June 24th Executive Order: Improving Price & Quality Transparency

An Executive Order was recently issued stipulating expanded healthcare price and quality transparency mandates. Hospital leadership, Revenue Cycle, and CDM Teams must carefully monitor how these mandates unfold.

Executive Order Overview

In a June 24th Executive Order, linked here, the Trump Administration continued to reinforce its position on hospital pricing and quality transparency. The mandates expand on earlier Executive Orders and establish specific time-driven requirements for hospitals, insurances, and others.

The Order’s stated goals for pricing and quality transparency are “promoting patient choice and increasing market competition”. This messaging remains consistent throughout other CMS rulemaking under the Trump Administration.  

After struggling with CMS’ vague and piecemeal charge publication guidance effective January of this year, hospitals are learning that they need a proactive approach to respond quickly as expanded price transparency requirements unfold. This is even more important now that enforcement is around the corner.

Why an Executive Order?

This action by President Trump comes as no surprise. CMS requirements have not been fully-embraced and the lack of enforcement may have a lot to do with hospitals failing to act. (H&A’s national survey resulted in a surprising number of non-compliant organizations.) CMS Proposed Rule language on Price Transparency has remained more focused on seeking public comment on broad goals with undefined timelines.

Healthcare spending has unfolded as a primary topic for the upcoming presidential election in 2020. Any action to increase transparency is expected to receive public support. The time-driven mandates will most likely be positioned as a Trump achievement whether or not they result in long term improvements in spending.

As noted in previous price transparency discussions, the purpose of transparency mandates are “eliminating barriers to information, increasing the availability of information, enhancing patient control, and protecting patients from unexpected costs of medical care”. However, the long-range effect that price shopping may have on spending has been challenged by many in the industry. Unfortunately, CMS and the Administration are rolling forward with their vision of a solution. Industry push-back on the limited usefulness of currently-mandated hospital pricing publication (CDM or otherwise) has not gained much traction.

What’s included in the Order?

Informing Patients about Actual Prices

60 day requirements (by Friday August 23rd)

The HHS Secretary must propose regulations expanding public posting of hospital charges to include:

  • Fees for services, supplies and fees of hospital employees
    • This last item seems to indicate that employed physician rates are going to also be required which expands current publication rules for ‘hospital services’.
  • Information based on negotiated rates for common or shoppable items and services
    • The requirements go on to state that information must be published in “an easy to understand and machine readable format using consensus-based data standards”
  • The HHS secretary must establish a monitoring mechanism to ensure compliance with the posting requirements

90 day requirements (by Sunday September 22nd)

The HHS and the Treasury must solicit 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 before delivery of certain types of patient care.

We discussed the substantial economic and administrative challenges for implementing pre-care cost estimates in our comments to CMS in a March 4, 2019 Proposed Rule. Watch for significant industry push-back on this topic as proposal language is released.

180 day requirements (by Monday December 21st)

The Secretary of the HHS (consulting Attorney General and FTC) must provide a report describing how price and quality transparency is currently impeded. The report must include recommendations for improvement.

Establishing a Health Quality Roadmap

180 day requirements (by Monday December 21st)

The HHS, Defense and VA must develop a “Health Quality Roadmap” with strategies to improve current reporting on data and quality measures for a wider array of health programs than currently exist.

Increasing Access to Data to Make Healthcare Information More Transparent and Useful to Patients

180 day requirements (by Monday December 21st)

The Order requires increased access to de-identified claims data for researchers, innovators, providers and entrepreneurs for development of tools. A list of priority datasets for future release must also be reported to the President.

Empowering Patients by Enhancing Control over Their Healthcare Resources

120 day requirements (by Tuesday October 22nd)

The Secretary of Treasury must issue guidance to expand the ability of patients to select high-deductible health plans.

180 day requirements (by Monday December 21st)

The Secretary of Treasury must propose regulations for “certain direct primary care arrangements” and “healthcare sharing ministries” as eligible medical expenses. Also carry-over funds for flexible spending arrangements shall be increased.

Addressing Surprise Medical Billing

180 day requirements (by Monday December 21st)

The Secretary of HHS must submit a report on additional steps to implement the May 9 “Surprise Medical Billing” directives from previous Orders from the White House.

Take-Aways

  • Watch for announcements of new and expanded mandates from CMS over the coming months.
  • Use the Order or this article to calendar your team’s regulatory review of anticipated regulatory changes.
  • Expect to see specific enforcement measures for price transparency beginning in 2020. Conduct an internal assessment for transparency compliance at least annually.
  • Ensure that your organization is compliant with the current mandates (including clarifications in the FAQs we shared in our News Center)
  • Consider methods to ensure that Charge Master data and other datafiles driving price are accurate. (Prices that are based on incorrect codes or erroneous charge structure create significant Public Relations risk in today’s era of industry watchdogs.)
  • Develop content, format, and extraction methods for your Public View pricing data. Plan to quickly review final rulemaking or other CMS communications so your team can modify data to meet potentially expanded publication rules.
  • Eliminate non-charge items or unused cost centers, improve vague descriptors, and fix invalid charge data in your Public View file version.
  • Meet with Reimbursement and Contracting staff to review payer mix, payment methods, and contract terms to fully-understand discounted rates. Prepare to gather the necessary payer-specific rate information when publication mandates become effective.
  • Ensure that the public can easily find and understand your CDM display version. Review tools like the ChargeAssist® Public Portal for a patient-friendly display of charge data. Prepare for increased monitoring by CMS.
  • Assess whether your current CDM auditing software tool supports easy internal monitoring of CDM data quality without delays, technical impediments, or high costs.
  • Stay proactive and monitor regulatory changes. Price Transparency is here to stay. Whether included in an Executive Order, in CMS regulations, or in FAQs, we know more mandates are on the horizon when it comes to hospital prices.

The graphic below lists further H&A concerns that may need to be incorporated into your team’s action plan as contingencies or ‘items pending confirmation’.

Other H&A posts on price transparency include updates on several CMS Proposed and Final Rules. See “Price Transparency “Round 2”– CMS Seeks Input” for the latest CMS regulatory discussions. This post includes more information from late 2018 on the Transparency mandates from CMS: “CDM Transparency – More Speculation and More Confusion.” The important CMS FAQs (never listed in Transmittal form) are linked here: “Q&A from CMS Leaves Hospital Questions Unanswered.”

We began writing on Price transparency many years ago. Check out our archives for other articles.

Holliday & Associates offers the ChargeAssist® CDM Public Portal within our ChargeAssist® software product- an HFMA Peer Reviewed™ Charge Master auditing and resource tool for easily auditing, collaborating, and maintaining Charge Master files. We also provide Charge Management CDM Coordinator Education and CDM Reviews by a team of credentialed clinical, coding and technical auditors. Contact information: (800) 831-3323 | Web Site: www.ChargeAssist.com |e-mail: info@chargeassist.com

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