White House denies Shulkin’s firing was about privatization

With help from Arthur Allen (@arthurallen202) and Darius Tahir (@dariustahir)

WHITE HOUSE DENIES SHULKIN’S FIRING WAS ABOUT PRIVATIZATION: Former Veterans Affairs Secretary David Shulkin, fired via Tweet on Wednesday night, says he was pushed out because he didn’t move fast enough on privatizing VA health care — a claim the White House summarily denied.

In a New York Times op-ed published online late Wednesday, Shulkin argued that the White House considered him “an obstacle to privatization who had to be removed,” and that he was “convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans,” POLITICO’s Andrew Restuccia and Louis Nelson report.

President Donald Trump’s comments during a speech in Ohio Thursday seemed to signal support for privatization, but a spokesperson said the nomination of presidential physician Ronny Jackson as Shulkin’s replacement had nothing to do with it, POLITICO’s Cristiano Lima reports.

“We’re going to have real choice,” Trump said Thursday. “That’s why I made some changes — because I wasn’t happy with the speed with which our veterans were taken care of. I wasn’t happy with it.”

Still, deputy press secretary Lindsay Walters said in an email that "[n]o one is talking about privatizing the VA,” Cristiano reports.

… Whatever the reason for his firing, Shulkin has been unmuzzled. In an NPR interview Thursday morning, Shulkin said he wasn’t allowed to defend himself after reports that he used taxpayer dollars to fund a leisure trip in Europe. “There was nothing improper about this trip, and I was not allowed to put up an official statement or to even respond to this by the White House,” he said. “I think this was really just being used in a political context to try to make sure that I wasn’t as effective as a leader moving forward.”

Shulkin also gave his first televised interviews since his removal Thursday night on the PBS News Hour and All In with Chris Hayes.

Read Andrew’s and Louis’s full POLITICO story here, and Cristiano’s here.

NO MORE CLARITY ON CERNER DEAL: Wells Fargo analysts see the abrupt leadership change as a disruption to the presumed contract with Cerner, potentially delaying the award by many months.

As Morning eHealth reported, Shulkin had yet to ink the deal with the EHR vendor for a $16 billion EHR system replacing VistA, and the VA has not said who will oversee that contract.

“This disruption in leadership at the VA puts in doubt the timing (and potentially the certainty) of CERN signing a long-awaited $10+ billion deal to modernize the VA infrastructure for medical records,” Wells Fargo analysts said in a note published Thursday.

The VA is unlikely to sign the contract while it tries to resolve the leadership gap, analysts wrote, especially as “questions are already surfacing about Jackson’s preparedness to run the almost $200 billion VA system.” Jackson is a rear admiral who has served in the White House for more than a decade but was a surprise pick with limited management experience.

Analysts didn’t think the shakeup would cause the VA to select another vendor, just wait to finalize the agreement with this one.

APPLE EXPANDS OUT OF BETA: The iPhone purveyor has expanded the number of health care providers whose patients can access their medical records directly through the Health app, about two months after launching the pilot.

Patients in 39 health networks can update their phone’s software to iOS 11.3 and view their medical records through the iOS Health app, according to Apple. As we reported earlier this month, many participants have remained silent on how useful patients have actually found the service, but the partnership between Apple and major EHR vendors could lead to increased investments in APIs.

Apple worked with Epic, Cerner and athenahealth to adopt the FHIR data exchange protocol so that records can flow directly into patients’ Health apps, instead of requiring them to log in through providers’ portals each time. The participating health systems collectively cover hundreds of clinics and hospitals, according to a company blog post.

The full story, for Pros, here.

eHealth Tweet of the day, appearing to quote expected CMMI pick Andrew Boehler: Lucro @LucroSolutions: Live from the Heritage Group annual meeting: “If I were in a position to influence gov’t policy I would have 2 priorities: (1) ensure data is as free and transparent as it can be, (2) align incentives to reward for doing the right thing” - @LandmarkHealth‘s Adam Boehler

And this, from the former CIA director under Obama: John O. Brennan @JohnBrennan: I personally know and greatly respect Ronny Jackson....as a terrific doctor and Navy officer. However, he has neither the experience nor the credentials to run the very large and complex VA. This is a terribly misguided nomination that will hurt both a good man and our veterans

Welcome to FRIDAY at Morning eHealth, where your author is heading home to Pittsburgh to indulge in some comfort food. Anyone else from the Steel City out there? Send your favorite bits of Pittsburghese and news tips to [email protected]. Or yinz can reach us socially at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro, @Morning_eHealth.

BIDEN TALKS CANCER MOONSHOT ON POD SAVE AMERICA: Former Vice President Joe Biden plugged the Cancer Moonshot, the public-private partnership intended to accelerate research — most prominently, immunotherapy — on Pod Save America this week.

“Cancer is the only bipartisan thing out there,” Biden said. “I remember Trump came along, he wanted to cut $9 billion from NIH and they not only didn’t cut it, the Republicans, they added two more billion.”

He noted that VA medical centers are using IBM’s Watson technology to analyze patient genomes and suggest possible treatment options and their likelihoods of success, a step toward personalizing treatment. Watch the full interview here.

WISHING FOR OUTCOMES-BASED DRUG DEALS — FOR MEDICAL-DEVICES: A new blog post in Health Affairs stumps for outcomes-based deals for medical devices. It’s a twist on a discussion we’ve had a few times before focusing on drugs: people (who aren’t sick) feel intuitively that insurers should pay only for therapies that work.

But, as we’ve cautioned before, defining what “works” requires a lot of data. And to figure it out, you typically need to download a lot of electronic health records and judge whether the health outcomes they chart reflect the result of a given intervention. Besides the conceptual challenges, it’s just hard to get your hands on good records en masse. The Health Affairs authors have a suggestion that would be relatively easy to implement: use patient-recorded outcomes. That would make for easy administration, but — we suspect — might attract some skepticism about its validity as a measurement for success.

MEDICARE ACOS BUMPED UP FEDERAL SPENDING: The Medicare Shared Savings Program has performed below its 2010 CBO estimate, increasing federal spending by $384 million between 2013 and 2016, according to an analysis from Avalere. Actual ACO net savings fell short of CBO projections by more than $2 billion. The ACO program hasn’t achieved the expected savings because most ACOs have opted for a bonus-only model, Josh Seidman, senior vice president at Avalere, said in a statement.

UNDER ARMOR SAYS MYFITNESSPAL HAS BEEN HACKED: The sports attire and tech company says about 150 million accounts on MyFitnessPal, a nutrition tracker, have been breached, according to Bloomberg News. Under Armor reportedly says an authorized user stole data in late February, that it learned of the breach earlier this week, and has already alerted users.

WHAT WE’RE CLICKING ON

—Doctors might not see patients’ last wishes in their medical records.

—Telemonitoring could reduce appointmentsfor low-risk pregnancies.