Trump’s Price Transparency Rules: What Health Execs Need to Know

November 19, 2019

Three things to know about price transparency rules for health insurers and hospitals.

President Trump issued controversial rules compelling hospitals and insurers to give consumers more information upfront about what their care will cost-requirements that officials say help Americans be better healthcare shoppers.

According to a White House press release, HHS is finalizing a rule that will require hospitals to make prices publicly available online. Hospitals will display prices for shoppable services as a total package in an easy-to-read, consumer-friendly format.

In addition, the Trump Administration is also proposing a rule to require insurance companies and group health plans to provide cost estimates to enrollees in advance of care. In addition,  it is proposed that these companies make a list of all of their pricing information available to the public.

“Hospital executives should have their organization ready to answer questions about their comparative negotiated pricing,” says Ross D’Emanuele a partner at the international law firm Dorsey & Whitney and the co-chair of the firm's healthcare practice. “Individuals and other organizations will have the opportunity to study, analyze, and criticize hospital pricing in ways we can’t yet predict. Executives should make sure they have done their own analysis and are ready to answer questions and critics.”

Related: Industry Skeptical About New Price Transparency Rules

The only providers who need to report pricing data are hospitals, according to D’Emanuele.

“Other competitors may be in a position to publicize their pricing when doing so is competitively advantageous,” he says. “Hospitals must be prepared to address why hospital pricing for many services are higher than pricing for similar services in ambulatory surgery centers and clinics.” 

According to D’Emanuele, here are the top three things healthcare executives should know about the rules:

  • Compiling and reporting required pricing data will require resources. “Be prepared to budget for this,” he says.

  • The rule requires reporting pricing on every service a hospital bills; even the professional services of its employed clinicians.

  • Understand your own pricing data and be prepared to justify your pricing practices and answer critics, according to D’Emanuele says. 

Tracey Walker is managing editor of Managed Healthcare Executive.