Consolidation, Lack of Regulation Enable Growing Facility Fees, Study Says

The growth of outpatient facility fees “derives from the intersection of the United States’ increasingly consolidated health care provider market, highly complex health care billing systems, and frequently inadequate health insurance coverage,” according to a new study from the Georgetown University Center on Health Insurance Reforms (CHIR). The study’s authors and managed care experts tell AIS Health, a division of MMIT, that unless regulators and policymakers act, the trend that serves as a tool for maximizing hospital revenue is likely to intensify. 

Facility fees are charges assessed by hospital systems for care delivered in an outpatient setting “that ostensibly cover the institution’s operational expenses for providing care,” the report says. They are separate from the professional claims that physicians, nurse practitioners, and other health care professionals submit [to insurers] for reimbursement for their services and expenses.” The practice of charging those fees is likely to happen whenever an independent practice is acquired by a health system — a frequent occurrence in recent years.