Health care transparency is the least-discussed and least-debated part of the Trump Administration’s agenda to “Make America Healthy Again.” Yet the vast majority of voters from both parties agree: patients deserve to know about quality and price before they make life-altering decisions about their healthcare.
The President’s agenda on transparency began back in 2019, when President Trump signed an Executive Order mandating hospitals publicly release pricing for their most common services. Unfortunately, many hospitals either willfully ignored the regulation, or buried pricing information under dozens of click-throughs on their websites.
But thankfully President Trump’s executive order signed earlier this year brought real consequences for providers and insurers who fail to achieve the price transparency that consumers need and deserve. It requires hospitals and insurers to disclose actual prices (not just estimates) and requires regulators to update enforcement policies to ensure compliance.
The two key regulations the Executive Order bolsters are the Transparency in Coverage (TiC) rule and the Hospital Price Transparency rule. Together, they require hospitals and health insurers to show the costs for medical items and services, including their negotiated rates, and the prices for covered prescription drugs, so consumers can compare hospital charges by facility.
But enforcing price transparency is not enough for success. It’s not a good deal if you pick a car by pointing to a number on a price list and saying, “I’ll take the $20,500 one.” Obviously, you need to know what you are buying, and weigh features like safety, mileage, and reliability.
Likewise, in health care it is unwise to assume all services are the same and prices are the only differentiator. Some care is high quality, and some is inadequate or even unsafe. The prices alone will not reveal which is which.
Every year medical errors, accidents, and infections kill over 200,000 Americans in hospitals, with untold additional preventable deaths in nursing homes and other settings where care is delivered. Some hospitals are twice as likely as others to harm or kill patients with a preventable error.
In addition to the devastating harm to patients and families, this is waste on a grand scale.
What Americans need in tandem with transparent pricing is transparent information on quality. We need an expansion of public data on how often facilities like hospitals and ambulatory surgery centers get the right outcomes for patients and prevent errors and infections. We need that data made public for every brick-and-mortar facility that patients - whether it is us or our loved ones - entrust with their lives.
CMS Administrator Dr. Mehmet Oz seems fully committed to improving and expanding public reporting on safety and quality. At a major CMS conference on quality July 1, Dr. Oz opened by remembering Dr. Lucian Leape, considered the father of the patient safety movement, and highlighted the need to transform quality and improve transparency. Secretary Kennedy reiterated that goal in a video appearance.
Employers and purchasers have some ideas for seeing that change through. Begin with reporting more critical quality indicators the public needs. Too many are hidden from view for settings of care beyond inpatient care, like nursing homes, ambulatory surgery centers, outpatient hospital units, urgent care, and even some hospitals like children’s hospitals, where very little data is made public. And even when hospital reporting is more transparent and robust, there are major gaps in what is made public. For instance, some hospitals are required to report infection rates for inpatient surgery, but not for outpatient surgery. So, if you don’t stay overnight, your infection doesn’t count.
Transparency for both price and quality is smart business, plain and simple. Today, employers pay about a third of the nation’s health costs, including costs of errors and infections. Yet employers too often don’t have visibility into the inputs affecting the price and quality of care they are purchasing, which profoundly impacts their employees and their businesses. Transparency is a policy agenda they can embrace because it gives them critical leverage in the market.
With transparency on quality, employers can stand up for their employees to demand excellence. With transparency on pricing, they can compare prices for excellent care. But they need to know which care is excellent before talking price. There is no good price for bad care.
Leah Binder is President & CEO of The Leapfrog Group, representing employers and other purchasers of healthcare calling for improved safety and quality in hospitals. James Gelfand is President & CEO of The ERISA Industry Committee (ERIC), a national advocacy organization that exclusively represents large employers that provide health, retirement, paid leave, and other benefits to their nationwide workforces.
