Faculty fee? Co-pay? What are these things?
When I read about how you manage and deliver healthcare, your forever wars start to make sense. As a nation, you either do not know how to solve problems, or you develop absurd workarounds to retain the core, unworkable system. Think Obamacare…
The only consistent feature of your solutions, besides not working, is that they are expensive and deny care to huge segments of the population.
So glad I left when I was in my 20’s. If you are young, and have real, marketable skills, leave now; it will NEVER get better. By this I mean that once you thought Nixon was the worst… Trump? The trend line is clear.
2
And I haven’t seen anyone mention the venture capitalists and investment firms that are buying up doctors and contracting them out. That’s part of what led to “surprise billing”. On the ACA in my area, a large percentage of the insurance being offered is Jared Kushner’s brother’s company, Oscar. I can’t look at it without thinking of the Kushners and their value system.
5
You get what you vote for. This is capitalism folks and not just in healthcare! Why should the CEOs of large companies get multiple millions/year along with a bonus versus your average educated employee salary? Why are insurance and pharma companies profiting massively? Why are professional sports members earning $20-40 million/year while our high school teachers make 75k? Extreme capitalism doesn't work.
4
I am 73. I have UPMC’s Medicare Advantage, which has a $4,000 per year out-of-pocket limit. I’ve got some health issues including recent involvement with neurologists, but I pretty much ignore any bills I get due to the annual limit. Works for me.
@Libby , you’d best look into that. When I hit my annual limit the bills stopped coming. If you’re ignoring bills, they’ll be sent to collections, destroy your credit, and subject you to collector harassment and/or legal actions. It’s hard to straighten out things for you now, I know, but waiting will make things a lot worse.
2
@Libby , specifically, contact your insurer and ask why they are not paying the full amounts of bills. Your statements should show your balance as zero. The medical providers have no way to know about your payment limits, and to them, you're just not paying your bills.
2
@Libby Libby, you have MEDICARE. A national government funded insurance program. It works great! Glad you have it.
Until Americans reach age 65 (mostly) they must contend with the inefficient, greed driven, mess of insurance options - if they can get insurance at all - which likely cost way more than $4000/year even before they get a single medical service.
I hope you realize how good it is to have Medicare when someone suggest Medicare for all.
Instead of saying "the Practice makes more," I would recommend a blunt statement "the Doctors make more."
@Gandhian , doctors are pawns, too, their practices bought out, themselves driven by corporate bosses. Corporation heads and idle investors are raking it in. And no one is going to win but them, at ANY cost. Only the power of a government representing justice for the nation’s people could have stopped them. And that we do not have.
3
Can I please go back to being a patient, instead of an "informed consumer of health care services?"
It's time to give for-profit healthcare the boot.
7
For years you have seen the same doctor with roughly stable charges.
Nowadays however, the bargaining and purchasing powers, not to mention the "non profit" status of hospital based provider systems has led to 70% of doctors surrendering and becoming employees of those systems.
So your old doctor's charge is now hugely inflated by the "facility fee" levied by his new employer for the same service often in the same place.
Provider system consolidation and power, without anti-trust challenge leads to this health care cost acceleration.
And we all pay.
3
Simple answer, our de facto criminal health care system, an aberration re the rest of our peer countries.
Any questions?
4
For $322, I can stay in a nice hotel. I think I will. If the "facility fee" is going to be thousands, then, I'll upgrade to a luxury hotel. Maybe fly first class. Dine in a gourmet restaurant. Plus add-on fees are not hidden.
All more appealing options than the generally mediocre, overpriced healthcare offered in the USA.
But, since we do occasionally need healthcare and prefer not to be ripped off, we've switched to private practitioners as much as possible. Should that be unavoidable, we ask about costs before the visit. facilities and practitioners who don't know or can't tell us don't get our business.
We prefer to avid "urgent care" palces as they tend to be a bit mediocre, too.
We also access healthcare overseas, via private facilities. No hidden costs and generally far better treatment.
We do as much as we can to stay out of the claws of the USA's medical/industrial complex.
if we need immediate care, we'll deal with any facilites fees it if they happen. Hopefully we will be cogent enough to request to be taken to the hospital with the lowest facility fees!
1
Hmmn .... I don't know the cost of my last doctor's visit. Nor the cost of my Emergency Room visit, angiogram, diagnosis of a heart attack, and quadruple bypass surgery a few months ago.
Ahh, but that's right ... "socialized medicine".
Publicly financed single-payer health insurance, folks.
8
Eventually, which may be a long time, the great sucking of all money into the health care system will have to stop else it will eat the economy. One thing is sure: Republicans will never do that.
3
@jack
The doctors and hospitals pay the democrats too.
1
One in a series of articles that naively asks the same question as each one prior: why so expensive? Simple: in the US, each clinic or hospital visit requires a percentage kicked back to the wise guys and the boss, e.g. the for-profit CEOs and their lieutenants in upper management. Compare to the UK, where, though still in possession of an American passport, I am resident since 2004. For the NHS, copays do not exist, nor do I pay out of pocket for prescriptions, hospital visits, or indeed, any procedure, however complicated — even if it requires a crack team of surgeons working on me under general anesthesia. Out of my salary an NHS deduction is made monthly, based on income. Were I to lose my job, I would still enjoy the same benefits, which have no relation to employment, never mind my relationship status. Good grief — how absurd that uncounted Americans stick it out in loveless marriages for fear of losing their medical coverage! NHS-run clinics and hospitals are no-nonsense, no frills affairs with minimal administrative overhead and no excessive, luxurious razzmatazz. Yet I’ve never received anything other than excellent care. If I need to see my GP, my wait time for an appointment is typically one day or less; usually the same day I call. And this is a busy, popular clinic in a market town that serves a large rural part of Co Down. I will never willingly live in the USA again and its lack of socialised medicine is the main reason.
8
@D Kowalsky
Or stick it out in miserable jobs, instead of starting their own businesses, to keep their health insurance?
3
I work a job that pays much less then an offer I got for a managerial position at a large company. That job was in pharma and I couldn't in good conscience accept it. The company I work for now is a manufacturer and I work with honest people who do real work, not working in a gilded office built on others suffering. The healthcare industry in America is simply immoral as are those associated with it.
3
So, I stop for a burger at a coffee shop that's part of a shopping mall. This logic says I can be charged a "Facility fee" because maybe the Mall has to have fire extinguishers or a planned evacuation route with signage. Step-by-step, we're approaching socialized medical care.
4
@Tom B. Please explain how charging facility fees is like socialized medicine? Perhaps I am misunderstanding your point.
@Aacat
I'm reading that last sentence as something like "the crazier our current system gets, the more attractive socialized medicine becomes."
3
This is very much an echo of what happened when the FTC required funeral homes to publish price lists: the prices of component parts went down, and instead a large service fee was added.
3
My cancer team was at a facility with many kinds of doctors’ offices, and all was well. Then I suddenly received a bill tripling the cost of a usual visit. Aetna wouldn’t pay for any of it. I was told that the center had “been designated” a hospital, and that I was now a “hospital out-patient”, though I’d never been an in-patient there—or any such thing. They would drain me of my deductible for office visits and “hospital” blood tests. Now at my workplace, we’ve been forced into one narrow plan—or we can have the “broad” choice of doctors for a six thousand dollar deductible paid before one cent from insurance. And the “narrow” choice is the “hospital designated” place. So the insurance companies are about to add thousands to our yearly costs off the top and to their endless profits. Don’t try to call to complain. No one’s there. So save the pennies, friends. You’re going to need them.
7
I am healthy and tend to avoid interacting with the healthcare-adjacent wealth-transfer industry, but I had reason to be at a new physician’s office recently. My major impression was that the office and the building and the nearby buildings looked like a glitzy new shopping mall. Lots of money being spent on the facilities’ high ceilings, marble floors, fountains… haven’t seen the bill yet, but it’s going to be astronomical.
4
@Troy Benson how about dentists' offices with fish tanks and fireplaces? and pushing $200 insurance plans.
There is a sacred relationship between the practice of medicine and the patient's wallet. If there is anything in the patient's wallet it must be extracted a quickly as possible. 20% goes as campaign contributions to politicians who protect the relationship and 20 % to PR flacks who blame lawyers for all the increases.
My wife a was a Brilliant career VA salaried physician . She found the "cheat the patient" system disgraceful
4
I am a salaried physician at a hospital, and I don't understand facility fees.
Some offices in my on-campus medical office are Regulated Space and charge facility fees. Others, like mine, don't.
2
Health care businesses (including a family physician, etc.) should be required to disclose specific facility fees (and really all costs) upfront, and have patients acknowledge & accept those charges before proceeding (ideally informed by whether or not their insurance will pay).
11
And how is that we still continue to tell the world we are the shining city on the hill?
12
70 years old and healthy as far as i am aware. Haven’t been to my family physician or had any tests for about 3 1/2 years, so there could be a hidden problem i am not aware of. Last time i saw my doctor i had free insurance through my employer, but now i only have Medicare A and B.
My Social Security pays just over $1,000 a month.
I am afraid to see my doctor since i can’t be sure what the bill would be. Also, i am not willing to spend my meagre savings on doctors. I would rather leave it for my child and grandchild who really need help.
My main hope is that i die suddenly because i know it would be difficult to resist treatment if i were in pain.
My husband had assisted suicide in Switzerland a few years ago due to a terminal condition, but now it is quite costly. However, i do have access to well-known guidebooks for ending one’s life. People often say that is what they would do before becoming helpless, indigent, etc, but they never seem to take into consideration the point at which they would actually be willing to do so.
I just really don’t want to take part in the koyanisquatsi that is the health care system in this country.
20
@Malinda I'm sorry you have had to deal with all of that. Your care for your decedents well being and desire to path on what you have is admirable. I also could not imagine living after my spouse, it must be a difficult thing.
