Getting an X-ray, ultrasound or even sometimes a telehealth visit with a hospital-affiliated doctor can leave patients with an extra charge. These so-called facility fees can range from $15 to several hundred dollars and sometimes more. And they are showing up on more patients' bills now that some 40% of doctors work for hospitals. This year, 15 states are trying to limit these fees, or at least give patients a heads up.
Kari Greene was surprised to see a mystery $92 charge after a visit to her rheumatologist’s office in Portland, Oregon. She told lawmakers she was confused why she was being charged a hospital fee for a routine visit to a doctor’s office.
“There’s no specialty equipment,” Greene said, “Some crinkly paper, grey chairs, a blood pressure cuff machine and a handwashing poster on the wall.”
Oregon lawmakers are considering whether to ban hospitals and affiliated practices from charging these fees for consults or follow up visits — like the one Greene had.
Right now, the government allows hospitals to tack these fees on to any visit, to cover the costs of running a disaster-ready emergency room.
“State officials accept that,” said Maureen Hensley-Quinn with the National Academy of State Health Policy. “That makes sense.”
What doesn’t make sense, she said, is when patients get hit with these fees for routine office visits. “You can prepare for those things. So why is the charge being levied for that?”
There’s no comprehensive data on the frequency or cost of these fees. But Hensley-Quinn said patients have been increasingly complaining to state lawmakers about them.
For a long time, Congress has talked about a fix, but there’s been no action.
“In the absence of Congress taking this step, states are pursuing prohibiting certain facility fees,” Hensley-Quinn said.
Hospitals bill in two categories: One covers the doctors services. The other — facility fees — can be a catchall for everything else. Often, insurers don’t cover the fees.
Molly Smith with the American Hospital Association worries limits on one could put vulnerable hospitals in a tight spot.
“I mean hospitals need to purchase drugs, supplies,” Smith said. “They need to pay staff, whether it is again, nurses or lab techs, or even, people who keep rooms clean.”
Connecticut has banned these fees for consultation and follow up visits. On one hand, state regulators say fewer patients are complaining about the fees.
But Dr. Deidre Gifford, who runs the state office that oversees this regulation, said it’s unclear how effective the law is at protecting patients. “Well, depends on how you define ‘working,’” she said.
Hospitals are still making more each year from these charges, but Gifford said hospitals may have just upped the fees for other kinds of care. This is the problem with one-off, well-intentioned fixes to high health care prices. It’s like squeezing a balloon, she said: The costs are still there, they just show up on one part of the bill instead of the other.
