Not too long ago I led a team that built data products using a massive dataset comprised of more than 6B medical claims. This included Medicare, Medicaid, and private insurance. Two thoughts:
1) Trump is either bluffing or he doesn't have anyone around him that actually knows how medical billing works. If he were serious, the executive order would mandate that HHS publish the information based on the data that's already included in every claim (i.e. invoice) submitted to CMS for payment.
From a policy standpoint there are already rules in the federal register that allow HHS to publicly disclose cost information at the hospital-level. I'm no lawyer but it seems to me that a well-crafted executive order could stand up in court. Even if it were struck down, putting forth such an executive order would be a shrewd political move because it would cast its opponents in a bad light. These would presumably be insurance companies, the medical billing industry, and for-profit healthcare providers.
From a technical standpoint: there are already data pipelines in place for this sort of thing. The CMS Open Data initiative already reports hospital-level aggregates. It's not that hard to comment out a few 'GROUP BY' statements in order to get a POC up and running quickly.
2) Even if the current executive order comes to pass, people will continue to receive surprise bills and experience sticker shock. That's because the total (billed) cost is a function of:
- professional services (procedures rendered by doctors/therapists, etc)
For any given hospital stay or office visit the quantity and types of items in each category can (and does) vary. The current executive order mostly addresses the latter.
Furthermore, two patients seeing the exact same doctor for the exact same thing but using different insurance companies will get vastly different bills. That's because different insurance companies require healthcare providers to bundle/group (and sometimes break out/itemize) services in their own way.
Because out-of-pocket costs are, in turn, a % of the total negotiated rate patients necessarily end up with the short stick in terms of cost transparency.
Given the current medical billing system, there's simply no way for patients to know exactly what they're going to pay ahead of time because the charges won't be finalized until the insurance company decides what they will/won't cover.
No executive order will change that. Transparency will require Congress to muster up the will to write laws that put the patient first, not last.
1) Trump is either bluffing or he doesn't have anyone around him that actually knows how medical billing works. If he were serious, the executive order would mandate that HHS publish the information based on the data that's already included in every claim (i.e. invoice) submitted to CMS for payment.
From a policy standpoint there are already rules in the federal register that allow HHS to publicly disclose cost information at the hospital-level. I'm no lawyer but it seems to me that a well-crafted executive order could stand up in court. Even if it were struck down, putting forth such an executive order would be a shrewd political move because it would cast its opponents in a bad light. These would presumably be insurance companies, the medical billing industry, and for-profit healthcare providers.
From a technical standpoint: there are already data pipelines in place for this sort of thing. The CMS Open Data initiative already reports hospital-level aggregates. It's not that hard to comment out a few 'GROUP BY' statements in order to get a POC up and running quickly.
2) Even if the current executive order comes to pass, people will continue to receive surprise bills and experience sticker shock. That's because the total (billed) cost is a function of:
- professional services (procedures rendered by doctors/therapists, etc)
- facility fees (hospital bed, in-house labs, etc)
For any given hospital stay or office visit the quantity and types of items in each category can (and does) vary. The current executive order mostly addresses the latter.
Furthermore, two patients seeing the exact same doctor for the exact same thing but using different insurance companies will get vastly different bills. That's because different insurance companies require healthcare providers to bundle/group (and sometimes break out/itemize) services in their own way.
Because out-of-pocket costs are, in turn, a % of the total negotiated rate patients necessarily end up with the short stick in terms of cost transparency.
Given the current medical billing system, there's simply no way for patients to know exactly what they're going to pay ahead of time because the charges won't be finalized until the insurance company decides what they will/won't cover.
No executive order will change that. Transparency will require Congress to muster up the will to write laws that put the patient first, not last.