Given the importance of healthcare due of its profound impact on our lives and given the healthcare industry is a huge, growing sector of the American economy largely insulated from consumer influence, the recent executive order of October 12, 2017 is an optimistic step toward reforming the healthcare pricing structure and developing a system of transparency to support healthcare consumers. With visibility into pricing, consumers are empowered to make informed, responsible decisions on spending for their healthcare needs.
The report accompanying Executive order #13813, entitled “Reforming America’s Healthcare System Through Choice and Competition” seeks to implement the following policy.
In order to support patients in making responsible, informed decisions regarding their healthcare
“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 policy will seek to achieve these aims by implementing the following measures:
- Health and Human Services (HHS) will require hospitals to publicly post standard charge information in a consumer-friendly format including services, supplies and billable fees and this information must be regularly updated
- HHS shall solicit comment on a proposed rule requiring healthcare providers, insurance issuers and self-insured group plans to provide or facilitate access to information about anticipated out-of-pocket costs before patients have received care or undergone treatment
- HHS shall issue a report describing the procedures followed by the Federal Government and the private sector which are responsible for impeding transparency in healthcare pricing and provide recommendations for eliminating these impediments in such a manner as to simultaneously promote competition among suppliers and providers
- HHS shall develop a “Health Quality Roadmap” that is designed to 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 Veteran’s Affairs Health System. The Roadmap shall improve the quality measurement system and propose the elimination of counterproductive measures.
- Consistent with applicable law and patient privacy and security, HHS shall access de-identified claims data from the Transformed Medicaid Statistical Information System and other sources and identify priority datasets that could assist group healthcare providers, researchers, innovators and entrepreneurs in developing tools to provide patients with information as they “shop” for healthcare goods and services. The data shall also identify inefficiencies in the system or opportunities for improvement
- Secretary of the Treasury shall propose guidance to expand patients’ ability to purchase high-deductible healthcare plans that may be used in coordination with a health savings account
- Secretary of Treasury shall propose regulations to treat expenses such as direct primary care or healthcare sharing ministries as eligible medical expenses
- Secretary of Treasury shall issue guidance to increase the amount of flexible spending funds eligible to carry from one year to the next without penalty
Healthcare transparency and competition may finally be coming to the marketplace.