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Large volumes of data ordered by recent Trump executive

order

could do little for consumers shopping around

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Enforcement aims to improve compliance versus earlier

transparency rules

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AI may assist in data sorting by third parties

By Amina Niasse

NEW YORK, March 27 (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.