Price transparency enforcement gets a boost as Trump signs executive order

Hospitals can expect stepped-up enforcement of price transparency rules now that President Donald Trump has signed an executive order (EO) on the topic.

In his Feb. 25 order, Trump noted that his first administration drafted the two sets of regulations requiring providers and insurers to make prices available to healthcare purchasers.

He thinks the Biden administration put insufficient emphasis on the regulations after starting to implement them in 2021, even though enforcement increased in recent years and the templates for hospitals to use in publishing their machine-readable files became more exacting.

The EO “directs the Departments of Treasury, Labor and Health and Human Services to rapidly implement and enforce the Trump healthcare price transparency regulations, which were slow-walked by the prior administration,” according to a White House statement.

Within 90 days, according to the EO, the departments are supposed to take steps that include requiring disclosure of actual prices, rather than estimates, and ensuring that price information is better standardized across hospitals and health plans.

The requirement to post actual prices may cause a stir among hospitals because of the time and resources that likely were required to meet a Jan. 1, 2025, deadline to post estimated allowed amounts. But Joe Wisniewski, assistant vice president for partnerships and government affairs with the price transparency platform Turquoise Health, thinks a compromise is feasible.

“The actual way the regulations will be enforced is up for debate,” Wisniewski said. “We’re going to be strong proponents of saying, ‘Those estimated allowed amounts are out there, they’re being enforced. A lot of hospitals are doing them and doing them well. There’s no sense changing that, and can we use that as a foundation to get bundled rates?’”

How the EO will translate

Andrew Donahue, FHFMA, CPA, director of healthcare finance policy with HFMA, said increased enforcement of payer transparency may be difficult to achieve because of ongoing dynamics with the regulatory agencies.

Whereas CMS has sole responsibility for enforcing hospital transparency mandates, enforcement of the Transparency in Coverage rule for insurers is more diffuse.

States are tasked with much of the oversight, and at the federal level, “You’ve got three agencies involved — HHS, Labor and Treasury — and they are not playing well together,” Donahue said. “There’s no expectation that even with this new executive order, they’re going to get their act together to do meaningful enforcement.”

More likely, he said, is that they will settle for issuing updated guidance.

Ongoing job cuts in the departments as part of the administration’s Department of Government Efficiency (DOGE) initiative further limit the likelihood of robust enforcement, Donahue noted. For example, HHS is losing several thousand positions, according to reports.

Shawn Stack, director of perspectives and analysis with HFMA, hopes the EO makes transparency enforcement more equitable.

“With payer compliance audits only now beginning — three years into the process — how can agencies and stakeholders responsible for oversight justify their neglect? True accountability remains out of reach when payers, who have never faced audits, are given a pass while hospitals are held to an aggressive new enforcement standard of a very complex set of regulations,” Stack said.

“If accountability is the goal, enforcement must be applied equally across all stakeholders to help consumers make informed healthcare decisions. This must be the standard moving forward.”

A different story for hospitals

On the hospital side, CMS can be expected to undertake “an acceleration of enforcement and rulemaking,” Donahue said.

“They’re going to do more than guidance [for] hospitals,” he added.

One comment in a fact sheet about the executive order could be interpreted as setting the stage for the addition of quality metrics to price transparency files, although it’s not clear whether that’s what Trump meant in emphasizing that the EO was written with consumers in mind.

“They’ll be able to check [prices], compare them, go to different locations, so they can shop for the highest-quality care at the lowest cost,” Trump said, as quoted in the fact sheet. “And this is about high-quality care. You’re also looking at that.

“You’re looking at comparisons between talents, which is very important. And then you’re also looking at cost. And, in some cases, you get the best doctor for the lowest cost.”

Wisniewski said CMS most likely is a long way from requiring quality information to be included in machine-readable files.

“We don’t see any indication at this time of CMS actually sitting there and telling hospitals and payers they have to layer in quality data,” he said.

Next horizons

Among the most noteworthy parts of the EO, Wisniewski said, is the instruction for regulators to ensure that health plans post Medicare Part D drug prices, including those generated by a plan’s affiliated pharmacy benefit manager (PBM).

Insurers were supposed to include those prices in their machine-readable file, according to the initial Transparency in Coverage regulations. The Biden administration delayed implementation of that requirement to ensure there was no conflict with a 2021 provision obligating insurers to report prices to HHS, Labor and Treasury.

Although CMS issued a 2023 determination that no such conflict was evident, the administration did not apply the drug-pricing transparency requirement.

“The Biden administration was sued in 2023 for not enforcing the prescription drug transparency requirements,” states the fact sheet for the new EO, referring to litigation brought by a group called the Foundation for Government Accountability. “The Trump administration will work to hold health plans accountable for making drug prices transparent.”

Congress could expand price transparency by passing provisions of the Lower Costs, More Transparency Act. In late 2023, the bill passed the House with widespread bipartisan support but did not make headway in the Senate. The transparency aspects were not the primary reason that the bill stalled, however.

The bill would have codified transparency regulations not only for hospitals and insurers but for settings such as ambulatory surgical centers, labs and imaging centers, along with PBMs.