Hahn … in?

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Quick Fix

— Hahn…in?: President Donald Trump nominated oncologist and hospital administrator Stephen Hahn to serve as FDA commissioner Friday — and more news from the agency.

— Google acquires Fitbit; privacy hawks, Congress howl: The search giant’s intent to buy wearables company Fitbit is drawing skepticism from privacy hawks and antitrust-minded lawmakers.

— No price transparency in Medicare payment rules: CMS’ proposal to require price transparency in machine-readable format will be delayed, the agency announced Friday.

And much more. But first, the jump.

eHealth tweet of the day: Shannon Sartin, @sartin_shannon, “Know what telemedicine is great for? Dog bites. Yesterday I got to have a no-pants party showing off my new future scar and talking about deep puncture wounds and infection from the comfort of my own home (not my dog btw)”

MONDAY: Hope everyone’s enjoying their first crisp fall days. (At least that’s what’s up in D.C. — our apologies if there’s a more wintry sting in the air where you are.) Your correspondent thoroughly enjoyed Parasite — you all should see it when it gets to town. Share movie reviews by email at [email protected]. Discuss movies socially at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

Driving the Day

HAHN…IN? — FDA nominee Stephen Hahn, an oncologist and administrator at MD Anderson, doesn’t have a long record on digital health issues (though he was been present for the rollout and financial hangover of the cancer center’s Epic EHR).

Hahn comes with the endorsements of some former colleagues. Thomas Feeley, who worked with Hahn at MD Anderson, told our pharma colleague Sarah Karlin-Smith that Hahn is a “quick study” and “very good problem solver” who would find it easy to get up to speed at FDA and would approach the agency from an apolitical perspective. Hahn also hasn’t taken a lot of money from the pharmaceutical or medical device industries, which may make him an easier sell to senators weighing his nomination, sources tell Sarah Owermohle and Adam Cancryn.

By contrast, acting Commissioner Ned Sharpless would have had an uphill battle to earn confirmation due to perceptions that he’d mishandled the vaping controversy, sources tell Sarah and Adam.

Nevertheless, Hahn’s most important constituency — the senators scrutinizing him for approval — appears to be noncommittal. Lamar Alexander (R-Tenn.), the chair of the Senate HELP Committee, offered a tepid comment: “I look forward to meeting with Dr. Hahn and scheduling a hearing to consider his nomination.”

Alexander’s counterpart on the committee, Patty Murray (D-Wash.), was more skeptical, promising to vet him thoroughly. Murray also said she was “alarmed” by the Trump administration’s choice to install Brett Giroir as the interim acting commissioner of the FDA, citing “his track record of letting ideology drive decisions at the expense of women and families.” Giroir, HHS assistant secretary of health, was reportedly a driving force behind the decision to end fetal tissue research at NIH, a key ask of anti-abortion groups.

— Abernethy at HLTH: Amy Abernethy is focusing on tech fundamentals at FDA, she told our colleague Sarah Owermohle in Las Vegas at the HLTH conference last week.

“When [I first got to the agency], I was talking about personalized medicine and real-world evidence and patient data,” she said on the sidelines of the HLTH conference. “When I got to the agency it was like ‘whoa, wait a second;’ in order to get over there we need to step back and do a couple of things.”

Abernethy became acting CIO “because it became clear that the first thing we needed to do was get our house in order from a technical perspective” to be ready for the wave of real-world data and digital health products on the way, she said.

That’s where thetechnology modernization plan announced last month comes in. Abernethy said it will take 12 to 18 months to “really push it forward” but about six months in, we’ll see the next phase of the plan: “Which is, if we can get the technology in place, then let’s focus on the data.”

GOOGLE ACQUIRES FITBIT; LEGISLATORS, PRIVACY HAWKS HOWL — Tech conglomerate Alphabet, best known for being the parent of Google, announced its intent to acquire Fitbit on Friday for $2.1 billion. The deal fits with the company’s recent emphasis on health care and data analysis, and a company executive said in a blog post that the purchase can help Alphabet improve its wearable devices.

