Competition
Is no longer a Sin!
Donald Trump
(No he never said that but he should)
Executive Order
Improving Price and Quality Transparency in American Healthcare to Put Patients First
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.
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.
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.
DYI: When it comes to MRI’s I know
this from bitter experience the costs are outrageous. With insurance one of the MRI’s I had done
cost me, for one knee $1,600 [total cost with insurance $2,200]. Technology drives down costs except when it
comes to the medical field. MRI’s were
first commercially available in the early 1980’s fast forward to today making
the computer/magnetics an old technology.
These costs should have dropped like a rock just as has happened in the
computer industry right along with increased computing power. What is going on is nothing less than price
fixing among competitors [who have zero enthusiasm for competition] to maintain
ever growing profit margins.
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.
DYI: I’ve not experienced this first
hand however many of my friends have with surprise
billings so great that if they survived whatever ailment they had the surprise damn near killed them. Many ended up filing bankruptcy wiping these
families out financially.
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.
DYI: Access an application on your
computer or smart phone – using my MRI example – finding providers within any given
area you choose for the best price. This
will change the direction of health care prices pronto! Instant competition!
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.
DYI: Let me save you the time, effort
and money. It is simple they have zero
desire to compete. Remember what John D.
Rockefeller said “Competition is a Sin!”
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.
DYI: Bingo let’s more and more of our
citizens back in the driver seat with the ability to determine between cost and
quality. This will help drive down costs.
(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.
DYI: Within the next 180 days if fully
implemented we should begin to see health care providers advertise for patients
based on cost and
quality. If this is done correctly over
the next two years health care costs will be driven down substantially and
continue to drop for many years to come.
Of course this industry as we speak has every damn lobbyist beating down
the doors of every damn congress person whether Republican or Democrat. The fireworks have just begun.
DYI
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