Wishing you the best, may your departed husband rest in peace and may your both know happiness and freedom from suffering.
5
@Malinda
Your children and grandchildren don't need your money. They probably would prefer you to take care of yourself. Spend the money on yourself, get the needed care, leave enough money to bury you.
4
Five years ago, confronted by a last straw of rising costs and decreasing payments, my independent medical practice was making so little that I would have needed to sue myself for paying me less than minimum wage. It was join up (facility fee coming in, overhead eliminated) or get out (retire). I would have to give up taking a careful history, listening to my patients, doing a thorough examination, and thinking about the care I was giving, because I would not be able to make the required work units in the time allocated per patient.
I retired.
17
@AJPeabody My wife was a salaried VA physician her whole career. She had lots of physician colleagues who bailed from the rat race
1
I would not so quickly take the advice that one avoid doctors -such as Emkay: "I highly advise going to a private practice/independent doctor whenever possible." I whenever possible use doctors who are part of a large hospital affiliated with a major medical school. The doctors are excellent and have actual access to medical records, test, and notes of visits is something not provided by another group practice I use which is part of a private doctors network which seems to be able to comply with medical records access requirements. Anyway, I take comfort that in real time my care is peer reviewable by other doctors in the same hospital practice and know that more than one doctor - sometimes in another practics - sees my records. The hospital is concerned about liability and there are many precautions taken to protect patients. This hospital does not charge facility fees.
1
@DejaVu I don't share your comfort in being safe in a hospital affiliated practice. Hospitals wanting to avoid liability sure didn't stop me from being assaulted in the ICU of a major hospital which theoretically should be a safe place. Bare bones overworked staff and profit over safety seems to be the norm from what I've experienced when dealing with hospitals. I do whatever I can to avoid the places.
4
You must have a very expensive insurance plan - either paid for by your employer or the government. The healthcare system you describe is the most expensive option, every time.
1
@DejaVu , you forgot to say “yet.” Because I would’ve said the same as you before the first surprise bills started coming. You won’t have any warning, by the way.
1
in rural Thailand we pay cash. we pick our doctor and he is available at local clinics after he, or she, finishes work at a hospital. that's outpatient. usually $3 a visit. for inpatient, we pay about $2,000 a year, at age 65. in 5 surgeries here, which included carpal tunnel surgery that my well-known HMO in Los Angeles would not provide, were all first class. for the carpal tunnel there were 5 surgery nurses and a surgeon, the surgeon was also a friend of mine who liked to eat 'farlng' food and met me several times during lunch and said to me 'I can fix your carpal tunnel'. $3. and seeing a specialist, top line, same day is something I also have experienced. only scans and imported drugs cost real money, but it is for a good thing and just as expensive as at home... and that's only when I decide on a test or something as inpatient, which I so far have not seen any need to cover with any outpatient coverage at all.
1
No rocket science here.
Doctors (most) paid 2x of what they should be, Administrators and Executives paid 10x, Pharma paid 3x
Divisions in the society where some folks don't want some others to get the care. This enables the farce to go on and become even larger while not getting fixed by voting.
Solution - A courageous and technical President.
3
It is maddening! and after experiencing it last year ($500 visit fee covered by insurance + $500 facilities fee not covered), it was one of the most expensive 10 minutes doc visits I have ever experienced. not returning to any provider in that organization (Harborview). And I am fortunate to live in a place with alterniatives.
KHN also wrote about it here "Her Doctor's Office Moved One Floor Up. Her Bill Was 10 Times Higher " https://tinyurl.com/hn3j2vcx.
6
Years ago, my wife's obgyn ordered a routine ultrasound for her at Sutter's California Pacific Medical Center. The procedure took about 5 minutes of a tech's time. The radiologist who interpreted the images charged $57. Sutter's "facility fee" was over $900 under Blue Shield insurance. I corresponded a Sutter VP to negotiate the price down. He explained that Sutter's charges were obligated by their contract with Blue Shield, and reflected "market rates" in the Bay Area, the details of which he couldn't discuss with me as they were "proprietary." Not long Elizabeth Rosenthal's book "An American Sickness," a dissection of the medical finance which focused on Sutter as its prime case study, noted that Sutter, in fact, sets the market rates for the region because of its size. Medicine has become a wealth extraction system, corrupting its purpose.
33
Basically half the commercials on TV are for insurance which is probably very expensive. They must be making tons of money from us.
4
@Pablo Everytime I turn on the tv, there’s a slew of commercials for various drugs. The possible side effects sound as awful, if not worse, than the ailment.
2
I have Medicare and Medicaid, so I pay nothing for covered services (everything I need but dental care.) It is just like Single Payer Medicare for All, but there are two payers. It makes life simple. I wish everyone had this coverage. Even rich people should not have their time taken away negotiating bills.
Please support Medicare for All.
21
@dr. c.c. Medicaid does pay for seniors who have it in all but 3 states - every state differs in type and amount of dental coverage. Check your state info.
With a gold plan, here in Montgomery County, MD, thee facility fee is $1000.
Interesting to read that other facility fees are in the low one hundreds.
2
Sorry for the typo.
Here it is, corrected:
With a gold plan, here in Montgomery County, MD, the facility fee is $1000 for a colonoscopy.
1
American health care: Two times, three times more costly than in Europe or Japan or Canada. The most expensive health care in the world. And, the result: The US ranks 37th in life expectancy. In other countries, the people who might try to do that would be prosecuted, declared guilty, and be imprisoned.
18
@Don The hypercapitalism in this country is killing us. It’s not just the medical field. No wonder Americans are so stressed and anxious. Every day is a battle against one scam or another.
3
Spent about 7 hours on Monday trying to find out how much a simple procedure (a follow up shot) would cost at the ER where I had been directed to take it.
Spoke to Dr's billing and estimate staff, hospital billing and estimate staff, medical insurance staff - in total about 15 people.
Total fail. Essentially most of my medical $$$ are going to a huge bloated inefficient administrative labyrinth empowered to provide no information to the patient.
The common line was we can't tell you how much that will cost UNTIL the cost has been incurred, it has gone through billing, coded and your account has been updated in 10-14 days.
ABSOLUTELY RIDICULOUS!!!! 7 HOURS of calls and repeated calls. No lie. Is there a facility cost for the shot? No one could tell me.
Found a private entity that took 1 call and 30 seconds to tell me the cost of the shot and make an appointment.
The U.S. can't go to a single payer system fast enough for me! Our health care system is SO ARCHAIC. Like manufacturing pre-industrial revolution, whereas the rest of the world is light years ahead of us and enjoying a superior product, efficiently produced for a lower cost.
OUTRAGEOUS!!!! UNC HEALTHCARE AND REX HOSPITAL AND DR. MICHAU - I'M LOOKING AT YOU!!!!
33
@Angry NC patient I experienced similar problems. Charges for preventative care which should have been covered by my insurance. Hours on the phone. My Dr.’s nurse said it would be recoded but their billing kept sending the bill. More calls. The doctor’s office, the hospital billing Dept, the billing company. The last bill threatened to send it to a collection agency. I don’t plan to get preventative care again.
1
@Angry NC patient Dealing with insurance and medical offices and trying to get a straight answer on anything is absolutely depressing. Eventually leading to utter despair as you deal with the Kafkaesque nightmare bureaucracy involved that has no real answers for you.
I've broken down in tears before, same with my wife. You try to do the responsible thing and "do your homework" like people say and you spend hours and hours of your precious time for nothing and go in circles only to be told you should just gamble and wait and see what you will be charged. Then when you get unexpected costs, they will say, should have done your homework and checked.
3
Facility fees have directly lead to hospitals etc buying up medical practices and further controlling the minute-to-minute interactions that doctors can have with patients, all in the name of more money for the hospital. (The facility fee does not go to the doctor/doctor's staff). I highly advise going to a private practice/independent doctor whenever possible.
13
@EmKay, in my experience, the facility fee does go to the specialist practice.
A case in point: the facility fee for a colonoscopy goes to the gastroenterology practice that owns the facility, and whose doctors perform the procedure.
The facility fee of $1000 is perhaps paid directly to the practice, or to the doctor.
The facility fee goes to the facility. If the facility is owned by the physician then what you say is true. But they are often separate.
10
The Walter Cronkite Republican notes the "facility fee" is just another consequence of the corporitization of American health care in its quest to focus on profits rather than health care delivery. It is another example of gaining control of a revenue stream to skim off the top by owners and managers.
13
What if you're on Medicare? Will Medicare pay, or do you have to pay?
2
@Horace
No - Medicare will not pay. Found out on my Welcome to Medicare vist.
5
So if Medicare does not pay, does my supplemental Federal BCBS pay? We go to a hospital owned practice and have not paid anything (except our exorbitant cost of this insurance)
@Horace, I dread going on Medicare.
1
Agencies in the U.S. government regulate various costs. However these are small potatoes compared to medical cost. Follow the money; who are the beneficiaries of the current rotten scheme of things? Why are we powerless to deal with this existential conundrum? Imagine an America where medical costs are in line with the rest of the world.
6
in response to the question posed in the beginning of the article: it is a form of theft, one which citizens must endure in order to hope to get well. The theft then continues to be one that steals piece of mind, as every walk to the mailbox will now involve fear of being subjected to theft of piece of mind again, and again and again.
11
As this is a question no Canadian would have need to ask, I was curious to read the article as well as the comments.
America: The only G-7 country that does not offer its citizens Single Payer Universal Health Coverage.
Countries far less wealthy than America offer this to its citizens.
16
@Angus,Brother of Fergus
or in response to the question posed in the beginning of the article: it is a form of theft, one which citizens must endure in order to hope to get well. The theft then continues to be one that steals piece of mind, as every walk to the mailbox will now involve fear of being subjected to theft again, and again and again.
