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Industry Observers Taking Wait-and-See Approach to Trump’s Executive Order

June 24, 2019

An executive order by President Donald Trump that was announced on Monday was crafted with the intention of bringing more transparency to healthcare costs so that patients can make more informed decisions about their care. Industry observers, however, are taking a wait-and-see approach to how the order will affect behavioral healthcare and addiction treatment.

“Transparency is very important, but the information that is made available has to be understandable and actionable,” Mark Covall, president and CEO of the National Association for Behavioral Healthcare, says. “Right now, the way the system is structured, just putting out the prices doesn’t meet that standard. It’s a worthy goal, but we have to be careful. If it isn’t understandable and actionable, people may make the wrong choice or not have information make a difference.”

Whereas consumers can shop around on the websites of different retailers to compare prices of the same bicycle, for example, healthcare has more variables that impact costs, including different payers as well as nuances in the care provided by different facilities, Covall says. Plus, many of the situations that drive a need for behavioral health or addiction treatment don’t lend themselves to comparison shopping, he says.

“In almost all instances, it’s an emergency admission,” Covall says. “It’s not an elective situation where you could potentially shop around and make a determination based on price and quality. In the case of inpatient psychiatric admission, that is a crisis situation. In many cases, the police take you to the nearest emergency department, family and friends try to get to the closest hospital, whether it’s a freestanding psychiatric hospital or a general hospital. There is no time to make those determinations.”

Trump’s five-part executive order calls for providers to disclose prices to be paid by patients and insurers in an easily understood format, although specifics of how this will be accomplished will be left to the U.S. Department of Health and Human Services to hammer out.

“The order itself is a little vague on that front, so we’ll have to wait and see,” says Andrew Kessler, founder and principal of behavioral health policy consulting firm Slingshot Solutions. “But I think there is potential to use it for a lot of positive advances.”

If the federal policy that results from the executive order can be leveraged to expose bad actors in the industry, that will be a net positive, Kessler says. Plus, it could present an opportunity not just for payers, but also lawmakers to gain a better understanding of the different types of treatment within the industry.

“If this leads to more transparency into exactly what goes into substance abuse treatment, I think that could be really educational,” Kessler says. “ ‘Treatment’ is a word that has been thrown around as we’ve dealt with opioid epidemic. People say, ‘Oh, more treatment,’ and 99% of policymakers throwing that word around don’t know what that means. We can break that down by inpatient, outpatient, intensive outpatient, psychiatric services, psychological services, recovery support services. If this gives us an opportunity to shine a spotlight on what treatment really is all about, that could potentially be beneficial.”

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