Tom Price’s resignation Friday as Health and Human Services Secretary, after just seven months in the position, leave HHS in a leadership void as it faces several ongoing challenges.

Ascending to fill his role in the interim is Don Wright, MD, of Virginia, who Trump has named to serve as acting secretary this past February. He currently serves as deputy assistant secretary for health in HHS.

Until now, Wright has been responsible for leading development of HHS-wide public health policy recommendations, overseeing 12 core public health offices, including the Office of the Surgeon General, and 11 advisory committees. He is also the Deputy Assistant Secretary for Health and Director of the Office of Disease Prevention and Health Promotion, a role he’s filled since 2012.

Don Wright, MD
Don Wright, MD

As head of HHS, among Wright’s new responsibilities is the Office of the National Coordinator for Health Information Technology (ONC), which oversees health IT policy and direction. ONC is expected to face new challenges in the coming year, as it deals with a reduced budget, new responsibilities for overseeing direct responsibility for certifying electronic health record software and the transition of the Meaningful Use program for physicians into the Merit-based Incentive Payment System (MIPS) for physicians treating Medicare beneficiaries.

The challenges of overseeing ONC will be dwarfed by the responsibility he’ll have as the transitional leader of HHS. The agency controls nearly $1.15 trillion in expenditures for Fiscal Year 2017, 86 percent of which goes to fund both Medicare and Medicaid; the agency is staffed by about 80,000 employees.

Price joined Congress in 2005 and was one of the original members of the Tea Party, which promotes small government. While his nomination to head HHS was backed by the American Medical Association, that group and almost every other healthcare trade organization issued strong statements opposing the administration’s Obamacare-repeal attempts.

Price was a vocal proponent of efforts to roll back the Affordable Care Act, carrying over the opposition that he offered as a U.S. Representative from Georgia. He was respected by colleagues, but in the highly partisan debate on bills in Congress, his impact on securing support for repeal legislation is difficult to discern.

Price, as a physician in Congress and as HHS head, was sympathetic to front-line provider concerns. He was supportive of information technology, but spoke out against documentation requirements for physicians, and particularly how electronic health records have introduced additional work for doctors and impeded relationships with patients.

Under Price’s leadership, HHS has continued research efforts at the Center for Medicare & Medicaid Innovation, which is tasked with finding new approaches such as value-based care and other reimbursement initiatives. Emerging CMMI pilot programs will eventually affect providers. Some programs—in particular, mandatory bundled payment initiatives for cardiac care and joint replacement—might be scaled back under a proposed rule issued in September by the Centers for Medicare and Medicaid Services.

Price’s resignation strengthens the hand of Seema Verma, who leads CMS and is responsible for running that agency and enacting much of the Affordable Care Act. Another is potential candidate for the lead position at HHS is Scott Gottlieb, the Food and Drug Administration commissioner, who has instituted several drug price programs and is updating FDA practices.

Verma is well known by the administration. She worked with Vice President Mike Pence to implement the Healthy Indiana Plan while he was governor and has been highly visible in supporting efforts to repeal Obamacare.

Less well known is Don Wright of Virginia, who Trump has named to serve as acting secretary. He currently serves as deputy assistant secretary for health in HHS.

The swift turn of fortunes for Price stunned several of his former colleagues. He resigned after revelations began to emerge about his use of private and military planes for travel in the U.S. and oversees. Some estimates put the total cost of his travel at more than $1 million.

Price, a staunch fiscal conservative, railed against waste of federal monies, strongly opposing Democratic efforts to purchase jets for federal use in 2009 and 2010.

“I understand and respect Tom Price’s decision, but the news is disappointing,” said Sen. Lamar Alexander, a fellow Republican from Tennessee. “He has had a distinguished career as a physician and public health advocate, and I hope I have the opportunity to work with him again.”

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