5
Well done article. As an older physician, one might think I would be aware of "facility fees" but alas when I recently had an evaluation by an orthopedic surgeon I was completely surprised when I received the bill. At least, I know now.
10
My wife has fairly good insurance. But when she went for follow up care to a physician who had moved his office to a Northwell facility parking lot, she was charged a facility fee. When I asked what the fee was for, of course I got a nonsense answer. So I wrote a letter to the U.S. Attorney suggesting that the bill was mail fraud and sent it to the hospital administrator with a note that I'd send the letter in 2 weeks.
Facility fee was waived.
20
Why are patients required to become experts in medical insurance codes to prevent being ripped off? How long do we have to wait before our democracy is ready to tackle the American medical industrial complex and bring cost to a reasonable level as other developed countries? Billing transparency would be a step in the right direction.
26
Gotta pay for all that new real estate they are building on hospital campuses. Our local hospital has a two-story "water feature" in the atrium. As my insurer would say; that's not medically necessary.
25
Our new hospital has looks like a premier art auction house.
5
"One can avoid these costs by seeing a doctor whose practice is not owned by a hospital. "
Where might one find a doctor whose practice is not owned by a hospital?
Hospitals have been gobbling up medical practices. One of the reasons for this is that Medicare reimburses at twice the rate when the practice is owned by a hospital.
It appears that hospitals are making offers to doctors which the doctors find to be too good to turn down. I can't think of any other reason why just about every one of my doctors would have agreed to be purchased by a hospital. These are not doctors who
are starting out and have loans to pay off . These are well established physicians who have owned their practices for many decades.
18
For the older private practices (non primary care), the options are either to fade away and retire or sell your practice to a hospital. Basically all primary care is within a hospital system now, and doctors within a hospital can only refer to other doctors within that system. So if you’re not in, you’re on your way out.
1
I had to pay $500 to see a ENT and I have insurance. $500 left on my $5000 deductable . Growing up my dads insurance covered everything.
11
"Will my insurance cover this procedure?" is no longer the precise question. You now need to ask "How much will I be liable for?" at which they will answer: "We don't know. It depends on a number of variables."
11
@David M
would it not be better to be blunt? "How much will the theft be?"
5
We have these issues because of Monopolies also known as crony capitalism. Having true price transparency will also help providers compete fairly. Providers should also be required to charge the same prices to all insurance companies or individuals. Surprise is that politicians do nothing about it, yes the ones you voted for. They do throw sone bones, for example by pretending to attempt to allow allow Medicare to negotiate drug prices, rather than stop blocking the previous president’s executive order to not charge Americans more than 25 percent of European or Canadian drug prices. Allow true competition and prices will automatically go down, it works everywhere else in the US.
10
Facility fees have beren around for years, mostly in Doctor owned facilities, like Surgicenters, Imaging centers and others where the MD owner refers his patients he owns a share in. So he gets the profit from the Center and his Fee for the service fee. The owner MDs make sure the schedules are filled with their patients, Simple solution global payment for a service including the facility fee and MD Fee. Good Luck...
3
@bahcom In my area, no more than 20 percent of the specialty centers are owned by the doctors themselves. The rest are owned and run by corporations. A family practice doctor or internist who has ownership in even the smallest of medical offices is really rare and becoming more so.
5
@bahcom Yes, everything is owned by corporations. Doctor-owned facilities are so yesterday. Everything is being bought up by corporations and doctors are simply care extenders earning far less than the administrators, who far outnumber the doctors.
9
@bahcom
Anyone have insight to offer here on the cost of medical malpractice insurance?
How much must various practitioners and institutions carry to be licensed to practice medicine?
Can physicians, particularly surgeons and obstetricians, for example, foot the bill for this in our land of litigious combat and payout, unless they work for a corporation or in a big hospital network?
3
I am a recently retired physician. Charging a "facility fee" in doctors' offices just because the practice is hospital-owned is a despicable money grab pure and simple. Nothing changed when the hospital bought the practice. This should be condemned and the practice stopped.
49
When every aspect of life in the US is worse than many developing countries, at what point to people stop saying the US is the greatest nation on Earth? I'm sorry, what are we great for? What are we even good for anymore that plenty of other countries can't also rightfuly claim?
I'd been living abroad in a few developing countries for over a decade and recently returned to the US and can't believe how difficult it is for the average citizen to get by and keep their family safe—all to secure and protect corporate profits, political weakness and outright corruption.
26
I lived overseas for 21 years in South Asia and then in the Arabian Peninsula. I wish I could have retired there but it wasn’t possible. Best 21 years of my life.
This country is a joke.
5
Yes, your Doctors visit was expensive but please don’t blame the Doctor, if you are fortunate enough to see one rather than some Mid Level “provider”. The wild cost of the visit is indeed due to the bogus facility fees our hospital’s off site clinics charge. These off sites along with the increasingly prevalent purely profit driven private equity mills are driving your independently owned physicians offices out of business. Soon, you will have no choice, the independent physicians office will be gone and quality of care despite all the absurd regulatory burdens will continue to spiral down. You will get the healthcare you deserve and it will be delivered by providers, not doctors.
15
@No Victim for the majority of us a majority of the time a "provider" is all we need. I would not knock the care provided by mid-level providers. It's often better. And it frees up the doctor for the cases who need her more (in theory, anyway).
1
@Melissa in Dermatology Mills extenders see most of the patients. They have no idea what they are so seeing so the managers say “fine, just do more biopsies” after all biopsies are lucrative and our Pathologists are all in house and we can have them order special immunostains which are $1800 a pop. Heck, we can even generate more unnecessary Mohs Surgery because our Surgeons are also in house. THAT is the business model.
2
Just think what would happen if Walmart added a facility fee at the end of your bill. Congress would hold hearing, both parties would denounce such piracy and even Fox News would would blast Walmart’s hidden fees. But, since it’s healthcare everyone sees it as business as usual. Wait until pediatricians hold newborn babies for ransom until you pay in Bitcoin.
23
Really.
Ridiculous.
Every time you hear the advice to “shop around” or “ask about fees” when it comes to health care you have entered a netherworld of nightmare. Asking a possibly ill person to “shop around.” It isn’t as if one is shopping for shoes.
Remember “slamming”? When you “accidentally” made a phone call from a telephone that was serviced by another company? And then you’d get an outrageous charge on your telephone bill? Remember that laws were made to prevent bilking the public?
Hello?
“Facility charge” is simply another way of “slamming”, bilking the public outrageously for their health care.
But laws against this? Not when our politicians fill their pockets from the health care industry.
22
And now my Medicare monthly payment includes an extra $21.00 to cover the new $21K or so/ a month Alzheimer's drug that was not shown to do any good but approved anyways... We peasants should revolt! French Revolution anyone?
25
Back in 'the old days', 'facilities fees' were called 'the cost of doing business.'
7
Another example of the insane health care system that we fight tooth and nail to keep here in the USA. I pay 973.00 a month premium for my medical insurance (through the exchange, unsubsidized as my income is not low enough), that is a 70/30 policy with a large deductible. Basically I pay almost 1000.00 a month to get a health insurance card that I cannot afford to use.
28
@Ray "We" don't fight to keep it. The hospital and pharmaceutical industries pay good money, in the form of bribes they refer to as campaign contributions, to politicians in order to keep it. And most politicians would take a dollar from Satan himself.
8
So glad I live in Mexico where health care is high-quality and affordable (at least for us Gringos). I always get at least an hour with any doctor I see. Specialists charge the most , $75 USD for that hour ( total cost - and sometimes in an office inside the private hospital- no facility fee). MRIs run $300 USD and I actually had a radiologist come speak to me right after. When was the last time you met a radiologist? I tell people that medical care in Mexico is like a fine-dining experience , sure it costs more than many things but you always feel good about what you spent and you usually enjoy the experience. BTW full health coverage (best you can buy and god all over the world) for two people over 60 costs us $4k USD per year (total for two of us).
14
Who would have thought, that medicine, the caring of patients, would cost a ton of money....even before being seen by health care personnel (Nurse, Physician, Physical therapist, etc). A business really. Unfortunately, it is 'killing' us, as it becomes totally unaffordable, especially for those unable to afford Health Insurance. No wonder far too many people that might benefit for preventive measures, and those with early onset DM, Heart disease, Hypertension, even cancer, are seen way too late, with the subsequent suffering and premature death, all avoidable if we could be more responsible in solidarity...by instituting a long unresolved need, delayed by our stinginess, a 'Universal Healthcare System', no questions asked, all and everyone being taken care of in an affordable quality and timely fashion. Oh well, dreaming is cheap, I guess. But not impssible, if we ever develop the will to be nicer to each other, social beings as we are.
10
When I shop at virtually any other business—let’s say I spend $1500 at a retailer for a computer—I do not incur a “facility fee”.
These other businesses also have expenses related to their operation.
Regardless of the fee’s labeling and transparency, the blatant for-profit greed of the healthcare industry has gone beyond ridiculous.
35
@Andre Hoogeveen Stop! You're giving all the other retailers ideas! (But seriously, great point)
4
"My mechanic charged $45 for an oil change and a $300 facility fee. He didn't tell me at the time, but sent me a bill later."
This is what I would love to hear from a hospital CEO, or the politicians who allow this robbery.
24
@Sha - I have been to auto shops where they add a 'misc shop materials' or a 'oil disposal fee' onto the bill.
Generally it's not that big and I accept it.
If it was half the bill that would be another thing.
2
@Ginger and you'd really object if it was 2-3 times as much as facility fees often are.
My dentist also sold out to corporate interests just this year. The result? All the hygienists quit, including my favorite one. She confided in me that the reason they were quitting was because of the new management and their new rules, which essentially gave them more responsibility without being compensated for it. Knowing this I’m planning to move on and find another dentist. But I fear with costs rising for these private practices, they’ll just sell out to corporate controlled services and I won’t get the level of quality I want for my dental care.
