Executive order on improving price and quality transparency in healthcare
Today, President Trump did something long overdue to aid users of healthcare and their families. This executive order (EO), still does not provide for more people to become insured, without further marketplace changes, which are not encompassed in this EO. And the EO will not accomplish everything needing to be rectified by our vastly flawed health care system.
Portions of the EO include a number of sections
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.
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.
3. Informing patients about actual prices
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.
4. Establishing a healthcare 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.
I devote special emphasis on this section because the possibilities for good and pitfalls for the unwary are still common, and likely will continue, perhaps in a reduced form, despite this EO.
"You get what you pay for"--hopefully. High cost does not ensure high quality. Nor does low cost imply low quality. Outcome measures as a marker of treatment quality are fraught with trouble. Oncologists' outcomes will always be worse than dermatologists outcomes. Who is to rate the expected outcome of particular specialities? Will a procedure by procedure analysis be useful? For instance hysterectomy for vaginal-rectal prolapse is more complicated with lower success and lower patient satisfaction than hysterectomy for in situ cervical cancer.
Online patient ratings are notoriously unreliable, skewed to both the highly satisfied and to the highly dissatisfied concerning their medical care experiences. The EO does however discuss "shoppable" procedures. This means, procedures (and providers) for whom there are more than one choice. Of course the out-of-network issue is a major element in preventing just such shopping. Until physician/hospital/lab/imaging networks are expanded, the idea of shoppability is but a fond desire, bereft of ability from which to benefit. I do not see that issue directly addressed in the EO.
5. Increasing access to data to make healthcare information more transparent and useful top patients
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.
Sounds great but this is a golden pipe dream from the experience of this essayist who for four decades has been a practicing physician. One of the reasons, I got out of medicine was the onerous Electronic Health Record (EHR) requirements imposed by Obamacare. I know of no clinically helpful EHR program that is physician-friendly. Admittedly, I have been out of the loop for a few years but my medical colleagues agree that these expensive, usually cumbersome programs are written by geeks for geeks--not for physicians or their patients. Too often, the physician or physician "extender" has their nose stuck in a computer screen, rarely making eye contact with the patient sitting across from them, anxious to have their story register with the physician--not simply as a series of seemingly disconnected data points. Because, that's what these EHR do. They parse all patient-related information into discreet data points, as demanded by the EHR--otherwise the information cannot be entered into the sacred computer.
EHR's do not afford physicians the latitude to make their diagnostic conclusions in ways relevant to patients's problems without traversing numerous computer-necessitated gymnastics. So the quality of intelligence by which we hope diagnoses are achieved are given short shrift. I don't have a solution for the EHR dilemma. Hopefully, someone will have found such.
6. Empowering patients by enhancing control over their healthcare
, 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.
This sections leaves me confused. It seems to be advocating for coverage of low cost preventive maintenance, as it were, separate from the high deductible programs already in existence. Perhaps this is a mandate to do what the ACA already does, provide for preventive healthcare, known also a "well-care". Such well-care is a cost-saving idea which, if used more broadly, could be a huge cost-lowering factor. The availability of low cost preventive care might entice those currently reluctant to enter our overpriced healthcare "market" to seek services that should be availed of by all individuals.
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.
As a consumer of healthcare, and I have consumed a lot--not by choice--I, too have received these unwelcome surprises. Most come from out of network charges but also some come with the deliberate unbundling of procedure costs which are ordinarily combined.
This is a step forward.
It will help pave the way for M4A. Once the public can be persuaded that governmental regulations, such as promulgated by this EO can be helpful, citizens may not be so reticent to accept further governmental control of healthcare, which Medicare in its still limited form provides.