Compensation per relative value unit was higher than average, but 2017 was the first year in more than a decade that physician compensation increased by less than 2%.
Physician compensation and productivity were listless in 2017, bucking a decade-long trend that saw annual increases between 2% and 3% in both metrics, a survey shows.
The findings by AMGA Consulting showed median physician productivity declined by a weighted average of 1.63%, while compensation increased only 0.89%.
Compensation per relative value unit was higher than average, but 2017 was the first year physician compensation increased by less than 2% in more than a decade, the survey showed.
"Given the marketplace dynamics, there are several factors that we believe are contributing to this year’s results, including continued effects of EHR's, the aging provider workforce and the continued shift in the marketplace from volume to value," AMGA Consulting President Fred Horton, and COO Wayne Hartley said in an email exchange with HealthLeaders Media.
The weighted average change in median compensation in all medical specialties during 2017 was +1.2%. Weighted average change in median work RVUs was -1.5%, and compensation per work RVU was +3.3%.
For primary care, the weighted average change in median compensation in 2017 was +0.8%. The weighted average change in median work RVUs for primary care was -0.2%, and the weighted average change in compensation per work RVU was +2.3%.
Horton and Hartley say compensation is declining because of productivity declines.
"While compensation plans are shifting to include non-productivity metrics, the vast majority of production-based specialties still have a significant portion of compensation tied to their production (85% typically)," they said.
Horton and Hartley said productivity declines to not appear to be linked to the growth of the employed physician model.
"We have analyzed past years' data related to productivity and compensation levels of independent vs integrated groups. In general, there is relatively the same level of production and similar levels of compensation," they said.
It's not clear if the survey findings are a one-year anomaly or the start of a new trend.
"We believe it is too early to tell, however, regardless, it is a signal that operational efficiencies must be addressed," Horton and Hartley said. "The detail of the survey leads to a conclusion that compensation is flat or declining, production is flat or declining and compensation per unit of production is increasing."
"In this situation, a healthcare organization will pay an increased rate of compensation for each unit of production, however there are fewer units available to cover expenses and since each unit is paid at an increased rate, there is also less margin on those units as in the past. Less throughput and lower margin for that throughput, equate to worse financial performance, unless operational efficiencies can be created to make up for the margin decline. It is a significant wake up call to address operations and focus on execution of the creation of efficiencies," they said.
Squeezing the Turnip
Travis Singleton, executive vice president at physician recruiters Merritt Hawkins, and who did not participate in the survey, says the AMGA findings are not surprising.
"This is in part a case of getting the behaviors you reward," Singleton says. "If you reward documentation and process, rather than number of patients seen or volume of patient care delivered as measured by RVUs, that's what you will get."
Singleton says a growing number of productivity bonuses feature value-based metrics, which include quality documentation, adherence to treatment protocols, etc., while de-emphasizing number of patients seen and RVUs.
"Last year, 43% of contracts we saw with production bonuses featured a valued-based component, up from 7% in 2011," he says. "Value is harder to measure than volume and this may be reducing comp based on what now is considered "productivity.' It's no longer see more patients, rack up more RVUs, get more pay."
Singleton said some studies suggest that physician productivity may be close to topping out. He said a 2016 survey Merritt Hawkins conducted for The Physicians Foundation found that 80% of doctors are either at full capacity or are overextended, and only about 20% said they had the time to see additional patients.
"You can only squeeze so much juice out of the turnip," he says.
Horton and Hartley say the stagnant compensation and productivity metrics for physicians reflect a "very unsettled environment" as the healthcare sector transitions to value.
"Organizations must prepare for the shift by putting in place new systems and support to prepare for the shift. So, you have an unsettled operating environment and some degree of confusion on if the focus should be volume or value," they said.
"The degree integration has occurred over the past 5-10 years is significant," they said. "There are organizations with multiple EHRs, specialties that consist of several previously competitive practices and so on. More emphasis on operational capabilities, than on acquisition and growth, will likely be the next required phase."
