Issued on: June 24, 2019
By the authority vested in me as President by
the Constitution and the laws of the United States of America, it is
hereby ordered as follows:
Section 1. Purpose. My Administration
seeks to enhance the ability of patients to choose the healthcare that is best
for them. To make fully informed decisions about their healthcare,
patients must know the price and quality of a good or service in advance.
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.
Pursuant to Executive Order 13813 of October
12, 2017 (Promoting Healthcare Choice and Competition Across the
United States), my Administration issued a report entitled “Reforming
America’s Healthcare System Through Choice and Competition.” The report
recommends developing price and quality transparency initiatives to ensure that
healthcare patients can make well-informed decisions about their care.
In particular, 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).
Shoppable services make up a significant share
of the healthcare market, which means that increasing transparency among these
services will have a broad effect on increasing competition in the healthcare
system as a whole. One study, cited by the Council of Economic Advisers
in its 2019 Annual Report, examined a sample of the highest-spending categories
of medical cases requiring inpatient and outpatient care. Of the
categories of medical cases requiring inpatient care, 73 percent of the 100
highest-spending categories were shoppable. Among the categories of
medical cases requiring outpatient care, 90 percent of the 300
highest-spending categories were shoppable. Another study demonstrated
that the ability of patients to price-shop imaging services, a particularly
fungible and shoppable set of healthcare services, was associated with a per-service
savings of up to approximately 19 percent.
Improving transparency in healthcare will also
further protect patients from harmful practices such as surprise billing, which
occurs when patients receive unexpected bills at highly inflated prices from
out-of-network providers they had no opportunity to select in advance. On
May 9, 2019, I announced principles to guide efforts to address surprise
billing. The principles outline how patients scheduling appointments to
receive facility-based care should have access to pricing information related
to the providers and services they may need, and the out-of-pocket costs they
may incur. Having access to this type of information in advance of care
can help patients avoid excessive charges.
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.
Sec. 2. Policy. 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.
Sec. 3. Informing Patients About Actual Prices.
(a) 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. The regulation should
require the posting of standard charge information for services, supplies, or
fees billed by the hospital or provided by employees of the hospital. The
regulation should also require hospitals to regularly update the posted
information and establish a monitoring mechanism for the Secretary to ensure
compliance with the posting requirement, as needed.
(b) Within 90 days of the date of this
order, the Secretaries of Health and Human Services, the Treasury, and Labor
shall issue an advance notice of proposed rulemaking, consistent with
applicable law, soliciting comment on a proposal to require healthcare
providers, health insurance issuers, and self-insured group health plans to
provide or facilitate access to information about expected out-of-pocket costs
for items or services to patients before they receive care.
(c) Within 180 days of the date of this
order, the Secretary of Health and Human Services, in consultation with the
Attorney General and the Federal Trade Commission, shall issue a report
describing the manners in which the Federal Government or the private sector
are impeding healthcare price and quality transparency for patients, and
providing recommendations for eliminating these impediments in a way that
promotes competition. The report should describe why, under current
conditions, lower-cost providers generally avoid healthcare advertising.
Sec. 4. Establishing a Health Quality Roadmap. 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
(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.
Sec. 5. Increasing Access to Data to Make
Healthcare Information More Transparent and Useful to Patients.
Within 180 days of the date of this order, the Secretary of Health
and Human Services, in consultation with the Secretaries of the Treasury,
Defense, Labor, and Veterans Affairs, and the Director of the Office of
Personnel Management, shall increase access to de-identified claims data
from taxpayer-funded healthcare programs and group health plans for
researchers, innovators, providers, and entrepreneurs, in a manner that is
consistent with applicable law and that ensures patient privacy and security.
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. 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. Such data may be
derived from the Transformed Medicaid Statistical Information System (T-MSIS)
and other sources. As part of this process, the Secretary of Health and
Human Services shall make a list of priority datasets that, if de-identified,
could advance the policies set forth by this order, and shall report to the
President on proposed plans for future release of these priority datasets and
on any barriers to their release.
Sec. 6. Empowering Patients by Enhancing
Control Over Their Healthcare Resources. (a) Within 120 days of
the date of this order, the Secretary of the Treasury, to the extent
consistent with law, shall issue guidance to expand the ability of patients to
select high-deductible health plans that can be used alongside a health savings
account, and that cover low-cost preventive care, before the deductible, for
medical care that helps maintain health status for individuals with chronic
conditions.
(b) Within 180 days of the date of this
order, the Secretary of the Treasury, to the extent consistent with law, shall
propose regulations to treat expenses related to certain types of arrangements,
potentially including direct primary care arrangements and healthcare sharing
ministries, as eligible medical expenses under section 213(d) of title 26,
United States Code.
(c) Within 180 days of the date of this
order, the Secretary of the Treasury, to the extent consistent with law, shall
issue guidance to increase the amount of funds that can carry over without
penalty at the end of the year for flexible spending arrangements.
Sec. 7. Addressing Surprise Medical
Billing. Within 180 days of the date of this order, the
Secretary of Health and Human Services shall submit a report to the
President on additional steps my Administration may take to implement the
principles on surprise medical billing announced on May 9, 2019.
Sec. 8. General Provisions. (a)
Nothing in this order shall be construed to impair or otherwise affect:
(i) the authority granted by law
to an executive department or agency, or the head thereof; or
(ii) the functions of the Director of
the Office of Management and Budget relating to budgetary, administrative, or
legislative proposals.
(b) This order shall be implemented
consistent with applicable law and subject to the availability of
appropriations.
(c) This order is not intended to, and
does not, create any right or benefit, substantive or procedural, enforceable
at law or in equity by any party against the United States, its
departments, agencies, or entities, its officers, employees, or agents, or any
other person.
DONALD
J. TRUMP
THE WHITE HOUSE,
June 24, 2019.
https://www.whitehouse.gov/presidential-actions/executive-order-improving-price-quality-transparency-american-healthcare-put-patients-first/?utm_source=American+Action+Forum+Emails&utm_campaign=d2b41339a3-EMAIL_CAMPAIGN_2019_01_07_08_31_COPY_01&utm_medium=email&utm_term=0_64783a8335-d2b41339a3-267125721
June 24, 2019.
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