Improving Price and Quality Transparency in American Healthcare To Put Patients First

This executive order directs federal agencies to increase healthcare price and quality transparency through new regulations requiring hospitals to post prices, expand patient access to cost estimates before care, develop common quality measures across government health programs, and increase access to de-identified health data. It also seeks to expand health savings account flexibility and address surprise medical billing.

Federal Register Open PDF 84 FR 30849

Impact dates

Dec 21, 2019
HHS report on transparency impediments; Health Quality Roadmap; expanded claims data access; Treasury regulations on direct primary care/sharing ministries; Treasury FSA carryover guidance; HHS surprise billing report
Oct 22, 2019
Treasury issues guidance on high-deductible health plans and HSAs
Sep 22, 2019
HHS/Treasury/Labor issue advance notice of proposed rulemaking on out-of-pocket cost estimates
Aug 23, 2019
HHS proposes hospital price posting regulation

Key directives

HHS to propose regulation requiring hospitals to publicly post standard charge information including negotiated rates in consumer-friendly, machine-readable format within 60 days
HHS/Treasury/Labor to issue advance notice of proposed rulemaking on out-of-pocket cost estimates before care within 90 days
HHS to issue report on impediments to healthcare price and quality transparency with recommendations within 180 days
HHS/Defense/VA to develop Health Quality Roadmap aligning quality measures across six federal health programs within 180 days
HHS to increase access to de-identified claims data from taxpayer-funded programs for researchers and innovators within 180 days
Treasury to issue guidance expanding high-deductible health plan options with HSA compatibility within 120 days
Treasury to propose regulations treating direct primary care and healthcare sharing ministries as eligible medical expenses within 180 days
Treasury to issue guidance increasing FSA carryover amounts without penalty within 180 days
HHS to submit report on surprise medical billing implementation steps within 180 days

Who is ordered

Timeline

Immediate

Policy statement establishing federal commitment to healthcare price transparency and patient empowerment

Near term (90d)

HHS Secretary to propose hospital price posting regulation (60 days)
HHS/Treasury/Labor to issue advance notice of proposed rulemaking on out-of-pocket cost estimates (90 days)

Long term

HHS report on impediments to price transparency (180 days)
Health Quality Roadmap development (180 days)
Expanded de-identified claims data access (180 days)
Treasury guidance on high-deductible health plans (120 days)
Treasury regulations on direct primary care and healthcare sharing ministries (180 days)
Treasury guidance on FSA carryover amounts (180 days)
HHS report on surprise billing implementation (180 days)

Risks & tensions

Hospital industry likely to resist mandatory disclosure of negotiated rates as proprietary information
Machine-readable format requirement may benefit tech intermediaries more than typical patients
De-identification standards for claims data involve uncertain privacy-utility tradeoffs
Surprise billing principles referenced but not defined in order text; actual policy remains vague
Multiple 'to the extent consistent with law' caveats create implementation uncertainty
Appropriations limitation in Section 8(b) may constrain data infrastructure investments