The not-for-profit health system says it will 'transition' out of acute care services by the end of 2018 and focus on population health, outpatient services, and removing barriers to care access.
Providence Health System will close its money-losing 283-bed hospital in the District of Columbia by the end of this year, and realign itself toward outpatient and population health services, the health system announced this week.
"We know that 15% of a person's life is spent in actual healthcare, which means the remaining 85% is spent in other areas that either positively or negatively impact their overall well-being," Providence CEO Keith Vander Kolk said in a media release.
"That is where the greatest opportunity to make meaningful change lies, and we must put our focus and energy on advancing a model of transformation that will serve the District in new and lasting ways," he said.
Not-for-profit Providence, which is owned by St. Louis-based Ascension, said its "new community-focused perspective" will look to enhance care coordination, telehealth/virtual care, primary and urgent care, home care, community-based behavioral healthcare, and senior care.
The closure of the Northeast D.C. hospital comes nearly a year after Providence announced plans to create an integrated "Health Village to encompass more than traditional healthcare services" and follows a national care delivery trend that focuses on access and preventive measures.
"While the acute-care mission of Providence has been so important and appreciated for over a century, Providence has also been known for adapting to the changing health needs of the community," said Sister Carol Keehan, DC, CEO of the Catholic Health Association of the United States.
"Changing its focus to providing preventive health and wellness in collaboration with the community marks a new phase in its commitment," Keehan said.
The joint venture with WellTower is being hailed as a 'first-of-its-kind partnership' and it gives not-for-profit ProMedica immediate scale in the fast-growing home health and post-acute care markets.
ProMedica Health System this week finalized its acquisition of bankrupt HCR ManorCare in a $3.3 billion deal that makes the 13-hospital, Toledo-based health system one of the largest in the nation by revenue.
The joint venture with real estate investment trust WellTower was hailed as a "first-of-its-kind partnership" when it was announced this spring,and it gives not-for-profit ProMedica immediate scale in the fast-growing home health and post-acute care markets.
"I hate to say we are in uncharted waters here, but it seems to be a unique, first-of-its-kind partnership. A nonprofit health system, a large post-acute provider and a real estate investment trust as partners is unique," ProMedica CEO and President Randy Oostra said in an interview with HealthLeaders Media this spring.
"We are in a non-growth market. How do we grow as a system? How do we begin to diversify? We have a health plan, we have hospitals, we have a physician group. Being more diversified in this space made sense," he said.
Toledo-based HCR ManorCare is the nation's second-largest provider of post-acute and long-term care. The company filed for bankruptcy protection in March with $7.1 billion in debts, owing largely to declining Medicaid and Medicare reimbursements. Its real estate assets were held by its landlord, Quality Care Properties.
S&P Global Ratings notes that HCR has annual operating revenues of about $3.7 billion, which doubles ProMedica's overall revenue base.
The acquisition creates a $7 billion not-for-profit healthcare network with 70,000 employees in 30 states, making ProMedica the 15th largest health system in the nation, as measured by annual revenues, ProMedica said.
Under the deal, Welltower owns 80% of the HCR real estate and ProMedica has a 20% stake, while ProMedica owns 100% of the HCR's operating company. The health system is using $470 million of cash and a $1.15 billion one-year bridge loan with Barclays to pay for the acquisition.
S&P said this week that its "A+" long-term ratings for ProMedica would hold unchanged with the deal's closure, but that could change because the ratings are now on CreditWatch with negative implications.
"While the CreditWatch Negative listing implies there is at least a one-in-two chance of a downgrade, we note a downgrade of more than one notch is possible, given the significant additional debt and cash usage to fund the acquisition," S&P said Friday. "In addition, the transaction involves other risks, including integration, and expansion into a new businesses sector that has faced significant challenges."
On the upside, S&P said the deal would diversify ProMedica into the post-acute care space, improve cash flow, and take advantage of synergies if the health system sells off money-losing HCR assets.
New Jersey's largest health system will invest $100 million initially, and $50 million each year over 20 years to expand education and research, and improve access to healthcare.