7
Some middle class people vote for Republicans because they want to pay less taxes, oblivious to the fact that they are paying health care taxes, in the form of ever increasing premiums, out of pocket expenses, unexpected charges, and as I learned today, facility fees!
26
@Sha They want to pay less taxes because they think they'll win the Lotto sometime! Delusional individuals who continue to vote against their economic interests... Great gaslighting the GOP!
9
These facility fees are a major reason why doctors are being purchased by hospital health systems. The income stream literally doubles, and this allows the big chains to purchase the doctors practices and monopolize care in many areas of the country. I am aware of many cases where the same practice in the same location with the same doctors has fees double overnight, when the ownership changes. This is a huge problem and a huge waste of money that should not be allowed.
25
We thought healthcare in this country was bad before, but now hospitals are “systems” and rampant consolidation has removed any real choice for patients. Sometime back my doctor wanted me to get an MRI. Even with the CPT code for this outpatient test, the hospital and Anthem Blue Cross linked arms and refused to tell me how much I would owe for this. They knew, of course, but by prior agreement between them, I wasn’t allowed to know. The idea was that I should wait for the bill in the mail! Legislators have long hammered away at the idea that the irresponsible public should be smarter consumers of healthcare, yet this is what they allow. Sky high deductibles apparently aren’t enough, as every avenue for informed decision-making is foreclosed. I didn’t get the MRI and I certainly won’t be going to any doctor trying to charge a facility fee. We must ask what is wrong with a country allowing the healthcare profession to behave in such a greedy, craven manner.
44
@Dianne Jackson I'm no expert in this, but it feels like you're describing a cartel.
8
@Dianne Jackson
"We must ask what is wrong with a country allowing the healthcare profession to behave in such a greedy, craven manner."
Uhhhhh.... voters?
11
And this is another reason health care is so expensive in the US. We keep blaming Pharma but they are the small potatoes in the cost meal. Easier to blame Pharma as their costs are more transparent. The malevolent brilliance of the rest of the industry is keeping costs hidden to the public.
18
After 20 years of solo, specialty medical practice, I finally gave up and joined a large health care system. As an Independent practitioner, I could not afford to pay ever rising rent, overhead and taxes with diminished insurance reimbursement.
Private practices are not allowed to charge facility fee, and this leaves them in a precarious financial position. The large medical groups owned by “nonprofit” healthcare systems and hospitals charge twice as much for a routine office visit as an independent practice. They also have significant tax advantages that small, independent practices don’t have.
There’s no way small practices can survive. The system is rigged against them. The way Walmart and Amazon have driven small mom pop shops out of business, the same thing is happening with large medical systems but with a significant difference: The rise of Amazon and other giant retailers led to lower prices but with the healthcare system, it’s just the opposite. Cost of health care has gone up with closure of independent, small practices.
46
@SNH This is absolutely the truth. I used to be in private practice, but it became impossible to pay the overhead, much less pay ourselves. So we sold out. Sad, but true.
1
America has decided to sacrifice health care for all citizens on the altar of corporate profits. Period. I'm entirely willing to believe/understand that many professional individuals fully believe tnhey are "practicing medicine to improve (my) patients' health," they participate willingly in efforts resulting (at times) in massive debt for already hard-strapped families. What's truly amusing is that so many citizens seem to believe that there's a different sort of "religion of care" practiced in these halls of profit. That is - until some esoterically new treatment is neither available nor "covered" and they tear into some wild "community wide" fundraising to be able to provide needed care for someone. Hey! Tell us all, once more, how "the USofA has the best doggone medical care in the world." (Especially if you can afford it...)
16
Private equity investment firms are the reason for the exorbitant fees hospitals and medical practices charge. This is unfortunately largely unknown by the general public. These firms have bought hospital after hospital and medical practice after medical practice across the country. It started about 10 years ago when they saw easy targets that could pay the millions of dollars the top executives make in bonus and salary. These sharks care only about the bottom line. Private Equity investment accelerates consolidation and is fundamentally incompatible with a stable, competitive healthcare system that serves patients and promotes the well-being of the population. They have ruined many other companies and industries and only aroused public knowledge and strong legislation will ever stop them.
28
@Reformist Wait and see, False Claims Act whistle blower lawsuits will soon be commonplace. The only way these PE driven mills generate demanded profit in a narrow margin industry is by overutilization and fraud
A question that can only be asked in the US. The for-profit healthcare system is the unfortunate (for us) answer.
7
In Orlando the major hospital systems have been buying up local independent practices for some time. I used to have doctors at two independent practices. When the letters came to inform me that both were now part of a major hospital system, I knew immediately that medical bills would be going up. I have kept my doctors anyway, since it's hard to replace medical relationships that go back several years. I suspect that the same situation exists all over the country.
20
Just another form of a Las Vegas resort fee. A non-transparent extra charge.
If you see a doctor in his office, there is a single co-pay. A hospital visit requires two co-pays. The extra co-pay is used to pay the doctor's office rent.
7
Why have so few sought to explore Australia's fantastic health care system? Actually the architect of our Medicare system, Professor John Deeble, is still alive in Canberra. Why doesn't anyone in the US invite him to talk publicly?
We have a hybrid system, but our public system is so good that most people are pretty happy to use it and not pay private health insurance premiums. Actually our private health care industry is in trouble because our public health is so good.
God bless Prof. Deeble.
28
@patricia azarias Money. Politicians are fueled by it and they get re-elected by having medical industry donations support their primary-vote challenges and election campaigns resources. Same reason why lead was permitted in gasoline for generations.
2
Never never never see a doctor who has an office in a hospital or in an adjoining building if you can possibly help it.
8
@Thea Our audiologist's office is clear across town but the practice is owned by the hospital so we're still charged a facility fee which our insurance refuses to pay.
2
I had the same inflated outpatient medical bill for my wife’s needle biopsy. I researched the CPT code for the procedure and estimated $1000-1500. The bill came back as 4500! I requested an itemized bill. There was no facility fee per se, but the hospital owned outpatient billed physician and procedure fee. The later, I found out was with DRG codes, instead of CPT. I complained to everyone and refused to pay more than the CPT amount.
10
Ask why we have so many administrators, that’s where your facility fees go to pay their salaries. Since 1975 physicians have increased 150% and administrators 3,200% why?.
37
@Scott SolowayMD
Same phenomenon in the "education" industry.
1
Why are commenters assuming that facilities fees will vanish if we have single-payer or "Medicare for all"? These two things have nothing to do with each other. Just because you have a single payer doesn't mean costs automatically drop or providers stop charging whatever they want to charge.
Price controls could be instituted by Congress, or facilities fees could be outlawed. But those things would not automatically happen even if we suddenly had a single payer system. They would have to be written into any law that created a single payer system.
8
@Cunegonde Misthaven Although in Canada I have been watching the US sytem with great interest having lived and worked in Texas back in late 90s. Accessible coverage is a different part of the Healthcare issue than the charges made to the system(users) by providers. Back in Houston, working with accountants in a large Oil Company I was stunned to hear "Oh you are SO LUCKY, living in Canada !" This was from folks who were very professional people working as temp staff as they had been laid off. They COULD NOT BUY coverage due to pre-existing conditions and they told me of family/friends who were paying $1000-$1500 per month for their insurance as they were in their 60s... none of these were fantasy tales - they were huge problems for these folks. Yes we have waiting lists but we are never denied service and we may have to wait a few months sometimes but we are covered and we do not go broke. Oh and by the way - I am a Harper Conservative (middle of the road)- so no insults please, this issue is for all people whatever stripe,shape,size,colour,pattern you are. Best wishes USA - I hope you defeat the Soviets - yes the upcoming 2020 battle.
18
@Lavinia Back in the 90s, I was paying $1,000/month for health insurance (self-employed) for a high deductible policy and was in my early 50s! Every cog in the wheel from insurance companies to hospitals and labs add in their fee and take another pint of blood from the patient until they bleed the patient (us) dry.
9
Vultures have more morals than this.
21
@David Devonis Please don't malign vultures! (Just kidding.) They're nature's garbage disposal, and they don't attack living creatures -- they wait until they're dead, which is more than I can say for some hospitals and medical care providers. BTW, I heard on NPR the other morning that vultures perch and wait on the border wall for migrants to die who are trying to make it across the desert. The vultures just sit and wait and watch. They know what's going to happen.
13
Isn’t for profit health care grand?
12
Sheesh. I’m so glad I live in Canada.
22
For 30+ years, being self-employed, I never had any health insurance, was never sick and never set foot in a hospital or saw a doctor. When Obama came along I signed up for O'care (cheap Bronze plan) and never had a need to use it.
I hope I croak before I ever need to set foot in a hospital or see a doctor.
7
@Rufus Congratulations on being lucky. That's incredibly rare.
10
@Rufus My mother had a fear (or something) of doctors too. She quit seeing one in her 40s. Died at the age of 72 from a massive stroke, no doubt due to uncontrolled high blood pressure. Not seeing a doctor for a well health visit annually is a sure recipe for an early death. My young children were devastated to lose their beloved grandmother. Don't be that person.
6
@Rufus "I hope I croak before I ever need to set foot in a hospital..." But you may not. In fact it is likely you will not. You will then go bankrupt and the rest of us will pay for your care.
Kaiser for all!
2
@Hazel Sure, if you want to be sent off to a physical therapist when you have a major problem that requires a specialist. It happens a lot and appears to be part of their business model.
3
A facility fee is just another name for price gouging. Medicare for all.
24
We don’t have a health care “system” in the US. We have a sickness industry operating like most industries in our capitalist system - its primary purpose is to maximize the financial wealth of the owners. Our sickness industry as such has been profoundly successful. This new “facility fee” is just one small reminder of how creative the industry can be in terms of adding pure profit onto every customer encounter. It reminds me of the “dealer prep” fee added to new car sticker prices, except its sneakier in that it pops up after sale is complete. A health care “system” does not exist yet in the USA, but the sickness industry is booming and the customers (patients) are getting crushed. What a disgrace.
