On June 24, President Trump signed an Executive Order on “Improving Price and Quality Transparency in American Healthcare to Put Patients First.” The Order requires the posting of standard charge information for services, supplies, or fees billed by hospitals, and special rates negotiated behind the scenes. “Providing access to this data will facilitate the development of tools that empower patients to be better informed as they make decisions related to healthcare goods and services.” And, “Access to this data will also enable researchers and entrepreneurs to locate inefficiencies and opportunities for improvement, such as patterns of performance of medical procedures that are outside the recommended standards of care,” the President wrote.
“To make fully informed decisions about their healthcare, patients must know the price and quality of a good or service in advance,” the President said. “With the predominant role that third-party payers and Government programs play in the American healthcare system, however, patients often lack both access to useful price and quality information and the incentives to find low-cost, high-quality care. Opaque pricing structures may benefit powerful special interest groups, such as large hospital systems and insurance companies, but they generally leave patients and taxpayers worse off than would a more transparent system.”
In 2017, the Administration issued a report titled “Reforming America’s Healthcare System Through Choice and Competition,” and was referenced in the June Ex. Order.
The report recommends developing price and quality transparency initiatives to ensure that patients can make wellinformed decisions about their care. “In particular,” the President wrote, “the report describes the characteristics of the most effective price transparency efforts: they distinguish between the charges that providers bill and the rates negotiated between payers and providers; they give patients proper incentives to seek information about the price of healthcare services; and they provide useful price comparisons for ‘shoppable’ services (common services offered by multiple providers through the market, which patients can research and compare before making informed choices based on price and quality).” Of inpatient care, 73 percent of the 100 highest cost services are shoppable and of outpatient, 90 percent of the 300 highest costs are shoppable.
“Improving transparency in healthcare will also further protect patients from harmful practices such as surprise billing, …”
“Making meaningful price and quality information more broadly available to more Americans will protect patients and increase competition, innovation, and value in the healthcare system.”
The President notes the Policy as follows: “It is the policy of the Federal Government to ensure that patients are engaged with their healthcare decisions and have the information requisite for choosing the healthcare they want and need. The Federal Government aims to eliminate unnecessary barriers to price and quality transparency; to increase the availability of meaningful price and quality information for patients; to enhance patients’ control over their own healthcare resources, including through tax-preferred medical accounts; and to protect patients from surprise medical bills.”
The Order also lays out the rules for making charges, including negotiated rates and rates worked directly with insurance companies, available to the public: “Within 60 days of the date of this order, the Secretary of Health and Human Services shall propose a regulation, consistent with applicable law, to require hospitals to publicly post standard charge information, including charges and information based on negotiated rates and for common or shoppable items and services, in an easy-to-understand, consumer-friendly, and machine-readable format using consensus-based data standards that will meaningfully inform patients’ decision making and allow patients to compare prices across hospitals.” […]
[…] “Within 180 days of the date of this order, the Secretaries of Health and Human Services, Defense, and Veterans Affairs shall develop a Health Quality Roadmap that aims to align and improve reporting on data and quality measures across Medicare, Medicaid, the Children’s Health Insurance Program, the Health Insurance Marketplace, the Military Health System, and the Veterans Affairs Health System. The Roadmap shall include a strategy for establishing, adopting, and publishing common quality measurements; aligning inpatient and outpatient measures; and eliminating low-value or counterproductive measures.”
Comments on Medscape, a popular physician and healthcare professional website and blog, were poignant.
Commenting was a psychologist. Dana Beezley-Smith| Psychologist ––Well, I for one am tickled pink. It’s a travesty that consumers have to purchase healthcare services without understanding what their portion of the expense will be. I wrote about this topic almost two years ago. (https://nationalpsychologist.com/2017/ 09/health-care-reform-update-pricetransparency-movementgrowing/104010.html) The devil’s in the details, of course, as proposed and final rulings will take some time, but if it plays out right, the entire provider
insurer-patient relationship will be transformed. No more secrets. Hospitals won’t like this, insurers won’t like this, but perhaps private physicians can prove they offer more value per dollar than giant hospital systems do. At the very least it encourages the consumer to ask more questions.
Popular comments included:
Dr. Chris Burritt| Psychiatry/Mental Health ––The Hospitals practically operate as cartels…pushback from them should be viewed as a sign of going in the right direction. I hope Trump stays the course – this should be a bipartisan effort!!
Dr. Yehuda Mond| Internal Medicine ––Politics aside, President Trump is the only president who has the guts to face on the pharma companies, call their bluff, and end the status quo. He’s the first to explain to the American people where the problem is and how it can be solved. We’re paying through the nose with unfettered billions of our tax and insurance dollars going straight to pharmaceutical companies. While this will not solve all our problems, if he is successful (ahem, so-called democrats), then it will reduce healthcare costs across the board. Please folks, put your unjustified hatred towards our president aside and show him your support.
Dr. Kathryn Duplantis| Plastic Surgery and Aesthetic Medicine –– president trump 2020! I wrote him a letter recently addressing the challenges that we doctors are facing including rising overhead, constant fighting with insurance companies to be paid and increasing liability! We are tired of all the big bosses running healthcare! I want doctors to be able to run their own practices and not deal with all the bosses that have driven up the cost of healthcare! My practice is all cash and will retire with a cash practice!