Great News – Transparency Rules Are Here to Stay


President Donald Trump’s executive order on surprise billing directs HHS to update the Hospital Compare website within six months to inform Medicare beneficiaries about hospital billing practices, but experts said it would take far longer to go into effect.

The information would include whether a hospital follows price transparency rules and gives patients an itemized list of the services they received at discharge.  It would also tell consumers how often a hospital sues its patients over billing issues, including whether a hospital tries to garnish a patient’s wages, places a lien on their home or withdraws money from a patient’s income tax refunds.

It’s an effort to name and shame providers for their aggressive billing practices, said John Barkett, senior director of policy affairs at Willis Towers Watson.

Surprise billing is the biggest outstanding healthcare issue for American consumers and businesses, said Cynthia Fisher, founder of Patient Rights Advocate, a group that supports healthcare transparency. 

“Everyday people are having highway robbery committed against them,” she said.

Reforming balance billing is part of the Trump’s administration’s broader attempt to increase market competition and consumer choice in healthcare through systemwide transparency and data portability.  But hospitals don’t want it because they “like the competitive barriers that exist today,” Fisher said.  She thinks giving consumers more information about hospitals’ billing practices would increase consumer choice and competition among providers.

Trump also issued an executive order mandating that people with preexisting conditions not be refused coverage, though details were lacking on how that would work.

But the surprise billing executive order is a sign that the Jan. 1 deadline for hospitals to meet the administration’s price transparency requirements is here to stay, said Carol Skenes, manager of advisory services for n’Thrive, a revenue-cycle management company.  Many healthcare industry executives hope HHS will extend the deadline for hospitals to follow the new rules, given the challenges posed by COVID-19 and creating a machine-readable data file.  But hospitals that are “rolling the dice for an extension” should prepare to meet the Jan. 1 deadline, Skenes said.

It’s unlikely hospitals and the administration could meet Trump’s six-month timeline for making all the changes, experts said.  HHS would only have three months to check whether hospitals were following the price transparency rules.  It would also need to collect data about legal actions and what information hospitals give to patients when they discharge them.  That could be difficult because many practices aren’t standardized or tracked consistently.  For example, hospitals might have to dig through legal documents to figure out exactly what actions they’ve taken against patients over billing issues.

I’m not aware of any instances where a patient leaves a medical facility with a 100% complete, itemized bill in hand,” Skenes said.

HHS would need to specify what information it wants and in what form.  The agency usually gives stakeholders a chance to weigh in when it wants to collect new, complex data, Barkett said.  It would likely have to do the same here to make sure HHS could give consumers useful information.  Hospitals could struggle to meet the requirements because many of them furloughed or laid off nonclinical staff to cope with pandemic-induced financial pressures, Skenes said.

Still, hospitals should be able to share their billing practices with the federal government – the largest healthcare purchaser – if they expect consumers to pay their medical bills, said Leah Binder, CEO of the Leapfrog Group, a group representing employers and other healthcare purchasers.  But she admitted it could take a while because it’s challenging to collect and report data.

Experts said the executive order shows the president wants to do something about surprise billing quickly, even if the six-month timeline is unrealistic. 

“This executive order reads like a campaign document for a politician who is not in office.  He’s not running on an accomplishment.  He’s running on a promise,” said Dan Mendelson, a former Clinton administration official and founder of Avalere Health.  “He currently has … the authority to do all these things.”

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Ms. Jenn Landers | Patient Advocate Alliance LLC