RWJBarnabas Health announced this week that it will invest more than $1 billion in a public-private partnership with Rutgers University to create "a world-class integrated academic health system."
"This is a transformational partnership for RWJBarnabas Health and Rutgers University, but, more importantly, for the people of New Jersey and beyond," RWJBarnabas Health President and CEO Barry H. Ostrowsky said Tuesday at a media briefing in New Brunswick.
"Together, we are poised to develop a widely renowned academic health system, driving medical innovations and clinical research to influence outcomes across the nation," he said.
Rutgers Biomedical and Health Sciences Chancellor Brian Strom said the partnership will create a medical group of more than 2,500 employed physicians from RWJBarnabas and Rutgers Health, making it one of the nation's largest medical groups.
"This unparalleled enterprise will further our shared goal to grow research activities and expand clinical trials statewide," Strom said. "Becoming an integrated academic health system will enable us to expand our academic and research mission so we can better train tomorrow's clinical workforce and quicken the pace of discovery for patients."
RWJBarnabas and Rutgers will remain separate organizations, each keeping their own employees and independent boards, which will form a joint committee for strategic planning and oversight of the academic health system.
Clinical services will be led by RWJBarnabas. Academic and research functions will be managed and led by Rutgers.
In addition to the medical group, RWJBarnabas Health will invest $100 million, and then more than $1 billion dollars over 20 years for education and research at the health system, that will include:
The construction of a clinical and research building for the Rutgers Cancer Institute of New Jersey, and a new ambulatory care center, both located in New Brunswick.
Recruiting clinical and academic faculty, including 100 principal investigators by Rutgers over 10 years who will double the university's research capacity;
$10 million for incentives to keep graduating Rutgers medical students in New Jersey;
Expanding residency and fellowship programs across New Jersey;
Expanding inter-professional clinical training for medical, dental, nursing, pharmacy, and other health professional students;
Expanding access to clinical trials of new and promising treatments to New Jersey.
"Through this partnership, we have formed the largest and most comprehensive academic health system in New Jersey and are well positioned to take our place as a national leader in patient care, health science discovery and innovation," Rutgers University President Robert Barchi said.
RWJBarnabus Health, New Jersey's largest health system, was formed in 2016 with the merger of Robert Wood Johnson University Hospital and Barnabus Health. The system includes 11 acute care hospitals, four pediatric hospitals, a 100-bed behavioral health center, and outpatient offices that provide care for more than five million people in a nine-county catchment area.
The health system is also New Jersey's largest public employer, with more than 33,000 employees, 9,000 physicians and 1,000 residents and interns.
Rutgers Biomedical and Health Sciences includes eight schools, a behavioral health network, and six research centers.
The nonprofit healthcare researcher and repository is building a website that will replicate much of the data found on the now-defunct National Guidelines Clearinghouse.
The ECRI Institute will step in to provide critical healthcare data that otherwise became unavailable this week when the federal government's National Guidelines Clearinghouse fell victim to the budget axe.
Karen M. Schoelles, MD, a senior director at ECRI Institute, said the Plymouth Meeting, Pennsylvania-based nonprofit stepped in after the Agency for Healthcare Research and Quality announced that the NGC website would shut down on July 17.
She said ECRI has the opportunity to replicate much of NGC's vast trove of evidence-based medical research and guidelines because it has played an ongoing role in the development and maintenance of the database since its inception in 1998.
"Much of the information will be similar, but our site will not be a replica of the site created for AHRQ," Schoelles said in an email to HealthLeaders Media.
"We are doing this because we believe the work we did for AHRQ was valuable to the healthcare community," she said. "ECRI's mission is to advance evidence-based health care globally, and we see this as a way to support that mission."
Schoelles said ECRI is developing the replacement database "without support or input from AHRQ" but with a plan to "simplify presentation of the information and use more visual means of communication."
"Eventually we will develop tools to help people put evidence-based recommendations into practice," she said.
ECRI is also contacting guideline developers and requesting permission to include their data on the website.