42
It is stuff like this that makes the EU or Canada health care as a model to replace the US health care system.
19
Once Warren or Sanders is our president, we can work on getting single-payer health care implemented and stop getting ripped off by the Greed Sector.
8
Still need enough members of Congress to vote on it. Pay attention to the down ballot elections too, not just who is running for President.
3
@Eugene Debs Good thought, but never gonna' happen. The delusional Trump cult will insure that.
3
My understanding is that having patients pay the building fee up front makes it easier for hospitals to get the credit necessary to buy more infrastructure for new specialty hospitals and clinics; they are able to pay these debts with the facility fees right away. Our currently very low interest rates are facilitating this rapid hospital growth.
4
@Dorothy Pugh - LOL
7
The “facility fee” is but the symptom of the society built rigidly on legalistic structure.
American have chosen organization best suited for the legalistic life. Limits of human rights and rightness are determined by a system of very broad laws. They have acquired considerable skill in using, interpreting, and manipulating law, of course, with the help of legal experts). Every conflict is solved according to the letter of the law and this is considered to be the ultimate solution.
Direct result of living a legalised society is the practice of defensive medicine. Doctors for ever live under the getting sued Sword of Damocles, naturally order multiple tests even when they are certain they know what the diagnosis. Everyone pays the bill on this with higher insurance premiums, co-pays, and out-of-pocket costs, as well as taxes that go toward paying for governmental healthcare programs.
Soviet dissident Solzhenitsyn brutally observed “I have spent all my life under a Communist regime and I will tell you that a society without any objective legal scale is a terrible one indeed. But a society based on the letter of the law and never reaching any higher fails to take full advantage of the full range of human possibilities. The letter of the law is too cold and formal to have a beneficial influence on society. Whenever the tissue of life is woven of legalistic relationships, this creates an atmosphere of spiritual mediocrity that paralyzes man's noblest impulses”.
4
I have read the article and many of the comments. There is a bit of history which would be very elucidating in this matter. There has been a concerted effort by the federal government through HHS to consolidate healthcare in this country. The Small private practices that we all grew up with are disappearing. This is because of the cost of running these practices due to amongst other things regulations, electronic medical records, and the morass of insurance billing. Younger physicians don’t want to jump into this mess and hang a shingle and older physicians are fed up. So what do they do? Join hospital groups. They get a salary based upon productivity. The hospital supplies the facility and then charges the facility fee. Physicians in no way benefit from this other than losing autonomy and becoming cogs in a medical meat grinder. Sure they don’t have to run a small business anymore with all of the inherent headaches but become nothing other than employed “providers“ rather than your community physician.They are no longer tied to the community where they start their practice and can move around at the drop of a hat. I still own my office which was paid off with interest over 30 years without a facility fee. I constantly deal with the stresses of running a practice and decreasing reimbursements and salary. I won’t have some overpaid manager tell me how to practice medicine for corporate profit. Perhaps in the healthcare debate we should learn from the “good old days”!
33
All costs have to be covered. Step one is getting a TRANSPARENT listing and accounting of all costs for health care properly sorted by (direct value add; administrative, profit and non-value added such as legal, malpractice insurance, paperwork etc)
Once we know what we are spending, then consumers and government can make well reasoned decisions.
Right now, no one knows the true cost of this.
10
Our healthcare system is broken, but medicare for all won't fix the problem. Everyone can see the problem is the costs are too high. To solve the problem we need to find ways to "cut" the costs, not find ways to "pay for" the costs.
3
@SCH Well, one way to cut the costs is to get rid of the private insurance sector, which makes billions in profits after paying CEOs double-digit millions of dollars.
34
@emr I agree private insurance sector is part of the problem, but if we want the US government to be the sole insurer and can sustain for a long time, curbing the cost is also necessary, charges like this facility fee should not have been allowed to happen in the first place, someone has to pay if it is allowed. I came from a country has universal health care, and the monthly premium is about $25, the hospital buildings/facilities are not fancy and the doctors' pay are moderate, the care is good. In some ways, I think in the US, some medical costs are just too high and they need to be examined and stopped.
12
@SCH You are right that more is necessary to curb costs. One way of doing that once there is a sole insurer, is by simply not paying for such idiotic things like "facility fees", that in any other industry are included in the price of doing business.
I currently live in a country with universal health care (but not single payer), the cost of premiums is pro-rated according to income. So of course people without income are insured for free.
Hospitals are not always as fancy as in the US, but all the top-of-the-line and state-of-the-art equipment can be found inside. And yes, doctors get paid less, too, however, they didn't have any medical school bills to pay off, either. So there's that...
9
Had hoped to see an Asthma specialist, though inquiring in advance was told the cost could range between four and eight hundred dollars. The higher end, it was explained, would be if a facility fee was issued. Chose not to go and avoid going to see a doctor, at all costs, as the saying goes. Only go for the annual "wellness visit." Everything beyond, pay out of pocket toward a skyrocket deductible. It's $210 for 15 minute visit for one symptom only. On individual insurance and pay a high monthly premium. Have opted to pay out of pocket to see a naturopathic physician, who asks and listens about all of the life of this changing and aging body and mind. First visit was an hour and forty-five minutes long and felt very seen heard and cared for and will continue to see a primary physician for the wellness visit/labs but this alternate care feels essential. Some things feels very off with the health care system(s) in this country. Very off.
12
They charge the fee because they can. There is no regulation or rule which restricts how much doctors,pharmaceutical companies and hospitals can charge for their services, drugs and now use of premises.
People are saying "We need Medicare" but while Medicare has the ability to negotiate costs for actual medical treatment it has no control over drugs or anything else the medical profession might wish to charge for - Medicare will still end up paying for these exorbitant charges.
5
A recent visit to the dermatologist resulted in a facility fee which was referred to a dermatology services. Surprise - exactly the same amount as the actual dermatology treatment received. But the facility fee was not covered by any insurance. Just a fee to pay for the chair in the lobby I guess
The attorney general of Montana has been able to eliminate this “double dipping” in their state employee health system. So It is time to fight back
15
Are the airlines running medical care now?
This is ridiculous. No other profession charges a "facility fee", not hairdressers, mechanics, lawyers. The cost of the rent is a part of their professional fee which accounts for rent, equipment, extra staff.
It should be law immediately that any and all medical professionals charging a facility fee are required to let the patient know at the time of scheduling what that fee is and how much it is.
45
Coincidentally, the same day I read this piece I received a bill from Shirley Ryan Ability Lab, Chicago. No explanation for what the charge covered. My phone call to billing: facility fee. Saw a rude resident then an attending for 7 mins. So I’m being charged for using the elevator and the “rent” for doc to use the room? Never an explanation of this fee before I received bill. Disgraceful totting up to cover decreases in insurance company payments to healthcare institutions. This is what E Warren should be focusing on- more bilking of patients. If hospitals can’t cover wastebasket liners etc and need to charge admin fees they should cut better deals with insurers who in turn should stop bilking their stakeholders.
21
This is capitalism at it's finest ( or it's worst, take your pick). But anytime we talk of change, it's toward a more socialistic model and we cringe at 'Socialism'. It appears that we really don't know what we want. Each system has it's flaws. There is an active dialog going on but who knows where it will end up.
5
And yet I keep hearing that the US has the "best" health care system in the world.
15
Our health care system is broken We need Medicare for all.
9
I just waiting for king Trump to get rid of the requirement for porter existing condition. What a fabulous thing to look forward to.
1
Who are the yohos who pay these outrageous bills and still think that any healthcare reform is socialist? This is not just confined to hospitals – any practice can tack on any charge they want knowing that many people will not fight these charges. Why has this charge appeared suddenly – the expenses to the facility were there all along. It is as if restaurants started charging customers a fee for using a table. Although she has the most thoughtful approach to healthcare, Warren may not become president because America cannot yet accept having a woman in charge.
14
What next?
Gasoline fee : for health care providers to commute?
7
@FedGod
Some ideas for new fees:
Parking lot charge; coat check; use of waiting room chair; heat/air conditioning; rental of paper cover-ups; post-shot band aids; hand soap and towels in restrooms; paper for printouts of clinical visit, and snow removal.
To start with.
2
Request a bill in advance of services and if you can't afford it, try a low cost facility. There are safety net hospitals in some cites so if you shop around you may find a place that won't gouge you.
1
I read in one of the comments that the patient was charged $100 facility fee for a dermatology visit costing $250. I could, in a stretch, see a small fee, something like $10 for this purpose but to charge nearly %50 more is ridiculous and untenable.
Politicians and health providers better be careful because you can push people only so far. Ir reminds me of medieval peasants being taxed to the point where they could not tolerate it any more and turned to violent revolt. The modern day revolt will be a turn to what they fear, a governmental heath care for all system.
16
@Frank Casa - My dermatologist, a staff physician for the only local hospital, charged my Medicare Regional PPO $125 for a 15 minute viewing of my back and performing a few cryto-freezes. I paid a $45 co-pay, then waited 45 minutes to see him. Subsequently, my insurer then paid the hospital $90 for his work, but refused to pay an additional $125 Facility Fee, although the work was performed off campus. The hospital came after me for the $125. I refused to pay. The hospital turned me over to a collection agency, which uses a variety of phone numbers to call me at least 3 times a week. What a country we have....
8
Counter bill them for your wasted waiting time. Hourly fee, lost wages, etc. Wait a month while they ignore that, then tell them you're going to small claims court to collect. The process is annoying and ridiculous, but sometimes it does get someone's attention.
Universal coverage can't happen soon enough in the States.
23
Meantime Barbara, the medical billing industry can destroy your credit ratings with the worthless credit “services”, which are another unavoidable but evil plague on the USA.