The blog post also made a preemptive acknowledgment of critics, noting, “We will never sell personal information to anyone. Fitbit health and wellness data will not be used for Google ads. And we will give Fitbit users the choice to review, move, or delete their data.”

Still, critics pounced. Twitter was full of privacyworries — and social media gadflies weren’t the only ones. Amid intensifying antitrust investigations into Alphabet by congressional, federal and state officials, some legislators blasted the company’s move.

“By attempting this deal at this moment, Google is signaling that it will continue to flex and expand its power in spite of this immense scrutiny,” said David Cicilline (D-R.I.), the chair of the House Judiciary antitrust subcommittee. “Google’s proposed acquisition of Fitbit would also give the company deep insights into Americans’ most sensitive information—such as their health and location data—threatening to further entrench its market power online.”

Sen. Josh Hawley (R-Mo.) struck a similar note: “Why should Google be permitted to acquire even more companies while they’re under DOJ antitrust investigation?” he tweeted.

NO PRICE TRANSPARENCY IN MEDICARE PAYMENT RULES — CMS is taking a pass, for now, on finalizing its price transparency requirements for hospitals, the agency revealed Friday when it unveiled a new batch of payment rules. Administrator Seema Verma and others in the agency told The Wall Street Journal that they’re working out a way to include insurers. The requirement — controversial in many corners of the industry — has drawn voluminous public comment and threats of legal action.

In other moves, the agency added to the Medicare Physician Fee Schedule a handful of telehealth services codes referring to a bundled episode of care for opioid use disorder treatment.

T-MSIS DATA QUALITY STILL UNRELIABLE — Data contained in the long-gestating T-MSIS project still needs improvement, an analysis presented at last week’s MACPAC meeting suggests. The project is seeking to give researchers and lawmakers access to a much richer set of information than previously available, allowing observers to see more information about what type of care Medicaid and CHIP patients are receiving.

The analysis, commission analyst Chris Park said, was conducted on data as of May 2019 and involved comparing basic enrollment information in two databases: T-MSIS and the more reliable (but bare-bones) benchmark data. While the two databases agreed on total enrollment for 43 states, the numbers beneath the hood often disagreed: In only 25 states did the two databases agree on various subgroups, like adults.

The disagreement suggests there are data-quality problems lurking elsewhere in the T-MSIS data, said Kaiser Family Foundation vice president Rachel Garfield. But she believes CMS and states are working to improve the quality of data, and says even imperfect data might be helpful. “We’ve been in a data hole in Medicaid for years,” she said. “It’s been very problematic, because it’s a time of transition.”

Data quality in T-MSIS has been a long-running concern of various watchdogs. Both HHS’s Office of Inspector General and the Government Accountability Office have penned reports spotlighting those concerns in recent years. The data is expected to go live by the end of the calendar year.

WHAT SUCCESS LOOKS LIKE FOR HEALTH CARE AI — It’s not just plug-and-play, finds a new survey of machine learning and natural language processing from KLAS and CHIME.

Among businesses they examined was IBM Watson Health, whose financial struggles Casey Ross and Ike Swetlitz have documented in Stat. The majority of a small sample of customers told KLAS and CHIME they were happy with the technology, which culls medical literature and clinical notes to make treatment suggestions; they also liked when IBM proactively trained them on data science and was responsive to questions. But when IBM didn’t take a hands-on approach, “organizations struggle[d] to progress and achieve desired outcomes.”

It’s a common misconception among AI customers that once a model is built, it’ll run by itself, KLAS and CHIME noted in the report. The model might not, for instance, apply to certain demographics, and may require assiduous maintenance to ensure the models are viable.

What We're Reading

A San Francisco doctor considers the brusque “bedside manner” of her hospitals’ Epic EHR in a New York Times essay.

Google is trying to build better search functions for electronic health records, CNBC reports from the HLTH conference.

The authors of a study on a racially biased pop-health algorithm pen a blog post pointing one direction forward in Health Affairs.

Two people are claiming to be chief data officer at HHS, FedScoop reports.