"We know already that some of the organizations whose guidelines were on the AHRQ Clearinghouse website are happy to share their information with us," Schoelles said.
"Once they share their guidelines with us, we will summarize them and evaluate them against the National Academy of Medicine's criteria for trustworthy guidelines," she said.
Budget Cuts
AHRQ spokesperson Alison Hunt said the NGC website was forced to shut down on July 17 after funding was reduced from $2.1 million to $1.2 million. Hunt said it's not clear if the shutdown will be permanent.
"We are exploring options to sustain the NGC and will share more information when it becomes available," Hunt said.
The American Hospital Association this week urged AHRQ to reconsider the NGC shutdown, calling the database "a valuable resource to clinicians and healthcare organizations in the United States and across the world for two decades."
"It provides easy access to evidence-based guidelines for practice, helping busy clinicians develop plans of care for patients, allowing healthcare organizations to create standard protocols for practice, embed decision support for their clinicians, and reduce practice variation to ensure the best outcomes for their patients," AHA said.
AHRQ acknowledged in a statement on its website that the decision to close the NGC, which had been getting about 200,000 hits each month, has "elicited significant feedback from the healthcare field."
"The Agency appreciates the passionate support that users have expressed. AHRQ is exploring options to support the NGC in the future and will continue to do so even while the site remains offline," AHRQ said.
Fees Envisioned
Schoelles said ECRI plans to "charge subscription fees to support the staff required to do this work, building our Website, and paying copyright fees."
"As a nonprofit, we cannot support the work entirely on our own, but we will do our best to keep subscription fees reasonable," she said.
ECRI is building the Website now and developing the content, with an aim to launch the site in early autumn.
"We plan to offer institutional and individual subscriptions, although working out the details for the latter may take a little longer," she said.
Commissioner Scott Gottlieb says the proposal would improve competition, expand access, empower consumers, and provide more affordable options.
The Food & Drug Administration is floating new guidelines that would lift restrictions on some prescription drugs and make them available to consumers over the counter.
"We're very mindful of the time and financial cost to patients and the healthcare system to fill a prescription medicine—particularly one taken repeatedly for chronic conditions," FDA Commissioner Scott Gottlieb, MD, said in a media release.
"Our hope is that the steps we're taking to advance this new, more modern framework will contribute to lower costs for our healthcare system overall and provide greater efficiency and empowerment for consumers by increasing the availability of certain products that would otherwise be available only by prescription," he said.
Gottlieb said the proposed rule "will clarify the requirements for a drug that could be marketed as a nonprescription drug with a requirement that ensures appropriate self-selection by consumers, appropriate actual use, or both, in order to obtain the drug without a prescription."
The over-the-counter access could include cholesterol-lowering drugs, and Naloxone, the opioid effects blocker sold under the brand names Narcan and Evzio.
Digital technologies, such as cell phone apps, could be used to help consumers understand the appropriate use and dosage for the drugs, the potential side effects, and possible interactions with other drugs or alcohol.
Gottlieb said the proposed guidelines apply to drugs under the FDA's New Drug Application process "and is intended to extend that NDA pathway to include therapeutic indications that have not, historically, been available for use without a prescription."
If consumer safety requirements can be demonstrated under the new guidelines, Gottlieb said drug makers could apply for nonprescription status.
"We see today's draft guidance as a first step as drug developers begin to study products that might be considered for marketing without a prescription," Gottlieb said. "We intend to continue this effort with proposed rulemaking in the near future and will provide additional information as we move forward."
CVS wants to eliminate 'pay-for-delay agreements' among drug makers, while the pharmaceutical lobby calls for 'delinking supply chain payments from the list price' for PBMs.
CVS Health and PhRMA are blaming each other for high drug prices.
In separate letters this week to Health and Human Services Secretary Alex Azar, the pharmaceutical lobby and one of the nation's largest pharmacy benefit managers offered diametrically opposite explanations—and remedies—for the high drug prices that have left consumers reeling.
"Until drug manufacturers reduce the high price they set for these drugs, we know this problem is not going away," CVS said, in response to a request for information by the Trump administration's blueprint to lower drug prices.
