President Trump Reintroduces Price Transparency with New Executive Order

Kevin: Welcome to the inaugural episode of Panacea’s new podcast Beyond the Bottom Line. Let’s talk healthcare, finance, revenue cycle and compliance. I’m your host, Kevin Chmura, CEO of Panacea Healthcare Solutions. Whether you’re a healthcare executive, a financial professional, or simply curious about how these essential pieces of the healthcare puzzle fit together, you’re in the right place.

Our goal is simple to give you actionable insights and expert perspectives that can help you optimize your operations and drive strategic growth. In this episode, I’m joined by Govi Goyal, Panacea’s President of our Financial Services Division. Financial Services Division at Panacea handles our strategic pricing and Price Transparency products and services. Govi is a nationally recognized expert on Price Transparency topics, having really been a leader since the first regulations were released by CMS. And we are providing a little bit of rapid reaction to a new executive order that was signed by the President yesterday and want to just give some initial feedback, some observations, some client interactions that we’re having, and just catch everybody up on what’s going on in as close to real time as we can.

So first, let me welcome Govi to the show. Welcome, Govi.

Govi: Hi Kevin.

Kevin: Good to talk to you as always. So as I mentioned, we have a new executive order signed by President Trump. It was less than 24 hours ago as we record this right now. Interesting, and but probably not surprising to those of us that have been immersed in this, I’m sure not a surprise to you Govi, in the first Trump administration, the president and his team showed a real commitment to Price Transparency. Really believing it was a way to help lower healthcare costs for individuals and employers to buy insurance.

Many people will likely recall that it was President Trump that signed the No Surprises Act in 2020, which gave way to Good Faith Estimates as another element of Price Transparency. He always showed a strong commitment to Machine Readable Files and to consumer displays for comparative shopping. So it probably shouldn’t be a surprise to any of us that within a month of taking office or so, he has signed an executive order, really doubling down on some of the work he did in his first administration.

I’m just going to for the audience’s benefit, in case you haven’t seen this yet, you’re hearing this for the first time. I’m going to just read one section of this. Just bear with me. It’ll only take a second. And then I’m just going to ask Govi for his reaction to it. So Section 3 of the executive order, signed on February 25th, 2025, is entitled Fulfilling the Promise of Radical Transparency.

I love the adjective in there, radical transparency, and it states this: the Secretary of the Treasury, the Secretary of Labor and the Secretary of Health and Human Services shall take all necessary and appropriate action to rapidly implement and enforce the healthcare Price Transparency regulations issued pursuant to Executive Order 13877, including within 90 days of the date of this order. Action to: A. Require the disclosure of actual prices of items and services, not estimates; B. Issued updated guidance or proposed regulatory action ensuring price information is standardized and easily comparable across hospitals and health plans, and; C. Issued guidance or proposed regulatory action updating enforcement policies designed to ensure compliance with the transparent reporting of complete, accurate and meaningful data. That’s the meat of the EO.

The preamble before that, what’s after that is generally general provisions and I have my own thoughts on it, but they will pale in terms of their importance to yours Govi. So Govi just it’s as new. We’re seeing it for the first time. Just curious if you could give me your initial reaction to what we’re seeing here.

Govi: Yeah, absolutely. So, you know, for a brief moment, the spotlight is taken off DOGE and away from all these federal workers who possibly might lose their jobs, and it was on Price Transparency. And a lot of this is not surprising. It’s a bipartisan issue. So the Republicans want it. The Democrats want it.

So I think, you know, a lot of what’s in here confirms that Price Transparency is here to stay. It’s also going to continue to evolve, and I think while this particular executive order is a lot more about enforcement, which has been lagging, there has been enforcement and we have seen some improvement in compliance. But there’s still a lot of gaps in the data, there’s errors. And I think it’s been almost a year since the last hospital received a Civil Monetary Penalty. This executive order doesn’t necessarily have what I would say, like new policies or new requirements that providers need to immediately start incorporating or applying in their process.

That should be a relief for many hospitals. Those who have invested significant time, costs and energy, especially on the January 1st changes we had this year with the Machine Readable Files of estimate allowed amount of pharmacy and modifiers and then all the changes that happened in 2024 with the standardized CMS template.

Kevin, you did touch upon I think I agree that is the perhaps the most important part. Section 3 taken from the executive order, especially that first line item where it talks about departments, and it’s referring to HHS, Treasury and so forth, where hospital payers need to disclose the actual prices, you know, not estimates, including pursuant drugs.

So in order for Price Transparency to really achieve the goals that it’s trying to achieve, which is to make healthcare more affordable, provide patients with informed decisions, increase competition. Three things need to happen. The files and data needs to be accessible, which I think we’ve come a long way. We’ve removed a lot of barriers to have the text file, the links are required in the footer of hospital websites. They need to be complete. So you can’t have significant gaps, things missing, and then they need to be need to be accurate. And if only they’re accurate, that’s the only way consumers will be able to shop around accurately. That’s one way we will be able to get to more standardize, less disparity in pricing across some across different organizations or healthcare organizations.

