By Amina Niasse
NEW YORK (Reuters) -A Trump administration executive order intended to provide patients with the prices from hospitals and insurers they need to shop around may prove ineffective because of the huge amount of unorganized data it will generate, experts say.
President Donald Trump first told hospitals to put prices online in 2019 during his first administration and transparency rules for insurers soon followed, as the government sought to lower U.S. healthcare spending, the highest in the world.
But not all prices were posted and consumers struggled to find and analyze the scattered data.
The new order, announced on Feb. 25, aims to fix the previous order’s non-specific instructions that led to inconsistent reporting by hospitals and prevented patients from easily accessing cost information, said Gary Claxton, a senior vice president at KFF, a health policy organization.
Still, the additional information may not make the cost data easier for consumers to digest or compare.
To comply with a narrower 2020 rule, insurers reported more than 56 billion prices in 2022, according to a 2023 research report in Health Affairs based on information from health data provider Turquoise Health. Hospitals under a similar rule reported 1.8 billion prices.
The new data will likely not be centralized in one location, impeding patients from finding the best price, said Kolton Gustafson, a principal at healthcare consulting group Avalere.
“The hospitals post them on their own websites, and the plans post their files on their own websites,” said Gustafson. “This is stuff that’s incredibly difficult for any patient to navigate.”
Healthcare costs vary too much to be reported and analyzed in the way the executive order imagines, said Jennifer Jones, executive director of legislative and regulatory policy at the Blue Cross Blue Shield Association.
“A machine-readable file structure cannot adequately capture how services are actually paid, nor how patients research this information,” Jones said.
Because health plans will be required to provide prices for each network of providers, there will be a mechanism for cross-checking the accuracy of the prices that hospitals disclose, said Turquoise Health CEO Chris Severn.
Leaps in artificial intelligence technology could further help deliver on the intended benefits.
AI tools could assist third-party companies in sorting through data and presenting it to consumers who want to shop around, said Severn.
ENFORCEMENT AND COMPLIANCE
Stepping up enforcement to ensure hospitals and insurers follow the rules could also help.
The government has instructed overseeing agencies including the U.S. Department of Health and Human Services to enforce the order, making hospitals and insurers comply with technical specifications meant to make the data more machine searchable.
The Department of Labor, which oversees employer health plans and is tasked with enforcement alongside HHS, did not respond to a request for comment.
Hospital compliance with the technical requirements of the 2019 order is estimated at 50%, Turquoise Health said, and enforcement under the Biden Administration was low. The U.S. government has issued fines to a total of 24 hospitals ranging from $32,301 to $883,180, according to the Centers for Medicare and Medicaid Services, a division of Health and Human Services.
“The list of civil monetary penalties, it’s far shorter than you think it would be four years into this,” said Severn.
Ariel Levin, director of policy at the American Hospital Association, which represents thousands of hospitals, said reports suggesting low compliance are incorrect and that it welcomed a review by Health and Human Services.
Levin also said patients should have the option of seeing a more comprehensive estimate that reflects bundled pricing and their health plan’s cost sharing.
(Reporting by Amina Niasse; editing by Caroline Humer and Bill Berkrot)
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