Yet another reason to elect Elizabeth Warren.
How many do you need?
19
"Facility fee could add thousands of dollars to your visit"? Another reason for a single payer medical plan.
13
Unbelievable! Next, we'll be seeing fees for "Exam Gown Rental", "Waiting Room Chair Fee", "Expedited Doctor's Visit", and "First Class Upgrade Specialist Fee".
I recently had an accident while on a cruise to Nova Scotia. My initial visit, in Halifax, cost $0, even though I am not a citizen of Canada. A subsequent visit to an ER in Maine cost $435, $130 out-of-pocket. A final visit to Tufts University Hospital in Boston, during which I languished in the waiting room for 3 1/2 hours and which included one X-ray, no lab work, and the opinion of two competent doctors, cost $1245, $225 out-of-pocket. Maybe there was a "facility fee"...
20
This is obscene. Basically only the rich or very poor will be getting health care. Who else can afford it. Frankly the old stand alone doctor's office worked far better.
19
I had this happen. I emailed the doctor and told her she should warn patients, esp since she has a second location that doesn't operate in a building with the facility fee.
11
I loved in New Hampshire 2010 to 2011 in the Monodnock (sp?) region, where I encountered the "facility fee". I could never get a straight answer from anyone from medical providers to the state's insurance commission. It was never ever stated up front and often came after I'd paid for the doctor visit. A ridiculous irritant.
5
I’m hoping Canada offers any United States resident a buy into their healthcare system. Please.
7
It’s getting scarier and scarier to live in this country. If you don’t have your health, you have nothing. And if you can’t afford healthcare even when you have healthcare, where does that leave you? It’s unbelievable that we’ve come to this place of such chaos, toxicity, greed, and overall dysfunction. And the people who are really hurting (pretty much everyone other than the very wealthy) are too exhausted and bogged down to do anything about it. Like I said, scary.
24
@SMN - Totally agree. It’s getting scary to live here, especially in CA (was born here). I work in the education sector at a private university (aka “corporation”) where things are also getting bad. Because my healthcare is tied into where I work, I don’t feel like I can leave. It’s odd how Americans value their independence and their freedom and yet we are more trapped than we know. How much more freedom we’d have if we didn’t have to be locked into this awful healthcare system provided mainly via our employers. We have a right to life (aka health), but oddly that is monitored more by corporations with self interests.
7
Warren 2020 - this will stop the rip off.
8
Single payer. Anyone?
7
This is tragic.
"Facility fee"? Just like the "resort fee" charged at the hotel?
As a Canadian with universal health care, I don't know how Americans live and tolerate this scam called "US health care".
24
This sounds the same as the “resort fee” at hotels. The might as well call it the “fee fee” ... or better yet, just tell you the actual price. Whoops, I forgot, they never tell you ANY of the prices for health care.
7
This happened to us at St. Vincent's in Santa Fe, a so called non-profit. Went into their pain clinic, paid copay, was seen by a PA without exam for future appointment and was billed as an "outpatient" with related facility charge buried in our billing. Called NM BC/BS and reported fraud twice and never heard back from them. Same thing in Los Alamos, NM when we go for lab work. Whose is guarding the consumer?
9
If they had a shred of decency, they'd offer a free euthanasia option for those of us who've had enough of this nonsense.
15
I look forward to the implementation of single-payer health care in the U.S. and no longer getting charged by multiple vendors for each doctor visit (and I have an HMO; in addition, I and my employer pay hefty monthly premiums). Dear Corporate Medical Greedheads: the centre cannot hold. You have sucked out all the money I can spare and the well is dry. Maybe put people before profits for a switch?
7
Or move to Canada.
5
For all the talk that Trump made about regulations, his team increased healthcare regulations substantially or at least did not rescind any regulations that were coming down the pipeline from previous administrations.
There is one particular one called meaningful use regulation - without doubt the most meaningless regulation ever implemented. All the costs of implementing these meaningless regulations would go towards facility fees.
An interest aside is that this is a consequence of attempts to lower costs and improve care. As there were increasing statutory demands for things like use of the electronic medical record, and various demands for quality measures (sounds great, but in practice often quite bogus); there were also cuts in fees for services. Consequently, independent practices, who were too small to negotiate fees favorably with large insurance companies , sold there practices to large hospital systems (I was one who went through this). The hospital systems negotiate for higher fees, and are largely run by suits (business folk) who squeeze the system to increase revenue, in the end costing more money and providing lower quality care, on average.
8
Does the facility fee entitle the patient to breathe the facility's air, or will that soon be a separate line item too?
14
Great reporting. This article and other concerning hospitals suing patients is more reason for medicare of all. Just look at a Canadian Health Care system no bills, no facility fees, and no trial to pay hospitals yet we have excellent state of art care for emergency, urgent and life saving care and well managed system to deliver care for non-urgent care.
11
@Hoshiar Many people in the US complain about the possibility of increased taxes for a one-payer system. Currently, my family pays about $350 monthly and my husband's employer pays thousands more a year for our very good insurance. Of course, there are co-pays for office visits, etc. Our dental insurance is separate and is paid for by our union (we have double coverage, which means dental care is typically free). I'm curious as to how much an average Canadian pays in taxes that cover health insurance.
3
@Somewhere in NY
There are no specific taxes levied for health care. Funding of health care come out from federal and provincial taxes which can reach to 43% on higher bracket of income in Ontario for people. There may be also small tax in some jurisdictions but generally less than $ 1000 per year.
5
@Somewhere in NY
Latest Data for 2018 - Fraser Institute - amount of tax (Federal & Provincial) for a family of 4 is C$12,935 for a year and for singles it is C$4,640. Seems a pretty good deal to me. One thing I learned, living in the US - I paid taxes deductions etc in USA then reported income in Canada for same period and claimed US tax via treaty so I was not double taxes. When you add in property taxes between like housing and pay the medical insurance privately (ours was $300mo for US coverage) the total costs for us were about the same under the US tax system or the Canadian system - a wash. but we were guaranteed coverage, no co-pays etc. However I think our insurance which was being purchased from a Canadian company and was for two people in their 40s - total $300 mo was pretty cheap in comparison with others we heard about.
1
Very informative. I work in medical billing for hospitals that charge a facility fee. Without exception, patients are floored to find there is a separate charge for the use of the building & its equipment on top of the expected doctor or lab bill. But as the article states, it is still worthwhile for a patient to understand his/her healthcare plan and how it works. Sadly very few of the patients I assist know anything detailed about their plan, its deductibles or its exclusions.
6
Facility fees are not new and they are exorbitant. The latest scam though is the new Emergency Care facilities. Never, never, never walk or even be carried or wheeled into a non-hospital Emergency Care facility at risk of being billed thousands and thousands of dollars because you were treated by emergency professionals and not by a doctor, nurse or physicians assistant.
In Florida we have choices to visit with our general practitioner or our specialist and we can visit them at Urgent Care or other such facilities. But, the new Emergency Care operations are there to fleece anyone who enters even for something as minor as a low fever, cough or migraine headache. These units bill for "emergency" care at the highest rates they can find. They also hold you personally responsible for fees not covered by your supplemental insurance and/or Medicare. And that too can be thousands of dollars.
If you have a real emergency go to the nearest hospital. If you have a headache or a fever see your general practitioner or the local urgent care facility. If you're having a heart attack and the first responders arrive, your spouse or partner or whoever is in charge should insist that you go to a hospital, but not the Emergency Care Facility. Use a real emergency room only in an emergency. But ER Care units are there to bankrupt you.
Health care today is only for people who can afford it. Otherwise don't get sick or have an accident or emergency.
15
@Jack Frost Wow, how are we supposed to understand the distinctions in an emergency?! Yikes!
6
Why is health care so expensive? because that's our goal! Health care is controlled by powerful insurance companies, hospital chains and the drug cartel, all of whom have one obligation: to make their owners rich. Why shouldn't they take whatever they want? Patients and doctor-employees alike are powerless. Many of these companies are already stronger than the agencies tasked to regulate them. If we do not revolt and establish medicare for all now, we may never get the chance.
30
As a physician, I hate this, but once the hospital switched to facility fees, there was no going back. They tasted the millions the make on it and hospital exec salaries went way up (not the doctors). $500 facility fee here...
32
In Washington State, we've lived with this for quite few years now. I remember back before I was on Medicare, when I was paying half my meager income for mediocre coverage (pre-ObamaCare) my yearly Pap smear adventure suddenly turned into an 4-digit-sized bill; I compared with the last year's billing and saw that the same room that had been 60 dollars the year before was now costing me 600, and all the other costs rose similarly. Turned out the clinic, which was across the street from my doctor's hospital, now could itself be considered "hospital", and charged accordingly. Though I valued my gynecologist's skills very highly, I had to find another I could afford. A while after that, the Seattle Times wrote about the regulations that made it legal, but it never seemed right.
10
Even Kaiser Permanente hit me with a surprise facility fee which didn't appear on my pre-operation estimate despite the operation being conducted by a KP doctor in a KP hospital for a patient with KP insurance. The facility fee was more than the fee for the operation itself so the overall cost was more than twice the pre-operation estimate. And that's all in-house. Imagine the shenanigans they pull when they can point fingers.
12
So, hospitals are learning from airlines or maybe going one better. They are charging fees for things that are inherent to their function. They already charge from kleenex to aspirins. I can see the next move is to charge for a glass of water or, as the name of the charge indicates, for using the "facilities".
12
so now I have to ask "is there a facility fee" when I visit my doctor? And if there is... can we just have the doctor meet me in the parking lot? I still have to pay for parking...
Who invents these terrible new fees to jack up the costs? We need to get to the root cause of this.
27
I live in NE Ohio where every medical practice except 2 that I know of, are owned by the 2 major hospital systems. This fee is unethical!
The private health insurance system makes medical care for-profit, which is also unethical.
