Pa. lawmakers must join other states in fighting the rise of exorbitant hospital ‘facility fees’ | Editorial

There’s so much unfairness in America today that it shouldn’t be surprising to see people take to the streets in protest because they no longer believe needed changes will ever occur if left to the broken political system that’s supposed to ensure right ultimately beats wrong.

What’s unfair?

How about going to your doctor for years and only being charged your health insurance copay, and then getting a bill in the mail after your last appointment saying you owe an “outpatient facility fee” of $50, $100, $200, or more. These fees cover expenses that aren’t directly related to your care, such as air-conditioning or security for your doctor’s office.

If your doctors are charging fees you were not being asked to pay before, they may have quietly ended their independent practice and become employees of a hospital system that now considers that office an outpatient center — which, by law, can charge nonmedical fees for services at a hospital “ambulatory care” facility.

More and more people are being charged facility fees because more and more doctors are no longer independent. Hospital ownership of physician practices grew 124% nationally between 2012 and 2018, according to a Georgetown University study. By 2021, an astounding 74% of all physicians in this country had become employees of hospitals or corporations.

Not only are most physicians no longer their own boss, they also must follow treatment rules imposed by health insurance carriers, even if they don’t agree with them. That dynamic has greatly impacted the doctor-patient relationship, which researchers in a 2015 study say is “one of the most moving and meaningful experiences shared by human beings.”

Along with excessive fees for office visits, patients must pay the ever-increasing premiums and deductibles charged by medical insurance companies. That double whammy is one of the reasons polls show many Americans remain uneasy about the economy despite its improvement. They see little or no relief in either their grocery or medical bills.

President Joe Biden has taken notice of the facility fees issue. “The travel industry has figured out how to charge customers $90 a night in resort fees for hotels that aren’t resorts,” he said recently. “Hospitals are trying to do something similar … charging hidden facility fees for going to a doctor’s office in the building owned by the hospital.” But with Congress still flailing in a partisan swamp, not much can be expected from Biden.

That is why 13 states (Connecticut, Colorado, Florida, Georgia, Indiana, Maine, Maryland, Massachusetts, Minnesota, New York, Ohio, Texas, and Washington) have written their own rules to protect patients from being gouged by hospital corporations that seem more concerned with producing maximum profits than treating patients fairly.

Connecticut has the strictest law, which prohibits any hospital or health system from charging a facility fee for services provided on a hospital campus outside of its emergency department. Other states have less restrictive rules, but a common thread among most of the new laws is a requirement that hospitals notify patients in advance that they may be charged fees their health insurance does not cover.

Pennsylvania, so far, has not even done that. Facility fees bills have yet to make it out of committee, including legislation introduced during the last session by two Democrats serving Chester and other nearby counties, State Sen. Katie J. Muth and State Rep. Dan K. Williams. Their proposed changes wouldn’t prohibit facility fees but would require prior notice to patients before they are charged. The legislation would also require state notification when ownership of a physician’s practice changes.

Revenue goals obviously mean more to some of the enterprises running hospitals today than the compassion for patients traditionally associated with the practice of medicine.

State Rep. Kathy Rapp of Warren, Republican chair of the House Health Committee, told the Meadville Tribune that the facilities fees proposals have stalled because “there have been issues with insurance companies opposing it.” But the insurance companies neither collect facility fees nor include them in their medical services payments to hospitals.

One must ask: If a physician was able to both pay the light bill and provide competent medical care to patients before selling that practice to a hospital, why must the hospital that bought the practice now charge patients an added fee to cover the same maintenance costs?

Revenue goals obviously mean more to some of the enterprises running hospitals today than the compassion for patients traditionally associated with the practice of medicine.

Government reimbursement regulations, insurance company directives, and, yes, corporate greed have changed today’s medical profession. As a result, more steps are needed to protect health-care consumers. Among them is imposing reasonable restrictions on the unfair charges and fees hospitals seem to be collecting from patients — not because they need to pay their bills, but because they can.