leadership, the wheat crop has increased by 2%.")

The August 2, 2019 Press Release re: Inpatient Final Rulemaking

For years, CMS has released an inpatient final rule every August.   The press release with the August 2019 edition is titled, "Trump Administration Finalizes Policies to Advance Rural Health and Medical Innovation."

The opening sentence begins, "Today, under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) finalized policy changes to spur competition and innovation..."  The second paragraph begins, "“The Trump Administration is providing relief to rural communities and addressing payment policies that have disadvantaged rural hospitals, making it harder for them to stay open and provide care to the one in five Americans living in rural areas,” said CMS Administrator Seema Verma."

Continuing, "President Trump is strengthening Medicare by clearing the way for Medicare beneficiaries to access the same transformative technologies and treatment options emerging in the private market,” [added] Administrator Verma.  That's four citations to "Trump" in just one routine CMS press release, including the title.


Searching CMS.gov

I used the built-in search function on the CMS website to search for citations to Trump, and there were 101 (that's 40 per year).   Searching for Obama, there are 270 (that's 33 per year).  But wait.  Large numbers of the Trump citations are from public comments on rulemaking where "trump" is used as a verb (rule A trumps rule B), so at least with this simple quantitative measure, Trump occurs less at HHS than Obama, although the Trump citations are sometimes more bold and colorful and memorable, as in the Verma quote above.

Among three Federal proposed rules released this week (for OPPS, PFS, and ESRD/DME), only the PFS rule contains the word Trump, and only once:
On October 26, 2017, Acting Health and Human Services Secretary, Eric D. Hargan declared a nationwide public health emergency on the opioid crisis as requested by President Donald Trump. This public health emergency was renewed by Secretary Alex M. Azar II on January 24, 2018, April 24, 2018, July 23, 2018, and October 21, 2018, January 17, 2019 and most recently, on April 19, 2019. 
A few quirks here.  This implies that President Trump himself can't declare a public health emergency (rather he requests that this be done by Secr. Hargan), and once a public health emergency is declared, it seems to have to be "renewed" at odd intervals every few months.

"President Donald Trump" vs "President Trump"

The Federal Register stylebook isn't consistent on this topic.  Official publications variably name his on first mention as either "President Trump" or as "President Donald Trump."  For example, in contrast to the full-name quote above, "President Trump" without first name occurs (but twice) in e.g. "Nondiscrimination in Health and Health Education Programs," May 2019 (4153-01-P).

CMS Press Release Practices Vary

Whereas an NCD press release (CAR-T NCD) from CMS in August 2019 referred to the impact of both President Trump and Secretary's Azar's leadership, a nearly-contemporary CMS press release about an NCD for acupuncture referred to neither man (here).   Thus, the CMS press room stylebook allows flexibility.






Tuesday, July 16, 2019

Tweetworld and Memory of a Flea

There is the famous question, "Did you stop beating your wife?" which is bad whether answered yes or no.  The Trump tweet here was like that:  You should go back to your country, if you hate it here and would be happier in your country.  That has a logical scaffold like saying, If you don't like tomato soup, don't order tomato soup.  Except it rings the bell of, Go Back To Your Country louder than anything else. 

We should disallow the politics and rhetoric of free-wheeling opposite logic.  DJT loudly decried the failing American system when running for President as a True Patriot- but he wasn't sent back to Scotland or Germany.  When someone else running for president critiques the status quo, now the new rule is, it's unpatriotic.   (And it's infinite: When Obama plays golf, it's horrible; when DJT plays golf, it's wonderful). 

It's this underlying flip flop of logic and frame that is supposed to be revolting to listeners, whether in 1719 or 2019, but in a Tweetworld, it isn't.

https://www.nytimes.com/2019/07/16/us/politics/trump-tweet-house-vote.html