It’s been more than three weeks since media reports indicated former Louisiana Representative John Fleming, M.D., would serve in a new health IT appointment within the Department of Health and Human Services. Since that report, there has been some clarity regarding Fleming's role at HHS, even as the agency refuses to officially recognize his position.
The appointment was met with surprise and confusion, both because Fleming has limited industry experience and because the newly created position appeared to be at odds with the existing administrative posts within the Office of the National Coordinator for Health IT (ONC). Initially, some wondered if the creation of a new health IT position within HHS signaled a reorganization of the ONC. Those concerns have largely subsided following the appointment of former Siemens executive Donald Rucker, M.D., as national coordinator, although HHS has yet to clarify either appointment.
As a result, health IT associations have been tentative to offer comments about Fleming’s position until HHS makes an official announcement. However, those same organizations were quick to applaud the appointment of Rucker as national coordinator. The American Medical Informatics Association (AMIA) declined to comment on Fleming’s appointment, but applauded Rucker as an “exceptionally qualified informatician.” Similarly, HIMSS declined to comment on Fleming’s appointment, but released a statement that tentatively acknowledged Rucker's appointment and praised him as “thoughtful, extremely knowledgeable, and well informed on a broad range of health IT issues.”
Meanwhile, Fleming has already begun preliminary meetings with healthcare IT groups and industry leaders after he was introduced during an ONC policy and standards committee meeting two weeks ago, and those with knowledge of the meetings say he appears eager to get a better understanding of the agency and health IT policy.
Still, industry experts have been hard-pressed to ignore the uncertainty that surrounds ONC’s new structure.
“It’s still a little confusing and the reporting structure is a little confusing,” Arien Malec, VP of data platform and acquisition tools at RelayHealth who served as co-chair of the ONC’s Health IT Standards Committee, told FierceHealthcare. But he was also quick to point out that this level of confusion is not uncommon during the transition to a new administration.
HHS declined repeated requests to comment on or confirm Fleming’s role at the agency, noting that it was “not commenting on personnel at this time.” Calls and emails to Fleming’s office went unreturned.
That said, here’s what we know about Fleming’s appointment so far:
He has a new title (but it’s just as long as the first one)
Initial reports of Fleming’s appointment indicated he would serve as “deputy assistant secretary for health technology at HHS,” although Fleming said he thought he was interviewing for the national coordinator position. Fleming was introduced by his official title two weeks ago at an ONC committee meeting and it’s nearly as lengthy: deputy assistant secretary for health technology reform.
He will report to Donald Rucker, the ONC’s new national coordinator
During that ONC committee meeting, current Acting National Coordinator Jon White, M.D., said Fleming would report to the new national coordinator. Last week, FierceHealthcare reported that former Siemens executive Donald Rucker would be appointed to that position. Meanwhile, White will resume his role as deputy national coordinator.
He’s no fan of Meaningful Use
Fleming is far from a health IT policy wonk, but many say he brings a new perspective as a family practitioner in Louisiana and an early EHR adopter (he said his practice was fully paperless by 1999). After he was introduced at the ONC committee meeting two weeks ago, he told attendees he had a passion for health IT because he believes that “healthcare is highly dependent on the central nervous system that healthcare IT provides for us.”
But during that same meeting, he also hinted at his distaste for Meaningful Use requirements, noting that vendors found it difficult to help physicians meet the federal requirements that were implemented.
The view reflects a letter (PDF) he signed alongside dozens of other House members in 2015 calling for the Office of Management and Budget (OMB) and HHS to refrain from finalizing Meaningful Use Stage 3 and 2015 Edition EHR certification.
Some see this as an opportunity to find common ground. Leslie Krigstein, vice president of congressional affairs at the College of Healthcare Information Management Executives (CHIME), said reducing the burdens associated with Meaningful Use is an organizational priority.
“From that vantage point [Fleming’s appointment] gives us some optimism or opportunity I would say,” she said.
He’s a staunch opponent of the ACA
While his public positions regarding health IT policy may be relatively sparse, his hatred for the Affordable Care Act is well documented. In 2013, he called the ACA “the most dangerous piece of legislation ever passed in Congress,” a comment that was widely criticized, and even drew a rebuttal from President Barack Obama himself.
Fleming has routinely advocated for a full repeal of the ACA and a replacement plan that will “put patients back in charge of their own care.” In 2015, he introduced a bill that proposed increasing the maximum contribution limits for health savings accounts.
