Squeezing The Golden Goose - Facility Fees
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Medical Facility Charges
Twenty years ago about 75% of doctors were in private practice. Today that number is closer to 25%. It can be simpler to be an employee than a business owner for a doctor but the effect on patients and their pocketbooks is another story completely.
In the past we have seen that when hospitals are purchased by investment firms or large conglomerates, facilities are often treated as a separate business that has to be paid. This is similar story.
Hospitals have been busy buying up outpatient service centers and physician practices. Typically when that happens, patients pay more. For example, from 2007 to 2013, hospitals acquired nearly 10% of the practices in one Science Direct study’s sample. Prices for the services provided by acquired physicians increase by an average of 14.1% post-acquisition. Nearly half of this increase is attributable to the exploitation of payment rules. Price increases were larger when the acquiring hospital has a larger share of its inpatient market. Ok - Not good.
Now comes real junk fees. In all 50 states hospitals that have purchased outpatient service functions like surgery centers, ambulatory care facilities or just doctor practices can charge a separate facility fee on your bill. They can range from $15 to thousands of dollars, depending on the service and are typically charged for lower-cost outpatient services. Many insurance plans don't cover facility fees or only cover a portion. (HealthAffairs.org)
According to the Wall Street Journal hospitals are collecting billions of dollars in this fashion.
Facility fee charges are becoming more common as hospital systems have accelerated their purchase of ambulatory settings and practices, leading to higher overall costs for outpatient care. Consumers bear the brunt of this, as they face increased out-of-pocket costs as well as higher premiums from these extra charges. Patient exposure to these fees, coupled with the fact that these fees often appear unrelated to the level of care received makes this appear to be just another way to extract money from us and the system.
As hospitals and health systems have bought and built outpatient departments and physician practices (some on or near hospital campuses, some miles away from hospitals), more care is being provided in these locations, which demand higher prices than independent provider offices. And the prices of these system-owned outpatient facilities appear far from rational, with facility fee charges varying enormously across the country, providers, services, and payers.
Here is a way to think about it. Before the purchase of these facilities - they were paying for themselves. Now that they have been bought, costs are higher to cover the new purchase price. It’s like they took out a mortgage on a new home and now have higher monthly payments so they are charging us facility fees to cover their purchase and jack up their profits.
Facility fees for outpatient and off campus services are legal in all states and only regulated in 15. Here is a link to a report from the Public Interest Network so you can see how your state fares.
The No Surprises Act (NSA), passed in 2022, requires facility fees to be included in the definition of "items and services" for price transparency requirements. Still doesn’t mean your insurance will cover it. Some facility fees are restricted for certain procedures under Medicare - but most of us are being taken to the cleaners to pay for hospital’s purchase costs and increased profits.
The report above had a number of recommendations. I’ll list them for you.
Ban facility fees for certain services. A budget estimate found that banning facility fees for certain Medicare services could save the program over $700 million in the first ten years.
Require separate hospital and non-hospital identification and billing codes. Doctor facilities owned by hospitals use different codes than a traditional doctor’s office. The result: insurers would be able to identify inappropriate facility fee charges.
Require up front notification to patients so they can determine if they are required to pay or if insurance will pay
Not allow facility fees for tele-health - Can you believe that they do that???
This is another area where we see healthcare used as a vehicle to generate money with no improvement in healthcare visible - just squeeze more money out of the system and us.
We can ban such fees but frankly, just as we have seen with Pharmacy Benefit Managers, they will find another place to increase fees and bills. The real answer is Single Payer Universal Healthcare.
There is a provision in HR 3421, the tremendously improved Medicare for All Act, called Global Budgets. It covers a facility’s infrastructure costs so those facility fees go away. Just another reason for Universal Single Payer Healthcare. Let’s remind Congress now.
ACTION
We can let our Member of Congress and Senators and the President know we are tired of being squeezed dry by the healthcare industry by medical facility fees and that HR 3421, Medicare for All, has global budgets built in that fix the problem. Their contact info is in the Resources Section below.
Or use RESISTBOT by texting SIGN TTTTTT to 50409 to send this email. (Learn about RESISTBOT here).
“I am your constituent and I am fed up with “facility fees” added to medical bills. Even if the process were transparent, we have to pay them anyway to get to our doctor or have our outpatient procedure/tests performed. Some companies even add them on to tele-health phone calls. This is another way to squeeze money out of the system and us since insurance does not often cover the fees. We really are being held hostage. Increased transparency is not the answer - the answer is to eliminate this kind of deceptive practice. HR 3421 does that with global budgets that cover a medical facility’s infrastructure costs. I want you to get that passed and start protecting Americans - All Americans.”
Resources
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Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
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Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
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