Facility fees are “clear profit-gambits” that take financial advantage of unsuspecting patients while failing to provide any benefits to them.
So says a new report from consumer protection organization the U.S. PIRG Education Fund, also calling for a ban on such facility fees.
More patients are seeing extra "facility fee" charges on their medical bills for regular doctor visits, often when the medical office is owned by a hospital. In many cases, patients are charged such extra fees while receiving exactly the same care they may have historically enjoyed with no such additional fees at the same doctor’s office before it was owned by a hospital or health system.
Such fees can even be tagged on for preventive care such as vaccines or for telehealth appointments when patients don't even step into a brick-and-mortar doctor’s office.
With healthcare costs already spiraling out of control due to increasing deductibles and higher copays, facility fees are simply adding to the burden of patients and even dangerously causing them to delay care, according to the report authors.
“Unjustified facility fees only add to patients’ fear of charges they can’t avoid and might not be able to pay,” the report says. “With more than one-third of Americans delaying care because of cost, we need to do better.”
Fortunately, U.S. PIRG says, there is action at the federal and state levels to push back against such fees.
For example, federal proposals have called for a ban on such fees for certain Medicare services which could save the system approximately $700 million annually. Congress is also calling for clearer identification of billing codes to ensure such fees are not paid by distinguishing between hospitals and non-hospital facilities.
But it is perhaps at the state level that most of the action to counter facility fees is happening, according to the report. Fifteen states have either enacted legislation or are considering bills to fight back against the fees.
Connecticut, for example, is the most advanced state in terms of enacting legislation against such fees with a series of initiatives carried out between 2015 and 2024.
Such initiatives include a total ban on such fees for certain kinds of care and locations, including outpatient care at hospital locations. Patients are also informed of any change in ownership of facilities to help increase transparency over any potential extra fees.
It also helped significantly that Connecticut has a robust data collection system, enabling legislators to be well informed before making related decisions, the report authors said.
“Any state considering facility fee policy proposals should consider the steps taken in Connecticut while undertaking its own solutions,” the report states.
The collection of data is essential before any legislation is passed in an individual state, the report says. Patients also need to be informed about facility fees ahead of time and whether their insurance companies will cover such costs.
A gradual approach may be more politically acceptable as opposed to a straight ban on all facility fees at once, for example, potentially starting with a ban on telehealth facility fees before proceeding to other bans. The ultimate goal must be an honest billing system, U.S. PIRG says.
“The addition of facility fees to patient bills without any change to the level or quality of care is just another way for the American health system to make a buck and stick patients or our insurers with more charges,” the report says. “We need action to put an end to facility fees, dishonest billing and unjustified health care costs.”