In a 2013 interview on CNN, he debated the merits of the ACA with the law’s architect, Ezekiel Emanuel. At one point, Fleming said Emanuel—who holds a joint appointment at the Wharton School and the School of Medicine at the University of Pennsylvania— was “not a physician in the classic sense in terms of actually seeing patients” adding that he “sits behind a desk, reading all of these studies, and he’s dreaming.”
He co-founded the House Freedom Caucus
Fleming was one of nine Republicans who founded the House Freedom Caucus made up of hard-line conservatives seeking to limit the role of government. The group, which has grown to roughly three dozen members, now holds sizable power within the House, and was (ironically) instrumental in blocking the GOP’s ACA replacement bill, arguing that it didn’t strip away enough of the ACA’s provisions.
He’s likely to serve as a conduit between ONC and the Hill
Several experts that spoke with FierceHealthcare believe Fleming will take on a specific role within the agency, serving as an ONC administrator who can tap into his congressional connections to push forward health IT policies.“There have been questions about the role of ONC and there have been questions about whether they have overstepped statutory authority, and I think actually having someone who has been on the Hill and who can advocate and represent ONC’s position with respect to his former legislative colleagues could actually be helpful for the agency," said Jodi Daniel, a partner at Crowell Moring and the founding director of the Office of Policy at ONC. "Not just what is the agency is doing, but actually helping to communicate out what the agency is doing in a way that helps get support on the Hill."
Malec offered similar sentiments, pointing to prior ONC administrations that have paired a policy expert with someone who has more hands-on health IT experience.
“I’ve advocated in the past for that combination of someone who understands the needs of health IT and someone who understands policy and politics,” he said. “It’s a really good combination because you’ve got a number of constituencies that need to be worked through and there’s a complex relationship between ONC, CMS and Congress and the White House.”
Industry experts also see him as a voice for physicians who have struggled with EHR usability—something HHS Secretary Tom Price has signaled as a priority— and view the creation of a new HHS appointment as a sign that the new administration plans to prioritize health IT.
Others see him as a White House surrogate
At least one former ONC administrator has a markedly different perspective. Jacob Reider, M.D., CEO of the Alliance for Better Health Care, who previously served in several senior administrative positions at ONC, told FierceHealthcare that he believes Fleming was selected to be the “eyes and ears for the White House.” Last month, ProPublica reported that Trump has installed more than 400 officials known as “beachhead teams” to serve as loyal informants for the administration.
“My view is that he isn’t qualified to be the national coordinator and his appointment here to this new position with an unclear role and responsibilities reflects that the administration probably agrees with me,” Reider added.
After he was spotted at Trump Tower in December, Fleming told a Louisiana news radio program that he met with the Trump transition team about finding “some role” in the Trump administration, adding that there are “probably a lot of places I’m qualified for because of my background.”
He’s been a loyal Trump supporter
Fleming was among several lawmakers to voice support for Trump even when other GOP leaders like Paul Ryan were waffling about backing the Republican candidate.
A day after a video was released of Trump making lewd and offensive remarks to TV host Billy Bush, Fleming called Trump’s comments “reprehensible,” but ultimately maintained his support for Trump as president.
Donald Trump's comments are reprehensible. No man should ever speak like that. They are unacceptable under all circumstances. #lasen— Dr. John Fleming (@FlemingforLA) October 8, 2016
Most of his experience is with substance abuse (and his views are a little unorthodox)
Fleming has spent a large portion of his career as a family practitioner with a distinct focus on substance abuse among adolescents.
In 2006, he self-published a book titled “Preventing Addiction: What Parents Must Know to Immunize their Kids Against Drug and Alcohol Addiction.” In it, he advocates for parents to administer drug tests and breathalyzers on their adolescents to prevent them from drinking or doing drugs at an early age. He put that into practice within his own home, requiring his 16-year-old son to take a breathalyzer test every day for two years.
During a 2007 interview, Fleming criticized the American Academy of Pediatrics, the American Psychological Association and the American Academy of Family Physicians for not endorsing the use of home breathalyzer and drug testing.
“I think that some of these organizations are really coming from a policy-locked position, sort of an ‘ivory tower’ type of attitude,” he said. “And I think that those of us parents—and I've spoken with many others—who are in the trenches feel a whole lot different about how we need to use these technologies to protect our kids.”
Editor's Note: This story was updated to clarify that the Meaningful Use letter was signed by members of the House, not Senators, as indicated in the original version.