Policy briefing: White House Executive Order on Price Transparency
On June 24, 2019, the Trump Administration issued an Executive Order (EO) on increasing transparency in healthcare prices for patients and families. Pricing data is often hidden, as this is a private negotiation in provider contracts. For example, a health plan may pay hospitals, laboratories, equipment providers, or care providers differently based on quality of care, the number of providers in the system, use of electronic health records (EHR), and other value indicators. However, the prices and arrangements are typically kept private.
In the EO, the Administration describes the case for price transparency. One example offered is imaging services. The extreme price variation in imaging services has been reported in many studies. In this EO, the Administration references an unnamed report that cited 19% savings to patients with accurate pricing information for imaging services.
There is little in this EO that would directly impact state health and human services programs. However, these objectives build on the Department of Health and Human Services (HHS) proposed regulations issued earlier this year. State programs may also want to monitor several efforts, such as the aligned quality roadmap initiative and how T-MSIS data might be used to further the goals of researchers and entrepreneurs.
In order to use the levers available to increase price transparency, the Administration detailed the following in the EO:
- Within 60 days of the EO, the Secretary of HHS is required to publish a proposed regulation to require hospitals to publicly post relevant price data, including the commonly negotiated amount, in a machine-readable format that will be easy for the public to understand and compare information across hospitals. The regulation should indicate how and when hospitals should update this data on an ongoing basis.
- Within 90 days of the EO, HHS, with the Departments of Labor and Treasury, should issue a joint proposed regulation to require health insurance carriers to offer relevant and actionable out-of-pocket cost data to members.
- Within 180 days of the EO, HHS, along with the Department of Justice and the Federal Trade Commission should issue a report about the ways in which government impedes clear and actionable price information.
- Within 180 days of the EO, the Secretaries of HHS, Defense, and the Veterans Administration (VA) should issue a quality improvement roadmap that aligns quality measurement and improvement efforts in Medicare, Medicaid, CHIP, the federal Marketplace insurance, and the military and veterans’ health programs.
- Within 180 days of the EO, the Secretaries of HHS, Treasury, Defense, the VA, and the Office of Personnel Management (OPM) should increase access to de-identified claims data to researchers, entrepreneurs, etc. for “taxpayer-funded healthcare programs and group health plans.” This provision specifies T-MSIS as one opportunity to share claims data. The Centers for Medicare and Medicaid Services (CMS) already offers de-identified claims data packages to these entities through the ResDAC program for Medicare and Medicaid data. It will be interesting to see what expectations the Administration has for other datasets for the other departments and OPM.
- Within 120 days of the EO, the Secretary of HHS should issue guidance on the expansion and availability of High-Deductible Health Plans and Health Savings Accounts.
- Within 180 days of the EO, the Treasury Secretary should issue regulations regarding the tax treatment for direct primary care relationships and healthcare sharing ministries.
- Within 180 days of the EO, the Secretary of HHS should issue a report to the President on surprise medical billing and strategies for how the government can help address this issue.