Improving Price and Quality Transparency in American Healthcare To Put Patients First
| Published date | 27 June 2019 |
| Citation | 84 FR 30849 |
| Record Number | 2019-13945 |
| Section | Presidential Documents |
| Court | Executive Office Of The President |
Federal Register, Volume 84 Issue 124 (Thursday, June 27, 2019)
[Federal Register Volume 84, Number 124 (Thursday, June 27, 2019)]
[Presidential Documents]
[Pages 30849-30852]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-13945]
[[Page 30847]]
Vol. 84
Thursday,
No. 124
June 27, 2019
Part IIIThe President-----------------------------------------------------------------------
Executive Order 13877--Improving Price and Quality Transparency in
American Healthcare To Put Patients First
Presidential Documents
Federal Register / Vol. 84 , No. 124 / Thursday, June 27, 2019 /
Presidential Documents
___________________________________________________________________
Title 3--
The President
[[Page 30849]]
Executive Order 13877 of June 24, 2019
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. 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.
[[Page 30850]]
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.
[[Page 30851]]
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.
[[Page 30852]]
(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.
(Presidential Sig.)
THE WHITE HOUSE,
June 24, 2019.
[FR Doc. 2019-13945
Filed 6-26-19; 11:15 am]
Billing code 3295-F9-P