Among its suggestions, CVS urged HHS to improve competition in the pharmaceutical industry by reducing artificial barriers to cheaper generic alternatives.
"More must be done to make generics available, including expanding the use of biosimilars, and eliminating tactics that stall competition," CVS said.
"We believe the Administration should support shortening the exclusivity period for biologics from twelve to seven years, and finalize interchangeability guidance, which is key to expanding adoption of these lower cost alternatives," the letter said.
CVS called for a ban on "pay-for-delay agreements" that it said would limit anticompetitive schemes by drug makers and bring generic equivalents to the market more quickly.
PhRMA's Version
In its letter to Azar, PhRMA pushed for reforms that prevent PBMs and other supply chain middlemen from calculating their compensation as a percentage of the list price of a medicine, instead of a charging a fee based on the value of their services.
PhRMA CEO Stephen J. Ubl said that the way drugs are paid for in this country "has evolved into a complex system of list prices and rebates that move through an opaque supply chain. A medicine's rebate—rather than its actual price—often determines if it is covered or where it sits on a formulary."
Because rebates are based on a percentage of a medicine's list price, Ubl said PBMs have incentives to want higher list prices.
"This creates an unfair system in which patients are often paying higher list prices regardless of the discount their insurer receives," Ubl said. "Reforms to prevent PBMs and others in the supply chain from being paid off the list price of a medicine can fix broken incentives and make the system work better for patients."
PhRMA claims that more than one-third of the list prices that are set by drug companies is rebated back to supply chain middlemen, which it said totaled $150 billion in discounts last year.
Ubl conceded that "delinking supply chain payments from the list price will be disruptive and requires our companies and others to adapt, but it is necessary to improve patient affordability."
"We hope realigning these incentives will result in a greater shift toward value and lower costs for patients," he said.
FTC Weighs In
Federal Trade Commission Chairman Joe Simons, in comments to HHS, complained about "regulatory barriers and abuse of government processes that delay and constrain competition," which he said "lead to higher prices and reduce access to those medicines – all to the detriment of consumers."
The FTC said the Blueprint should focus on the "misuse" by the pharmaceutical industry of Risk Evaluation and Mitigation Strategies programs, using regulatory or legislative action.
"REMS programs can protect the public from pharmaceutical abuse, but they can also be misused to disrupt competition and innovation," FTC said in its remarks to HHS. "Branded manufacturers may abuse REMS programs by refusing to make product samples available to generic manufacturers and by denying access to shared REMS systems, both of which are necessary for generic firms to obtain approval for biosimilars from the U.S. Food & Drug Administration."
The FTC also called for removing barriers to competition for biologics, which the commission said has become the "fastest-growing and one of the most expensive segments of prescription medicine."
"Certain FDA regulations create unnecessary barriers to biosimilar and interchangeable competition," the commission said. "The FTC recommends that the FDA reconsider its naming guidance for biologics and expedite the approval process for interchangeable biosimilars, which likely would increase market acceptance and competition for lower cost biosimilar products."
The former president of Philadelphia's Juniata Community Mental Health Clinic bought buildings that housed the clinics, used clinic money for renovations, and raised the monthly rent from $4,500 to $75,000.
A Philadelphia woman was sentenced to nearly seven years in prison for stealing more than $2 million from the nonprofit mental health clinic she managed, the Department of Justice announced.
Renee Tartaglione, 62, the former president of the Board of Directors of the Juniata Community Mental Health Clinic, was convicted by a federal jury in June 2017 of 53 counts of conspiracy, fraud, theft and tax crimes.
A U.S. District judge this month ordered Tartaglione to serve 82 months in prison followed by three years of supervised release.
Evidence presented at last year's trial showed that, between 2007 and 2015, Tartaglione purchased a building on 3rd Street in Philadelphia that housed the clinic and then raised the rent repeatedly, from $4,500 per month to $25,000 per month.
