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January 26, 2017

Health agencies, VA hit by Trump's federal hiring, regulation freezes

Daily Briefing

President Trump on Monday issued a presidential memorandum instituting a federal hiring freeze that affects federal health care agencies and Veterans Affairs (VA), USA Today reports.

Hiring freeze details

The memorandum ordered "a freeze on the hiring of Federal civilian employees to be applied across the board in the executive branch." The memorandum stated that under the freeze, "no vacant positions existing at noon on [Jan. 22] may be filled and no new positions may be created, except in limited circumstances."

The freeze does not apply to military personnel or hires that were underway before noon Monday. In addition, the memorandum stated that the leaders of any executive departments or agencies "may exempt from the hiring freeze any positions that it deems necessary to meet national security or public safety responsibilities."

The memorandum ordered the directors of the offices of Personnel Management and Management and Budget (OMB) to within 90 days "recommend a long-term plan to reduce the size of the federal government's workforce through attrition." According to the memorandum, the hiring freeze will expire once that plan is completed.

What it means for VA

White House press secretary Sean Spicer on Tuesday confirmed that the hiring freeze also applies to VA, which has more than 2,000 open positions, including hundreds for health care providers, according to USA Today.

Spicer said, "What we need to do, whether it's the VA or any other agency, is make sure that we're hiring smartly and effectively and efficiently." He continued, "And I think the VA in particular, if you look at the problems that have plagued people, hiring more people isn't the answer, it's hiring the right people, putting the procedures in place that ensure that our veterans—whether health care or mortgages or the other services that VA provides to those who have served our nation—get the services that they've earned."

However, acting VA Secretary Robert Snyder said the department "intends to exempt anyone it deems necessary for public safety, including frontline caregivers," from the hiring freeze.

VA spokesperson James Hutton said the department is "in the process of determining precisely what positions meet the criteria."

A White House official on Wednesday clarified that the exemption applies to any position "deem[ed] necessary for public safety, including frontline caregivers."

VA stakeholders react

Admanda Maddox, a spokesperson for Senate Committee on Veterans Affairs Chair Johnny Isakson (R-Ga.), applauded Snyder's decision to exempt "critical health care personnel" from the freeze.

However, a group of 53 lawmakers, led by Sen. Jon Tester (D-Mont.) and Rep. Tim Walz (D-Minn.), on Wednesday sent a letter urging Trump to exempt all VA positions from the hiring freeze. Tester and Walz in a joint statement said the freeze would "make it harder for veterans to get in the door at the VA and receive the timely benefits to which they are entitled, and that is totally unacceptable."

Garry Augustine, executive director of the Washington office of Disabled American Veterans, said the group hopes Trump "will be considerate of the need to fill vacant positions in the VA, especially in VA health care."

Several veterans groups criticized the move. Paul Rieckhoff, CEO of Iraq and Afghanistan Veterans of America, in a statement on Tuesday said the "freeze raises serious concerns about [Trump's] commitment to veterans and improving the VA."

Charles Schmidt, national commander of the American Legion, expressed concern that the hiring freeze could further stall a backlog of veterans' benefits claims. He said, "We have strong concerns ... about how this will impact the veterans who have been waiting too long to have their claims processed."

Hiring freeze could affect FDA efforts

The hiring freeze also applies to FDA, which reportedly has about 1,000 vacant positions, Regulatory Focus reports.

According to Regulatory Focus, the freeze could affect FDA efforts to approve new and generic drugs and medical devices. However, Regulatory Focus reports it is not clear whether FDA could fill some positions under the memorandum's exception for "public safety responsibilities." Spicer said that exception "could include public health."

A Pharmaceutical Research and Manufacturers of America spokesperson said the group still is reviewing the order. However, the spokesperson added, "Patients deserve the best and brightest minds to be able to review the medicines they need. [FDA] is the gold standard, and a stable and sustainable workforce is crucial to [the agency's] ability to keep pace with scientific advances in biopharmaceutical drug development while ensuring safe and effective medicines reach patients in a timely manner."

Trump places freeze on federal regulations

Trump on Friday also issued a presidential memorandum to institute a 60-day freeze on regulations that have been published in the Federal Register but that have not yet taken effect.

The freeze applies to guidance FDA released over the past few months but has not yet taken effect, including long-awaited guidance on biosimilar drugs and revisions to regulations regarding medical research conducted on humans in the United States.

The memorandum stated that federal agencies may not send any regulations to the Office of the Federal Register (OFR) "until a department or agency head appointed or designated by the president after noon on [Jan. 20] reviews and approves the regulation." In addition, the memorandum temporarily postpones the effective dates of regulations that already have been published in the Federal Register, but that have not yet take effect for "60 days from the date" the memorandum was published.

The memorandum also directed OFR to "immediately withdraw" from OFR review or approval regulations that were sent to the office but not yet published in the Federal Register as of the memorandum's publication.

Under the memorandum, OMB's director or acting director can exempt the freeze in "emergency situations or other urgent circumstances relating to health, safety, financial, or national security matters" (Slack, USA Today, 1/24; Presidential memorandum, 1/23; Brennan, Regulatory Focus, 1/25; Lawrence, NPR, 1/25; Rein, "PowerPost," Washington Post, 1/25; Kesling, Wall Street Journal, 1/25; Kesling, Wall Street Journal, 1/24; Conn, Modern Healthcare, 1/23; Presidential memorandum, 1/20).

You've filled the position. Now what?

Retaining new hires is one of the longstanding challenges in health care. Despite manager and HR efforts, newly hired employees continue to turn over at a rate far above that of more tenured staff members. In fact, new hire turnover is a disproportionate driver of an institution's overall turnover rate. Nationally, employees with less than one year of tenure make up nearly 25 percent of all health care turnover.

But there's good news: better employee onboarding can dramatically reduce these rates. And we have two toolkits to help you improve the onboarding process, including editable templates, checklists, and guides to equip both HR and managers to efficiently and effectively onboard new employees.


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