22
"One can avoid these costs by seeing a doctor whose practice is not owned by a hospital. "
Good luck with that. Not many left and getting fewer by the day.
31
@Bob
Good luck is right. Just try to find a pediatric cardiologist not owned by a hospital. When my son’s cardiologist was bought by a hospital his bill went from $100 to $1,000 for his annual check-up. Same doctor, same office, same equipment, same tests. This is a massive scam.
12
The last piece of advice in this article encapsulates all that is wrong with health care today. When acutely I’ll the doctor you want to see is the one who knows you and knows your long term baseline health and problems. Unfortunately it is almost impossible to get an appointment with that doctor when acutely I’ll. Thus, sick complicated patients seek help at urgent care centers from “practioners” who don’t know them. Thus is just wrong.
14
@Martin I just give my patients my cell phone number. if a kid has a rash they text me a picture of the rash and I tell them what to put on it. Of course there's no way to bill for this, so I try to get them to come to the office occasionally, but this only works because I am used to living frugally.
11
This is a total racket. I used a dermatologist for years that was located in a hospital-affiliated physicians building. When I got a new $100 facility fee tacked onto a $250 procedure, that was the end of our relationship. And no, this fee was not posted or disclosed in advance. When I called and complained to the billing department they quickly waived the fee but it didn't incent me to stay with this provider - happy to now support an independent clinic practice.
20
@NWW
There are many dermatologists and smaller specialists who a straining to remain independent.However it is hard to fight against these integrated systems but it can be done.
5
A facility fee applies if you see a doctor who is practicing in an outpatient clinic of a hospital. You are registered as a hospital patient. The facility is required to post notice notice of the fee in a prominent place and no doubt, a notification requiring the patients' signature is included on that clipboard of forms the patient gets handed upon admission.
There should be no facility fee attached to seeing a doctor in a non-hospital clinic, doc-in-the-box or doctor's office.
8
@PWR
Totally agree.
Just make sure the doc-in-the-box, urgent/convenient care center isn't hospital owned....a lot of them now are...
1
As a Canadian with fair and functional health care system I find this simply unbelievable and unacceptable. They don’t even calculate the cost until after the visit. Good luck if you're on a tight budget.
42
I live in Belgium,and I am shocked when I see these amounts,I feel fortunate.
28
@Luk Brown I hear this all the time. The costs are not added until after treatment AND the claim is billed to insurance. Patients try to view healthcare costs as if they are fixed, like the cost of a meal or pair of shoes, and try to get an idea of what the expense will be. While this pricing is an attempt to act with foreknowledge, such knowledge isn't practically available. So my business now offers patients who insist on it an estimate of what their expense may be based on why they seek healthcare. THEN the complaint becomes about the estimate varying greatly from the actual bill. I'm not saying hospitals are in the right but it's a now-win proposition for both sides.
1
@Luk Brown
I was about to say the same thing - as Jeopardy clue: "Something no Canadian has ever had to say"
3
I thank my lucky stars every day for our national health services funded through general taxation and free at point of delivery.
Our grandparents and great grandparents fought in WW2 and sacrificed their lives and returned home and refused to any longer accept a health service that discriminated against those not able to afford it. We thank you.
We don't need Jesus and God, we've got the NHS.
36
I lived in London for five years and loved the NHS. Why we ever came back to this country mystifies me. Our healthcare costs are astronomical.
22
@dan the NHS is being defunded.
Tuition costs for nurses etc are rising drastically.
1000's of overseas-born health professionals are leaving NHS to return to natice countries.
universal credit,bedroom tax,housing insecurity,hunger and homelessness as well as a sharp rise in mental health issues are contributing to the problem.
4
@Laura The people of every country with universal health care have to decide to commit the resources to maintain it. If they cannot agree to do so you could end up like the US, paying unbelievable costs for limited care.
11
My first thought upon reading this was, “Warren for President.” While I would prefer a phased transition to Medicare for All, we clearly need someone who is willing to take on the health care industry. WfP was also my first thought when I sat down to navigate our family’s complex health insurance scenario through open season, when I realized my over-27 adult child is about to lose health insurance, and when I learned that decisions about my new grandchild’s care could be determined by the family’s need to maintain employer health insurance. Enough of this! Warren for President!!
39
Recovering from broken clavicle.
3 hospital visits. Top notch specialists. X-rays and all that jazz.
Zero waiting - ZERO. Took 60 seconds to get admitted and registered.
Later spent 10 minutes between x-ray and doctors along with maybe 15 other patients.
Total bill - ZERO dollars. No charge for the two specialists. No discussion of payment when choosing best course of care - surgery or no surgery.
No charge for the nurse helping me with my clothes.
Zero bill and top care -
70
@Bruce Sound miraculous but you're only telling part of the story. There is nothing free. You may not have paid out of your pocket BUT somewhere somehow those doctors, nurses and hospitals were compensated for their time, expertise and care. Hospitals are for-profit businesses. How else could they afford the latest equipment, keep abreast of cutting-edge (no pun intended) healthcare practices if they gave away their skills? This infatuation with the concept of "free" is what ruins our expectations. As adults, we should face the fact NOTHING but air is free.
1
@Bruce You Canadians are always acting superior to us in the US just because we have expensive and inefficient health care and deny care to poor people and you have universal health care at a reasonable cost.
On the positive side, we have escaped the evil of socialism, which might require Donald Trump to pay an equal share of taxes.
6
@Dale smith No. That is the whole story. The doctors and nurses and administration are all paid.
Our taxes in Canada are on par with the US - I pay less on my income than my US based friends earning the same $$ pay.
The focus is squarely on care.
9
Just because someone presents you with a bill doesn't mean you have to pay it. There has to be a valid contract in effect before there is a legal obligation. This critical point is missing from the discussion. Patients need to push back and demand proof of a legal contract between them and whoever is trying to bill them before making payment. A contract between the insurance company and the provider is not binding on the patient.
14
@David The problem; then they turn you over to a collection agency. I've had this happen. The hospital practice I went to billed 3 times, then a collection agency started calling and threatened to ruin my credit. I paid. I just refuse to go to them for anything else. They called and emailed; I told them to take me off their mailing list or else
12
@David You're forgetting the crucial element that no one is handing out bills willy-nilly. You ate at the restaurant, you had your oil changed, you had your blood pressure taken at a clinic. You receive services and you pay for those services. The "contract" is implicit in your presenting yourself voluntarily to be treated or helped. Splitting hairs about "contracts" is counter-productive. According to your way of thinking, you could eat at a five-star restaurant then walk out the door without payment on the premise that there was no binding contract. You'd have another non-binding contract with the bail bondsman when you are hauled to jail for theft.
4
I have insurance, and have chronic medical conditions, but I can't afford to go to the doctor. I go anyway, and have amassed massive debt as a result. Every time I receive my "explanation of benefits" I chuckle and think, you mean the explanation for why you're (the insurance company) not paying for my treatment. I can't for the life of me figure out why for the same service, my copay for one provider has fluctuated wildly year-to-date, then suddenly I owed more than $1K because the office had not been charging enough. They told me the cost of the service had increased within the calendar year. Nothing makes sense, and no part of the experience is not maddening and disheartening.
28
“Explanation” in “explanation of benefits” has the same meaning as in “shut up, he explained” (Ring Lardner).
1
@mkenative These stories are shocking. In Canada and most other developed countries individuals do not pay for health care. I recently had spinal surgery with the accompanying pre op visits to neurologists, the neurosurgen,the CT scan, MRI, Bone scan and drug costs. I paid nothing, cost is something Canadians never even consider. Of course we pay a bit more in tax, however it is much less than Americans pay for monthly insurance premiums, co-pays and hospital costs. There are so many levels of profit taking before any medical care is received, I do not understand why anyone is willing to put up with this ridiculous situation.
9
Just quit going to the doctor unless it is an absolute emergency. Best medicine - lose weight and exercise. You'll save a lot of money.
14
@Sarah99 I wish this wasn't the right advice, but it really ends up being the only practical advice there is. I have insurance and a primary care physician. I looked into getting a doctor's appointment last week, they said the earliest available date was MARCH. Why bother? And last time I came to see this doctor, she quickly diagnosed me with something that ended up being completely off base after a very rushed appointment. But there are no other doctors in town that would see me any sooner, especially when I would have to schedule - and pay for - another new patient appointment. I use Nurx for birth control and specialist for long term conditions - why bother ever struggling to get an appointment with my primary care doctor who isn't remotely interested in seeing me?
13
@Sarah99
Fine.... unless you happen to have an inherited condition or allergies that cause issues or get in an accident and break something.
Then what?
6
@Sarah99 Great advice unless you have the bad fortune to have several autoimmune illnesses and a genetic condition, none of which are curable. And I already exercise six days a week.
7
This is happening all over the medical landscape. It is blatantly taking advantage of patients and is an example of wasted dollars that permeate the US healthcare system. Another is the increasing use of "throwaway" office, hospital and surgical supplies that cost patients thousands of dollars a day. None of the so-called "plans" put forth by our politicians address any of this. To "fix" the system, costs need to be addressed first and foremost.
19
@Marian It not just inefficiency. The companies that control insurance, health care and finance _want_ costs to go up because our profits go up.
5
Allowing hospitals to buy up doctors' practices (and urgent care facilities) is such a blatant conflict of interest that it is amazing that it is allowed. I went in to an urgent care practice without knowing that it had been purchased by the local "non profit" hospital. Two ECG's (conducted by unqualified nurses) and an ambulance ride later I ended up in the emergency room where a doctor who didn't participate in my insurance plan declared that there was nothing wrong with me and that I could go home. Welcome to the high tech American medical system
27
@ianstuart
Many doctors willingly give up private practice and move under the shield of a Hospital or Medical Group. Mostly to escape sky high malpractice premiums and mountains of paperwork.
We need tort reform.
