{"id":625202,"date":"2023-04-03T17:49:34","date_gmt":"2023-04-03T22:49:34","guid":{"rendered":"https:\/\/news.sellorbuyhomefast.com\/index.php\/2023\/04\/03\/states-step-in-as-telehealth-and-clinic-patients-get-blindsided-by-hospital-fees\/"},"modified":"2023-04-03T17:49:34","modified_gmt":"2023-04-03T22:49:34","slug":"states-step-in-as-telehealth-and-clinic-patients-get-blindsided-by-hospital-fees","status":"publish","type":"post","link":"https:\/\/newsycanuse.com\/index.php\/2023\/04\/03\/states-step-in-as-telehealth-and-clinic-patients-get-blindsided-by-hospital-fees\/","title":{"rendered":"States Step In as Telehealth and Clinic Patients Get Blindsided by Hospital Fees"},"content":{"rendered":"
\n

When Brittany Tesso\u2019s then-3-year-old son, Roman, needed an evaluation for speech therapy in 2021, his pediatrician referred him to Children\u2019s Hospital Colorado in Aurora. With in-person visits on hold due to the covid-19 pandemic, the Tessos met with a panel of specialists via video chat.<\/p>\n

The specialists, some of whom appeared to be calling from their homes, observed Roman speaking, playing with toys, and eating chicken nuggets. They asked about his diet.<\/p>\n

Tesso thought the $676.86 bill she received for the one-hour session was pretty steep. When she got a second bill for $847.35, she assumed it was a mistake. Then she learned the second bill was for the costs of being seen in a hospital \u2014 the equipment, the medical records, and the support staff.<\/p>\n

\u201cI didn\u2019t come to your facility,\u201d she argued when disputing the charges with a hospital billing representative. \u201cThey didn\u2019t use any equipment.\u201d<\/p>\n

This is the facility fee, the hospital employee told her, and every patient gets charged this.<\/p>\n

\u201cEven for a telehealth consultation?\u201d Tesso laughed in disbelief, which soon turned into anger.<\/p>\n

Millions of Americans are similarly blindsided by hospital bills for doctor appointments that didn\u2019t require setting foot inside a hospital. Hospitals argue that facility fees are needed to pay for staff and overhead expenses, particularly when hospitals don\u2019t employ their own physicians. But consumer advocates say there\u2019s no reason hospitals should charge more than independent clinics for the same services.<\/p>\n

\u201cIf there is no change in patient care, then the fees seem artificial at best,\u201d said Aditi Sen<\/a>, a Johns Hopkins University health economist.<\/p>\n

At least eight states agree such charges are questionable. They have implemented limits on facility fees or are moving to clamp down on the charges. Among them are Connecticut, which already limits facility fees<\/a>, and Colorado, where lawmakers are considering a similar measure. Together, the initiatives could signal a wave of restrictions similar to the movement that led to a federal law<\/a> to ban surprise bills, which took effect last year.<\/p>\n

\u201cFacility fees are simply another way that hospital CEOs are lining their pockets at the expense of patients,\u201d said Rep. Emily Sirota<\/a>, the Denver Democrat who sponsored the Colorado bill.<\/p>\n

Generally, patients at independent physician clinics receive a single bill that covers the physician\u2019s fee as well as overhead costs. But when the clinic is owned by a hospital, the patient generally receives separate bills for the physician\u2019s fee and the facility fee. In some cases, the hospital sends a single bill covering both fees. Medicare reduces the physician\u2019s payment when a facility fee is charged. But private health plans and hospitals don\u2019t disclose how physician and facility fees are set.<\/p>\n

Children\u2019s Hospital Colorado officials declined to comment on the specifics of Tesso\u2019s experience but said that facility fees cover other costs of running the hospital.<\/p>\n

\u201cThose payments for outpatient care are how we pay our nurses, our child life specialists, or social workers,\u201d Zach Zaslow, senior director of government affairs for Children\u2019s Hospital said in a February call with reporters. \u201cIt\u2019s how we buy and maintain our imaging equipment, our labs, our diagnostic tests, really all of the care that you expect when you come to a hospital for kids.\u201d<\/p>\n

Research suggests that when hospitals acquire physician practices and hire those doctors, the physicians\u2019 professional fees go up and, with the addition of facility fees, the total cost of care to the patient increases, as well. Other factors are in play, too. For instance, health plans pay the rates negotiated with the hospital, and hospitals have more market power than independent clinics to demand higher rates.<\/p>\n

Those economic forces have driven consolidation, as hospital systems gobble up physician clinics. According to the Physicians Advocacy Institute<\/a>, 3 in 4 physicians are now employed by hospitals, health systems, or other corporate entities. And less competition usually leads to higher prices.<\/p>\n

One study found<\/a> that prices for the services provided by physicians increase by an average of 14% after a hospital acquisition. Another found<\/a> that billing for laboratory tests and imaging, such as MRIs or CT scans, rise sharply after a practice is acquired.<\/p>\n

Patients who get their labs drawn in a hospital outpatient department are charged up to three times what they would pay in an office, Sen said. \u201cIt\u2019s very hard to argue that the hospital outpatient department is doing that differently with better outcomes,\u201d she said.<\/p>\n

Hospital officials say they acquire physician practices to maintain care options for patients. \u201cMany of those physician practices are not viable and they were having trouble making ends meet, which is why they wanted to be bought,\u201d said Julie Lonborg, a senior vice president for the Colorado Hospital Association<\/a>.<\/p>\n

