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

  • Aug 11, 2023

    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. 

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  • Peter Johnson

    Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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