So I think that is an important call out because a lot of hospitals, health systems have been leaning more towards using historical claims and payments data to arrive at their negotiated rates, which is which is okay to do for the estimated allowed amount, but in terms of getting to your standard negotiated rate, that should really be taken from your actual payer contracts to be as accurate as possible.

Kevin: Yeah, that’s something that we for reference for those listening, at Panacea, we work with a few hundred hospitals across the country to help with their compliance needs relative to Machine Readable Files and other elements of Price Transparency. And so we, you know, we live in the world of accessible complete and accurate as Govi put out there and each has its one or two of them are simple, complete and accurate can be complicated.

As we learned with the January 1st compliance deadline, with the inclusion of estimated allowed amount. So one of the things that strikes me about this, Govi, and just wondering what you think about it, is really B and C both talk about issuing updated guidance on proposed regulatory action, and they both say that same thing. They don’t say we’re going to update the regulation and the rules. We’re not going to add an additional field. This is very much to me enforcement oriented. Would you agree?

Govi: Yes, I would agree. I think likely the scenario we had this year and last year was hospitals were getting a little bit of a break. You know, there was it was such a big change to go from the 2021 requirements of Price Transparency to all of a sudden jump to the 2024 and 2025. So the thought process was give a little bit time breathing room for hospitals to respond and apply those changes.

Maybe with the direction we’re seeing of this executive order is, okay, the time’s up, it’s time to get more serious about enforcement and potentially, you know, we could see an evolution in the way CMS is doing their review is to confirm compliance, potentially gathering actual payer contracts again, to kind of see if the actual negotiated rates or prices that are on the files.

Kevin: Yeah. That that would be something because that’s a big gap in the enforcement as it exists today, especially when you get to complete and accurate. There’s really, it’s difficult for an outside entity to really be able to tell that without all of that information. So that would be some step up in enforcement, would be pretty intrusive, but probably the only really way to get to those two points.

I know it’s been less than 24 hours since this was signed. Wondering, you are the face of this for Panacea. Have we heard anything from our client community or other partners in the space about this EO? Any chatter out there?

Govi: Yes, it’s certainly getting the attention of many, and I think, you know, the immediate and the immediate concern is, you know, are we okay? Do we need to take any immediate action? You know, what kind of sort of lies ahead? As in for now, everything is status quo. For the most point. There are some, you know, questions even that I have, and the way you might interpret this as the executive order states, you know, not estimates currently under Price Transparency. See, there’s two parts to it. One is the Machine Readable File. The other parts, the consumer display, which is really just showcasing a hospital’s top 300 shoppable services and their associated negotiated rates. A lot of hospitals have opted, in lieu of that, to have a patient estimation system.

It’ll be interesting to see if we start to see some rebranding or renovation where we start calling that, you know, the patient accurate system where there’s going to be more pressure to get these out-of-pocket estimates, to more out-of-pocket actuals and whatever estimate or actual quote that is provided to patients or hospitals gonna be more held to that in terms of what they can bill and bill to the patient.

So that’s going to be interesting to see how that all plays out here with this executive order.

Kevin: Yeah, we’ll have to get with our folks and trademark that name Govi. I like the way that sounded so let me just push it one step further and pull in your thoughts on the No Surprises Act in Good Faith Estimates, which are often, because of the amount of work it takes to get Machine Readable Files produced and published, and then secondarily, the consumer displays, oftentimes GFEs are sort of left out of the discussion, but it’s President Trump’s signature on the on the No Surprises Act that gave birth to those. Do you have any thoughts on do you think we’ll see a stepped up enforcement of GFE regulations?

Govi: I do think so. We sort of hit the pause button on the on the Good Faith Estimates, part of the No Surprises Act. So back in 2022, when it was required for all hospitals and providers to provide a Good Faith Estimate to those that are self-pay uninsured for any schedulable service. The plan was always to expand in that and not have it only apply to self-pay uninsured patients.

The plan and the way the policy was written was that it also applied to those that have insurance. Whether you’re in-network or out of network. And the process would work that the healthcare provider or hospital would basically send that Good Faith Estimate, call up an advanced bill, over to the payer of the plan, and then the payer plan would send an advanced EOB to the patient, letting them know whether their insurance is in or out of network and what their out-of-pocket costs would likely be prior to services being scheduled.

That Good Faith Estimate was also supposed to include expected charges from co-providers and others that are involved in the care that might not be part of the hospital or a provider, which is a really challenging feat on itself.