In 2010, Tartaglione bought a building on 5th Street, and Tartaglione used clinic money to improve it. In December 2012, Tartaglione leased the 5th Street building to JCMHC for $35,000 per month for the first two years, and $75,000 per month for the next three years; charges for both buildings that were substantially higher than market rates.
None of the JCMHC rent increases or the lease agreements were approved by JCMHC's board, and prosecutors showed that Tartaglione created fictitious documents to make the transactions appear legitimate.
Tartaglione was also ordered to forfeit $2.4 million from her scheme, and to pay $2.3 million in restitution to the Pennsylvania Attorney General's Office, which will hold the money until a successor charitable organization can be identified.
"The defendant funneled millions of dollars, meant to help economically disadvantaged people with mental health issues, into her own pockets to finance her comfortable lifestyle," U.S. Attorney William M. McSwain for the Eastern District of Pennsylvania, said in a media release.
"(This) sentence reinforces the basic precept that nonprofit organizations – especially those that provide important services to the disadvantaged – exist for the people they serve and not for the personal enrichment of their leaders," McSwain said.
The publicly operated health plan will pay for scholarships, loan repayments, and recruiting costs for primary care doctors serving Los Angeles County's safety net.
L.A. Care Health Plan will honor eight students this Thursday as the first group to receive full medical scholarships through the plan's $31 million initiative to provide more primary care physicians for the county's underserved populations.
The scholarships program is one of three grant initiatives sponsored by L.A. Care, which will also offer loan repayment for primary care physicians who agree to serve safety net populations, and which will underwrite recruiting costs for safety net clinics.
John Baackes, CEO of L.A. Care Health Plan, the nation's largest public-operated health plan, spoke with HealthLeaders Media about the initiative.
The following is an edited transcript.
HLM: This $31 million is over how many years?
Baackes: It's $31 million this year and we will repeat that for perhaps five years and segregate the money into a board-designated fund. I do not know what the draw on this will be in terms of people applying for it. My hope is that we don't spend it all in the first year, that it sits there and we create an endowment so this can go on for more than five years.
HLM: Why $31 million?
Baackes: We looked at a similar program done in San Bernardino and Riverside County through Inland Empire Health Plan, and over four years they spent $31 million and added 230-some-odd providers to the county.
We are much bigger of a county than San Bernardino, and the deficiencies at the primary care level we know now it's about 9,000 statewide. Martin Luther Kingdid a survey of their catchment area, which is representative of the communities most of our members live in, and we said let's use that number.
We're taking it out of unassigned reserves, which sit at about $477 million. We said let's segregate that amount and see what the demand is and if we're able to continue to operate at the margins we've got over the next few years, we would be able to do similar set-asides in future years. It wasn’t very scientific but it segregates the funds and now we can start the program.
HLM: Who is eligible?
Baackes: There are three elements to the program. The first one of immediate importance is that we will offer grants of up to $125,000 to organizations that employ primary care physicians that would be in our network. In other words, they are working for organizations that will serve the uninsured and other vulnerable populations. That would include every federally qualified health center that contracts with us, all Department of Health services, primary care clinics around the county, and any medical group that is contracted for the Medi-Cal population. They can apply for these funds.
So, there is the grant that goes to the organization that employs the physician. Then, we assume those physicians will also have medical school debt. We will also do payoff the loan and we will do that through our grant to a third-party organization that makes the loan payments on behalf of the student, so the student doesn't have a tax consequence.
Under the loan repayment arrangement, we want them to stay for three years. We will pay off the whole thing in monthly payments. If they leave before the three years is up, we will only have paid the monthly payments up until they time they leave. So, it's an enticement to get them to stay.
We're also trying to build a pipeline for the future. We have medical schools here in L.A. County, so we would like to support those medical schools by offering scholarships to students who commit to coming back to L.A. after they have their licensing and are practicing. We are doing eight scholarships and the students have already been picked who are coming in this year. They understand it is a free ride and they've made the commitment.
HLM: Why only primary care physicians?
