Dive Brief:
- President Donald Trump issued an executive order earlier this week directing three federal agencies to “rapidly implement and enforce” healthcare price transparency regulations he first rolled out in 2019.
- During Trump’s first administration, he ordered hospitals to publicly disclose prices reflecting what patients and insurers “actually pay” for services, with the goal of helping patients shop around for care.
- However, multiple advocacy groups say hospitals have failed to fully implement price transparency rules. Trump blamed the Biden administration for not enforcing the rules and promised a stronger stance on noncompliance.
Dive Insight:
The executive order calls upon the Departments of the Treasury, Labor and the HHS to develop a framework to enforce Trump’s 2019 executive order on price transparency within 90 days.
Hospitals will be required to disclose actual prices of services, not estimates, and post information in a standardized fashion that is easily comparable across hospitals and health plans.
Specifically, hospitals will be required to list pricing information for up to 300 shoppable services and provide a machine-readable file with negotiated rates for every service the hospital provides. Health plans will also be required to post their negotiated rates with providers, as well as their out-of-network payments.
Requiring hospitals to post prices could lead to major savings for consumers, according to an economic analysis from the Trump administration. They estimate that posting prices both causes hospitals to reduce costs for their most expensive procedures and allows consumers to better shop around — potentially resulting in billions of cumulative savings for consumers, employers and insurers.
The order comes after advocacy groups say hospitals have mostly dropped the ball on implementing hospital price transparency measures, which went into effect under CMS guidance in 2021.
In November, separate reports from patient advocacy group Patient Rights Advocate and the HHS’ Office of Inspector General detailed widespread noncompliance with the rules.
Patient Rights Advocate found only 21.1% of hospitals studied were in full compliance with the rules, down from 34.5% since its last review.
At the time, the organization’s chairman and founder Cynthia Fisher blamed the Biden administration in part for hospitals’ backsliding, noting the administration had only fined a small fraction of hospitals that were out of compliance with the regulations.
Trump likewise accused Biden of slow walking the measures.
“Hospitals and health plans were not adequately held to account when their price transparency data was incomplete or not even posted at all,” Trump wrote in his executive order. “The Biden Administration failed to take sufficient steps to fully enforce my Administration’s requirement that would end the opaque nature of drug prices by ensuring health plans publicly post the true prices they pay for prescription drugs.”
Fisher cheered the executive order in a statement to Healthcare Dive.
“Consumers have long been left without the ability to see upfront prices, or to have remedy or recourse for overcharges, hidden fees, and surprise medical bills. This opacity has allowed healthcare costs and insurance premiums to skyrocket, and medical debt collections to soar,” Fisher said.
