A little-known line-item in patients’ bills is contributing to high health care costs, medical debt and worsening health care access for underserved Coloradans. So-called “facility fees” are extraneous, unnecessary and often hidden charges hospitals add to a patient’s bill as a surcharge for services performed at a hospital. Thankfully, the Colorado General Assembly has an opportunity to rein in these fees with House Bill 23-1215.
As a physician, I worry that these facility fees will discourage people from seeking and getting the care they need. Patients with chronic conditions or complex medical histories requiring multiple points of care will likely see significant additional costs from facility fees. People of color, low-income Coloradans and those who face language barriers will also suffer because of facility fees. While patients can fight their medical bills, they should really be spending their time and energy on recovering and getting well, not battling a hospital’s corporate bureaucracy.
Unfortunately, as Colorado health systems consolidate, these facility fees are becoming commonplace and indiscriminate. Both nonprofit and for-profit health systems in Colorado add these hospital charges to patients’ bills. At the same time, we’re witnessing widespread hospital consolidations, where hospitals are gobbling up private practices — in the Denver metro area in 2018, for example, four hospital systems, UCHealth, HealthONE, SCL Health, and Centura Health, owned 20 of the area’s 24 hospitals and received 85 percent of the total hospital admissions. These new massive health systems are slapping a hospital charge on just about everything done within their network, and getting away with it because they can.
These added hospital fees drive up costs without improving outcomes or alleviating access. One patient reported finding an $800 “facility fee” on a bill for a 5-minute visit. One bill included an $847 facility fee – for a remote telehealth consultation. A dad was ambushed with a second $503 bill because his child’s outpatient pediatric psychology visit took place in a building that Children’s Hospital Colorado happens to own.
These so-called facility fees are paving the way for the next gold rush in the race for profits within the health care industry. The Medicare Payment Advisory Commission found that “facility fees can increase the total cost of a service by three to five times compared to the same service provided by an independent physician.”
The time has come to rein in these unfair and burdensome fees.
Our state policymakers should make hospital facility fees more transparent, reasonable, and rare. Fees should only be charged when services are provided at a hospital campus facility, for care that could not be safely done outside of a hospital facility. Patients should be notified of any potential fees, how much the fees are, and how much of them insurance will cover. Other states have done this already.
Here in Colorado, hospitals continue to make money. Yet more than 730,000 Coloradans are struggling withmedical debt. Hundreds of thousands of Coloradans are skipping specialty care treatment and half of all Coloradans have delayed preventive care because of costs. And while Colorado is starting to address high prescription drug costs and health care premiums, facility fees threaten to stall our state’s efforts to make health care more accessible and affordable to all Coloradans.
As hospitals continue to consolidate, the problem of facility fees will only worsen. It’s time for our state leaders to act to ensure Coloradans can get the care they need to live and thrive without breaking the bank.
Dr. Michael Belmonte, who is an OBGYN in Aurora
Hang on there – as a doctor, you should know that under hospital-based billing, $0 of the payment that goes to the physician goes back to the clinic staff members. Do you not think those nurses, housekeepers, security officers, registration staff and others deserve to be paid? Could you, as a doctor, practice without those staff members and a clinic to see your patients? Remember – though you might not like it – the federal government requires split billing in hospital-based clinics. It’s not a choice. Hospitals don’t have the option to combine physician, staff and facility fees into one global bill, which is what community clinics do.
Importantly, hospital-based clinics take care of a larger portion of Medicaid low-income patients. So – when these clinics close because they have no funds to pay their staff members – it will be those low income and Medicaid patients who are affected the most. Instead of getting excellent outpatient care, they’ll end up in emergency rooms – driving up health care costs for everyone.
-John
John, what part of ‘nonprofit’ don’t you understand?
Hey Gene – more than half of the hospitals in colorado have negative margins, with many more below sustainable levels. This bill will drive almost all hospitals into negative margins – forcing clinics and hospitals to close.
Oh, wonderful. A doc with almost no experience who thinks that the staff he works with aren’t needed. Well, even if you think nurses, CNAs, pharmacists and others aren’t needed, what about your residency program? Fellowship programs? The electronic medical record and supplies you use? Because the facility fee pays for all of that. I hope the staff members who care for patients in the clinics where you work see your thoughts on their value. (FYI – I’m a nurse, and the facility fee is the only thing that pays for me and my colleagues.)
Armando yes! Dr Belmonte certainly gets supported by clinic staff, Medical Assistants, Nurses, Environmental service workers and a large team of IT personnel who support his medical records, scheduling, and the entire environmeny in which he practices. All of that is paid by facility fees. If I was on his team I would be quite upset.