Along with Colorado and Connecticut, other states that have implemented or are considering limits on facility fees are Indiana<\/a>, Minnesota<\/a>, New Hampshire, Ohio, Texas<\/a>, and Washington<\/a>. Those measures include collecting data on what facility fees hospitals charge, prohibiting add-on fees for telehealth, and requiring site-neutral payments for certain Medicaid services. A federal bill<\/a> introduced in 2022 would require off-campus hospital outpatient departments to bill as physician providers, eliminating the possibility of charging facility fees.<\/p>\n

Connecticut has gone the furthest, banning facility fees for basic doctor visits off-campus, and for telehealth appointments through June 2024. But the law\u2019s application still has limitations, and with rising health care costs, the amount of facility fees in Connecticut continues to increase.<\/p>\n

\u201cIt hasn\u2019t changed much, partly because there\u2019s so much money involved,\u201d said Ted Doolittle<\/a>, who heads the state\u2019s Office of the Healthcare Advocate. \u201cThey can\u2019t just painlessly take that needle out of their arm. They\u2019re addicted to it.\u201d<\/p>\n

The Colorado bill would prohibit facility fees for primary care visits, preventive care services that are exempted from cost sharing, and telehealth appointments. Hospitals would also be required to notify patients if a facility fee would apply. The ban would not apply to rural hospitals. The bill was scaled back from a much broader proposal after criticism from hospitals about its potential consequences.<\/p>\n

Rural hospital executives, like Kevin Stansbury<\/a>, CEO of Lincoln Health, a small community hospital in the eastern Colorado town of Hugo, had been particularly worried about the impact of a fee ban. The state hospital association estimated his hospital would lose as much as $13 million a year if facility fees were banned. The 37-bed hospital\u2019s netted $22 million in patient revenue last year, resulting in a loss. It stays open only through local taxes, Stansbury said.<\/p>\n

\u201cThis will still harm access to care \u2014 and especially essential primary and preventive care that is helping Coloradans stay healthier and out of the hospital,\u201d Lonborg said of the revised approach. \u201cIt will also have a detrimental impact on access to specialty care through telehealth, which many Coloradans, especially in rural parts of the state, have come to depend on.\u201d<\/p>\n

The Colorado bill presents particular challenges for health systems such as UC Health and Children\u2019s Hospital, which rely on the University of Colorado School of Medicine for staffing. For outpatient appointments, the medical school bills for the doctor\u2019s fee, while the hospital bills a facility fee.<\/p>\n

\u201cThe professional fee goes solely to the provider, and, very frequently, they\u2019re not employed by us,\u201d said Dan Weaver, vice president of communications for UC Health. \u201cNone of that supports the clinic or the staff members.\u201d<\/p>\n

Without a facility fee, the hospital would not receive any payment for outpatient services covered by the ban. Weaver said the combination of the clinicians\u2019 and facility fees is often higher than fees charged in independent clinics because hospitals provide extra services that independent physician clinics cannot afford.<\/p>\n

\u201cProhibiting facility fees for primary care services and for telehealth would still cause significant problems for patients throughout our state, forcing some clinics to close, and causing patients to lose access to the care they need,\u201d he said.<\/p>\n

Backers of the Colorado bill disagree.<\/p>\n

\u201cThe data on their costs and their revenue paints a little different picture of their financial health,\u201d said Isabel Cruz<\/a>, policy manager for the Colorado Consumer Health Initiative, which backs the bill.<\/p>\n

From 2019 through 2022, UC Health had a net income of $2.8 billion, including investment gains and losses.<\/p>\n

The Colorado market is dominated by large health systems that can dictate higher rates to health plans. Plans pass on those costs through higher premiums or out-of-pocket costs.<\/p>\n

\u201cUnless the employers and patients that are incurring the prices are raising the alarm, there really isn\u2019t a strong incentive for health plans to push against this,\u201d said Christopher Whaley<\/a>, a health care economist with the nonprofit think tank Rand Corp.<\/p>\n

Consumer complaints helped pave the way for the federal No Surprises Act<\/a>, which protects against unanticipated out-of-network bills. But far more people get hit with facility fees \u2014 about half of patients compared with 1 in 4 hospital patients who receive surprise bills, Whaley said.<\/p>\n

Dr. Mark Fendrick<\/a>, a University of Michigan health policy professor, said facility fees are also generally surprises but don\u2019t fall under the definition of the No Surprises Act. And with the rise of high-deductible plans, patients are more likely to have to pay those fees out-of-pocket.<\/p>\n

\u201cIt falls on the patient,\u201d Fendrick said. \u201cIt\u2019s a tax on the sick.\u201d<\/p>\n

Tesso held off paying the facility fee for her son\u2019s visit as long as possible. And when her pediatrician again referred them to Children\u2019s Hospital, she called to inquire what the facility fee would be. The hospital quoted a price of $994, on top of the doctor\u2019s fee. She took her son to an independent doctor instead and paid a $50 copay.<\/p>\n<\/p><\/div>\n

Read More<\/a>
\n Markian Hawryluk<\/p>\n","protected":false},"excerpt":{"rendered":"

When Brittany Tesso\u2019s then-3-year-old son, Roman, needed an evaluation for speech therapy in 2021, his pediatrician referred him to Children\u2019s Hospital Colorado in Aurora. With in-person visits on hold due to the covid-19 pandemic, the Tessos met with a panel of specialists via video chat. The specialists, some of whom appeared to be calling from<\/p>\n","protected":false},"author":1,"featured_media":625203,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1066,34810],"tags":[],"class_list":{"0":"post-625202","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-states","8":"category-telehealth"},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/posts\/625202","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/comments?post=625202"}],"version-history":[{"count":0,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/posts\/625202\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/media\/625203"}],"wp:attachment":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/media?parent=625202"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/categories?post=625202"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/tags?post=625202"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}