Baackes: There is a demand for specialists and mid-levels. But if you don't have the primary care doctors, who are central to the Medi-Cal program, it doesn't matter about the rest of it. So, for year one, to see what the demand is, we will limit this to primary care doctors who are new to L.A. County, or who are new to the safety net. We don't want organizations to hire doctors from across the street and have them steal a doctor from another safety net provider. That is not the point.
HLM: Do you have a target number of recruits?
Baackes: Between that and the loan repayment and scholarship programs we would hope to we can get 50 doctors a year brought into the system under this program.
HLM:Why a three-year commitment from physicians?
Baackes: In talking to the institutions that employ these doctors, they said they wouldn't hire anyone who wouldn't commit to at least three years because the cost and time it takes to recruit physicians is a big investment. We said we would match that expectation, and the grant will add some oomph to that in terms of adding to the doctors' commitment.
HLM: Are international students eligible?
Baackes: Absolutely! If they are a licensed physician. How they got the medical license is not a qualifier, as long as they can be credentialed into our system.
HLM: How will you measure this initiative's success?
Baackes: MLK, in their catchment area, determined that there was a shortage of about 600 primary care doctors. It's about getting the doctors into L.A. County and placing them in the geographies that are important. So, our measurement will be volume and placement in the correct geographic areas. We don't need more doctors in Beverly Hills. We need them in South L.A.
HLM: Why is it so difficult to get primary care physicians in these underserved areas?
Baackes: One of the biggest expenses these places have that they can't afford are the replacement costs. We said of that $30,000 or $40,000 for a recruiter, use part of the grant money to pay for that and use the rest to support the salary of the doctors. The doctor is going to get paid by the organization, but they are using our grant to help them do that.
The problem they're having is that when doctors are recruited in L.A. County, Kaiser Permanente outbids everybody. The safety net clinics cannot match Kaiser's salary and benefits. Or, they can't match the teaching institutions that might hire these doctors to be in their clinics. So, if this allows that organization to boost the salaries so they can compete, then great! We've done some good.
HHS denies former secretary's chartered airplane trips were unauthorized 'as a matter of law' and says federal auditors made 'legal conclusions' that overstepped their authority.
Federal auditors are urging the Department of Health and Human Services to recoup more than $341,000 in unauthorized air travel expenses that led to the ouster of former Health and Human Services Secretary Tom Price.
"Of the 21 trips, we determined that for one trip all applicable federal requirements had been followed," HHS's Office of the Inspector General said in a 58-page audit released Friday. "The remaining 20 trips did not comply with federal requirements, including all 12 chartered aircraft trips."
"Overall, we determined that the use of chartered aircraft and identified noncompliance issues resulted in waste of federal funds totaling at least $341,000," the audit said, with a recommendation that HHS "determine appropriate administrative actions to recoup" the expenses.
Price, an orthopedic surgeon, was forced to resign last September, eight months after his appointment, after reports of his travel abuses surfaced.
HHS Deputy Secretary Eric Hargan conceded the sloppy documentation for air travel, and said HHS has since "instituted new travel review procedures applicable to all political appointees" that he called "most rigorous controls on travel in the organization’s history."
However, Hargan said auditors were not tasked with determining whether Price broke the law.
"The work of an audit is to review compliance with procedures, not make legal conclusions. As a matter of law, none of the travel at issue was unauthorized," Hargan said in amedia release.
Specifically, auditors said that Price's use of chartered aircraft was noncompliant with federal guidelines because the former secretary did not do a cost comparison to commercial airline services, did not adhere to contract requirements, and did not properly authorize the use of chartered aircraft.
"We also found specific instances of noncompliance related to the travel records for former Secretary Price and certain HHS travelers," the audit said. "Insufficient review of authorizations and vouchers and many employees' failure to complete required travel card training contributed to these instances of noncompliance."
In January, Price was named on the advisory board Jackson Healthcare, an Atlanta-based staffing firm that declined to detail his compensation.
"Nobody has as profound an understanding of the national healthcare landscape as Dr. Price," Richard L. Jackson, chairman and CEO of Jackson Healthcare, said in a January media release.
