The Trump administration on Monday finalized a rule that aims to make the data files mandated under price transparency regulations more usable.
The Centers for Medicare & Medicaid Services said that the final rule will improve the data files made available by payers and providers by reducing duplicative information, adding further context about in-network pricing and holding stakeholders accountable for submitting incomplete or inaccurate data.
Under regulations finalized during the previous Trump era, both payers and providers are required to make publicly available data on negotiated prices for services. However, those files have often proven difficult to find and tend to be massive, making it far harder for the transparency data to be useful.
The rule would update reporting frequency to quarterly, rather than monthly, to ease administrative burden while requiring higher quality data. Insurers will also be required to provide personalized pricing information to members by phone, rather than just online.
CMS Administrator Mehmet Oz, M.D., said during an event hosted by the Department of Health and Human Services on Monday morning that "the changes are going to weed out redundancies, provide essential context, standardize how the data is going to get presented in ways that actually could be used by other parties."
"All this may seem pretty technocratic, but here's what's going to unleash very concretely: there's going to be an explosion of independent, innovative price transparency applications," Oz said. "There's going to be conversations with superintelligence and cost comparison tools."
We're going to give companies and patients the clearest picture yet on what they're actually paying for, and if it's the right value for them based on what their desires are," he said.
The enhanced price transparency rules were first proposed in December. It's supported jointly by HHS, the Labor Department and the Treasury.
In addition to the potential benefits for technology companies that can make the data easier for patients to parse, access to greater transparency in pricing is critical for employers and plan sponsors looking to respond to the complex cost environment.
Monday's event featured multiple panels, including a session on employers. Elizabeth Mitchell, CEO of the Purchaser Business Group on Health, spoke on that panel and said that the group believes the rules "are going to make a really significant difference" for its members.
"There are not a lot of wins in health policy, and we think this is a big one," Mitchell said.
PBGH represents large and jumbo self-insured employers, and Mitchell said that these firms are eager to put this data to work. One particular element in the regulation that she highlighted is a requirement that C-level executives at health plans attest to the data's accuracy, as demonstration project the group undertook last year ran into significant errors and omissions.
Given increasing pressure on employers around their fiduciary duties, access to this data will be critical for these organizations moving forward, she said.
"This has the potential to meaningfully address the affordability crisis in the commercial market," said Mitchell.
Also at Monday's event, Federal Trade Commission Chairman Andrew Ferguson said the regulator plans to crack down on hospitals that are not providing complete and accurate price data, whether or not they are compliant with CMS' transparency requirements. The FTC sent warning letters to 24 large health systems and encouraged them to quickly take corrective action.