State and Feds Seek Better Health Care Price Transparency for Patients

July 9, 2019

President Trump signed an Executive Order on June 25, entitled “Improving Price and Quality Transparency in American Healthcare to Put Patients First.” The purpose of the order is to direct federal agencies to issue regulations to improve the transparency of healthcare prices and quality, create a more competitive marketplace and give consumers the information they need to make informed purchasing decisions. More specifically, the executive order: 

  • Directs the Secretary of Health and Human Services (HHS) to issue regulations within 60 days that would require hospitals to publicly post standard charge information, including information based on negotiated rates, in an easy-to-understand format.

  • Requires the Secretaries of HHS, Treasury, and Labor to seek comments on proposals to require healthcare providers, insurers, and self-insured group plans to give consumers access to information about expected out-of-pocket costs before they receive healthcare services.

  • Requires the Secretary of HHS, in consultation with the Attorney General and the Federal Trade Commission, to issue a report within 180 days on ways the federal government or private sector impede healthcare price and quality transparency for patients, with recommended solutions.

  • Directs the Secretary of HHS, within 180 days and in consultation with other federal departments and agencies, to increase access to de-identified claims data from taxpayer-funded healthcare programs and group health plans for researchers, innovators, providers, and entrepreneurs to develop tools that empower patients to be better informed purchasers of care.

  • Requires the Secretary of the Treasury, within 180 days, to propose regulations to treat expenses related to certain types of arrangements, potentially including direct primary care and healthcare sharing ministries, as eligible medical expenses for Health Savings Accounts, and to increase the amount of funds in flexible spending accounts that can carry over at the end of the year without penalty.

  • Directs the Secretary of HHS to submit a report to the President within 180 days on additional administrative steps that can be taken to address the issue of surprise medical bills.

TMA will monitor these efforts and how they could impact physicians and patients. Members can submit comments or suggestions to legal@tnmed.org .

On the state level, the Tennessee General Assembly recently passed the “Right to Shop Act” requiring health insurance carriers to implement an online shopping and decision support program for their enrollees, effective January 1, 2021. It allows health plans to incentivize enrollees to choose in-network providers who offer services at lower rates. The program must at least include physical and occupational therapy, imaging, labs, and infusion therapy. TMA’s advocacy is responsible for limiting the bill to those four services and for minimizing requirements imposed on physicians and medical practices.

The bill also requires health insurers to develop interactive portals that enable enrollees to request out-of-pocket cost estimates and quality data for services, or the average payment made by the carrier to network providers for comparable services. Licensed healthcare providers must provide enrollees with a copy of an order for a comparable healthcare service within two (2) business days of the request, to help patients know what to search for on the carrier’s website.

The program is not required to apply to TennCare, CoverKids, or ACA exchanges.