Improving Price and Quality Transparency in American Healthcare To Put Patients First, 30849-30852 [2019-13945]

Download as PDF 30849 Presidential Documents Federal Register Vol. 84, No. 124 Thursday, June 27, 2019 Title 3— Executive Order 13877 of June 24, 2019 The President 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 thirdparty 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 wellinformed 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). jspears on DSK30JT082PROD with PRESIDENTIAL DOCS 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 highestspending 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. VerDate Sep<11>2014 20:18 Jun 26, 2019 Jkt 247001 PO 00000 Frm 00003 Fmt 4705 Sfmt 4790 E:\FR\FM\27JNE0.SGM 27JNE0 30850 Federal Register / Vol. 84, No. 124 / Thursday, June 27, 2019 / Presidential Documents 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. jspears on DSK30JT082PROD with PRESIDENTIAL DOCS (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. VerDate Sep<11>2014 20:18 Jun 26, 2019 Jkt 247001 PO 00000 Frm 00004 Fmt 4705 Sfmt 4790 E:\FR\FM\27JNE0.SGM 27JNE0 Federal Register / Vol. 84, No. 124 / Thursday, June 27, 2019 / Presidential Documents 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 jspears on DSK30JT082PROD with PRESIDENTIAL DOCS (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. VerDate Sep<11>2014 20:18 Jun 26, 2019 Jkt 247001 PO 00000 Frm 00005 Fmt 4705 Sfmt 4790 E:\FR\FM\27JNE0.SGM 27JNE0 30852 Federal Register / Vol. 84, No. 124 / Thursday, June 27, 2019 / Presidential Documents (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. THE WHITE HOUSE, June 24, 2019. [FR Doc. 2019–13945 Filed 6–26–19; 11:15 am] VerDate Sep<11>2014 20:18 Jun 26, 2019 Jkt 247001 PO 00000 Frm 00006 Fmt 4705 Sfmt 4790 E:\FR\FM\27JNE0.SGM 27JNE0 Trump.EPS</GPH> jspears on DSK30JT082PROD with PRESIDENTIAL DOCS Billing code 3295–F9–P

Agencies

[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 III





The 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