So a lot of the policies were written, but the process was left out. So this is all, you know, part of the goal with Price Transparency, to give the patient more well-informed choices and to meet the spirit of intent. So I do think that we’ll start to see some more movement on that, which is, it’s been delayed for quite a bit, so maybe this is the push that it needs.

Kevin: Yeah, I, I agree with you and it’s something that the professionals that are listening, don’t lose sight of that. Right. That’s a that’s an important element of this as well. You know this is, effectively this executive order is doubling down on the executive the Executive Order 13877, which was signed June 24th, 2019, with a forward looking compliance deadline of a couple of years.

But this has been out there the No Surprises Act was signed the following year, 2020. And so, I think that what’s proving to be a slightly aggressive administration, maybe not so slightly, they’re going to take a hard look at the every element of these and that’s what this EO is doing. It’s directing these government departments to look at enforcement.

And it’s got to, within 90 days of this order a time frame, so you’re talking about spring, for needing to be up and running and feeling good about where you are. Perhaps, maybe the way to think about it, just interested in your reaction to this is, if you were at all concerned about the quality of your output, be it your Machine Readable File, your GFEs, your consumer display, maybe now you take a second look at it and make sure you’re where you need to be.

Govi: Right, right. I mean, this executive order is not prescriptive on what those increased enforcement actions would likely be. But I think, you know, for any hospitals or providers looking to do some due diligence and have protection, and not be in a mad scramble if they are put in a awkward or difficult position where their files or estimation system is not where it is up to be, should likely take steps now to confirm they’re in full compliance.

We will also like, I think what also we’ll likely see as you kind of give a view into the future here and what this all is trending towards, is we’ve had some other there’s a few other bills out there, House bills, Senate bills, that have been kind of lag. One of them I’m thinking about is the Lower Costs for Transparency Act House Bill 5378, which about a year ago was passed the House and I believe it’s up in the still up for the Senate, this would you know it’s likely we’d see some movement on this.

I mean the legislative process can be slow and unpredictable, but if this gets passed, that would expand Price Transparency to non-hospital locations such as your emergency surgery centers, imaging centers and so forth. We’ve already seen it happen in Minnesota. So some states aren’t waiting, they’re taking their own measures and moving forward. So it’s kind of interesting to see this come at at many different angles, you know, whether it’s the Republicans or Democrats or at the state or federal level.

Kevin: Yeah, that’s great insight. And I think you’re right. I think that this has been primarily focused on hospitals and payers that don’t want to leave them out. You and I work primarily with hospitals, so that’s where our focus is. But, and they are the foundation often of the healthcare system, but by no means the only providers that submit bills to patients.

And so I think it’s likely that we will see Price Transparency be expanded out and cover additional providers, and likely those that will have less resources to get to a place where they’re compliant. So could be a lot more of a struggle for everybody. So, let me just tell the audience before I wrap and I ask Govi one more question, we at Panacea, Govi and his team of experts actually produced a series of webinars on Machine Readable File compliance, and then also some practical uses of data and other things. Please visit our website to, if you’d like to review those. If you have any concerns about where you need to be, any questions about some of the technical elements, you’re likely to find the answers to those questions buried in those webinars, or reach out to us, we’re happy to talk to you.

So Govi I’m going to wrap it. I’ll ask you to just one question and just drawing from your deep experience here. I mean, any advice that you have for the audience right now that that could be now concerned about where they are in their compliance journey relative to Price Transparency?

Govi: Yes. I mean, aside from what is being discussed in terms of getting another potentially second set of eyes to look at your Price Transparency, client compliance, it does seem that there’s going to be more pressure towards being able to defend, you know, being able to defend your prices, as enforcement increases, compliance will increase will so will transparency and accessibility of your files.

So just, it would be, it would probably be the right path right move to take a look at where do your, you know, where do your prices sit in line to your market. Do an assessment, and just be prepared in the event that you’re going to have more scrutiny, more scrutiny over what your rates are, what your prices are, there’s a lot more pressure on variation, you know, within the same geography.

So I think I would make those recommendations, in addition to, you know, just double checking your compliance status.

Kevin: That’s great, great advice. It’s a 1-2 punch. The first punch is compliance. The second is defend your prices. And that’s likely coming after that. So sage advice from an expert. So Govi, thank you. That was very insightful, appreciate you joining us.

Govi: Thank you.

Kevin: Before we wrap today’s episode, I just want to extend a huge thank you to our listeners for joining us on this journey. Your commitment to excellence in healthcare finance inspires us every day. We invite you to Subscribe. Leave a review and join the conversation on our social media channels. Your feedback is invaluable and we strive to bring you the most relevant and impactful content in the industry.

I’m Kevin Chmura, and this has been Beyond the Bottom Line by Panacea. Stay tuned for upcoming episodes featuring our expert guests. And remember, when it comes to healthcare finance, every detail matters. Until next time, keep striving for excellence and driving innovation in healthcare. Thank you!