7
@Bob No, we don't. Legal expenses are not a major driver of consolidation from the acquirers end. The ability to remove duplicative administrative staff, negotiate higher prices with payers and capture additional margin is. There is a significant amount of evidence that indicates that the cost of healthcare is simply driven by a lack of price control or motivation. It is not a normal economic good and cannot be regulated like one.
12
@ianstuart
FYI-RNs ARE qualified to “conduct” ECGs. But many times, in these practices, the term “nurses” can actually be used by medical assistants who are, in fact, unqualified or a term used by the consumer because the staff was female and in scrubs.
3
Don't forget - if you have two procedures done at the same time (colonoscopy and endoscopy aka lower and upper) you get charged two facility fees. Now I have to note that a private (not hospital system owned) physician wouldn't do both procedures on the same day if she/he weren't "owned" because they wouldn't collect for both procedures on the same day-- so going to a physician who was employed by a hospital system allowed me to get both procedures on the same day which avoids two anesthesias, two days of stress, etc. but it was still 2 ASC facility fees.
9
@Rebecca
I believe that two facility fees for one outpatient admission is incorrect, despite your having had two procedures. That would have been a situation for you, or your insurance company, to fight.
3
I always wonder why my health insurance is billed for a doctor's visit when I've seen a PA or a Nurse Practitioner because the doctor is out of office. I believe it should be less because I'm paying to see my doctor, not some newly created position for these people to get high salaries. If so, why do we need doctors for office visits? What a system!!!
32
@Diane Steiner
The doctor signs a piece of paper stating that he "supervised" the PA pr NP. Then a physicians fee can be charged.Usually this means that he actually made a face to face visit.with you. If he did not but charged an MD fee that is technically fraud.
2
It never ends.
Facility fee!?
What's next, a fee if you'd like to sit down in a chair in the waiting room inside? If not, just let patients, take a ticket (like at the deli counter), stand outside in line and wait for their number to be called.
I remember when the ATM first came into use. No fees, no waiting in line, it's FREE! and always will be, we were told.
NOT.
Now banks charge for ATM(s), paper statements, replacement cards, and even charge YOU for having the pleasure of keeping your money in their bank.
Banks should charge "facility fees". I mean, after all, emptying the trash cans, cleaning the windows, and keeping the free (for now) lollipops and pens in stock can't be cheap.
22
The facility fee is the biggest rip off of the consumers of health care! Hospitals and healthcare institutions are the thieves! Medicare should ban that practice or pay the same amount to private practicing doctors. (This will also prevent hospitals buying up or employing primary care doctors!)
38
Maybe they got the idea from hotels charging a “resort fee.” Same greedy concept.
2
Sanders/Warren 2020. 'Nuff said.
38
@Mary They are not in any way addressing the costs of healthcare, just who pays for them.
1
Unfortunately most people do not realize that when they go to a Doctor Who is employed by a hospital owned practice that it costs much much more. Not only the hitting facility fees, but all tests x-rays, labs and everything that the doctors orders cost twice as much then when a private doctor in their office does it. Even what Medicare pays for a surgical facility in a hospital setting is two times thatOf an outpatient ambulatory center that is not hospital owned. The hospital urgent care can be 40 miles from the hospital and they charge hospital fees. Everyone complains about doctors fees but it’s not the fees to the doctors office or the fees for the doctor visit it’s all the extra charges the hospitals ad. What’s the time should be telling people is that it’s much cheaper to go to a private MD office for all patients Medicare or non-Medicare a regular insurance private pay everything is cheaper 
13
@Concerned Good luck finding an independent physician. The vast majority have flocked to employment (mostly by hospitals who are natural allies) due to income declines as a result of mandated office computer systems and reporting, growing practice overhead (including malpractice insurance), and reimbursement cuts by Medicare and insurance companies. Hospitals recover the losses attributed to employing physicians ($100-300K/yr, on a direct cost basis) by adding fees and collecting more for office based diagnostics.
8
@Concerned
Doctor Who would be baffled by the US health 'care' system.
2
This is a bogus practice, it should be illegal.
25
@someone over 50 - I agree. It's Medicare enrollment time again and doctor visits are going up, as well as everything connected to hospital stays, ambulance, x-rays, out-patient surgeries. When is this going to stop? I only go to the doctor when it can't be avoided; that isn't healthy. It shouldn't be this way.
Every western country has a better system than we do. Considering that and prescription drugs, seniors have to make decisions between rent, food and medicine. I agree with capitalism but this is getting to be greed.
24
This article makes a compelling case for Medicare for All
30
Unfortunately it’s not Medicare or Medicare for all that is the solution. Even with Medicare these fees exist andit’s the facility fees paid to the doctor employed by the hospital even with Medicare for all the costs are twice as much for these doctors employed by hospitals. then for a private doctors office
1
@Concerned Totally agree. The Medicare for all mantra doesn't address costs at all, only who pays for them.
3
@Concerned
The issue isn't who employs the doctor, it's where the service is rendered. If the service is provided in a hospital clinic, there's an outpatient facility charge, whether or not the doctor is employed by the hospital. If the services is provided in the doctor's office, even one in a professional building associated with a hospital, there should be no facility fee, even if the doctor is a hospital employee.
1
A facilites fee needs to be disclosed prior to a visit. So you know what your visit will cost.
Opaque pricing is just one of the many challenges for healthcare consumers ( along with quality concerns). What other purchase do each of us make that is so opaquely and sometimes bizarrely priced?
There’s just so much $ in retaining the present broken system. And we are frightened by the unknown alternative. A perfect storm.
21
@TNM Unless it's an emergency ASK before you go what the fees are. I've started doing that before every appointment. I used to assume the tests, etc. were covered in the appt. Most likely they are not. I have employer ins. and Medicare.
I had an appt for an EEG in the doctor's office. One hour before the appt. his staff left me a msg about the appt. and said I hadn't met my deductible so it would be self pay, $1,000. I left a vme cancelling. While waiting for a call back, I called my ins. company, confirmed I didn't have a deductible, but learned they did need a pre-auth. I let the doctor's office know if they got the pre-auth I would have the test. They don't want to bother with the ins co. either and if it comes out of your pocket what do they care.
The ins. company pays less and less. I quit using my prescription coverage; a general plan available to the public is less than my co-pay! Our health care is in trouble. An employer paid plan is no longer a guarantee of anything
10
Facility fee=fraudulent inducement. You think you are going to the doctor. They think you are paying their rent.
29
Before the ACA started, I quit a major practice in Tucson after finding out that the doctors had all joined Banner health which was tacking a facility fee onto every specialist visit. This year, I got a tetanus booster in my doctor's office and got charged $227 for the shot. OUCH! My Medicare Plan D only reimbursed part of it and not without a big hassle. I could have gotten the shot at Costco for $41. Who knew?
My advice is to avoid doctor visits at all costs. It's cheaper and less aggravating to suffer at home.
27
@me
Don't elect Republican state governments!
2
@me Just got the flu shot. Free. Zero charge and zero wait.
3
This ranks right up there with corporations, such as banks, and real estate transactions that ‘nickel and dime’ users. Fee income was the mantra at the bank - redefine services to allow for additional fees. A facility fee for medical services is another symptom of not having a more civilized health care system as with the rest of the developed world. So will my mechanic charge a facility fee? How about my hairdresser, dog trainer, farmer’s market vendor? Why are medical services different?
14
Add “resort fees” at hotels and airline’s baggage, cancellation and premium seating fees to the list. Hidden charges are not justifiable in any setting.
21
The idea of separate facility and professional fees vs a single global fee is completely reasonable if used appropriately. A separate professional fee only for the physician's service when it is provided in a hospital facility. The global fee is used when services are provided in separate physician's office. It is higher because it is including the cost of that office facility which may include the cost of devices and people assisting. The cost of procedures, surgery, imaging, inpatient etc provided in a hospital are very disproportionately facility costs. That's the hospital/facility bill.
Are hospitals too expensive? Sure, but, that's a separate question whose answer is not addressed by unnecessarily confusing people. As we go forward trying to address health costs, let's ask journalism not to unnecessarily confuse and inflame discussion.
At the best academic hospital in Toronto the government only pays for four-bed rooms on a med-surg unit. The old-fashioned austerity of that and of long waits for procedures may or may not be the tradeoff we are willing to accept. Except US hospitals are already paying the bonds on the palatial facilities we've built. So, we may have already foregone those choices. It's complicated. Don't make it more complicated than it already is with fictitious complexity.
6
@Michael Hart
I doubt this has been "fictitious complexity" for some time: https://khn.org/news/fees/ ("‘Facility Fees’ Are Surprise Cost For Many Patients" Kaiser Health News, 2009).
Numerous hospitals across the country are on questionable ground, and have been for some time, based on their expansive facilities plans: https://www.nytimes.com/2019/09/01/opinion/hospital-spending.html . Those facility fees are helping to grow the bloat (not help many general problems in under-served areas) and duplication of expensive services.
8
@Michael Hart
Thank you for your rational and informed comment. As I watch candidate debates, read newspaper articles and reader responses, I am struck by how little the public understands about how the financing of health care services actually works, even among educated people.
1
This entire comment section should be mandatory reading for everyone registered to vote in upcoming elections.
21
Charging "facility fees" for services seems a practice which will likely not stand up in court. Shouldn't a public spirited attorney (!!) take this up?
4
When my British grandmother had a stroke my mother flew to London. She went to Nana's doctor to find out what was what. They had tea in the garden behind his office while he patiently explained everything in detail. Fancy Harley Street doctor? No. He was part of the NHS.
I don't expect teatime in the garden here in the US. However, I would like to see universal, single-payer healthcare and patients treated with respect and honesty rather than just another "mark."
28
@Carole A. Dunn
I have used the NHS for 60 years and I have never heard of tea in the garden. Frankly you're lucky if you can get an appointment at all.
7
"One can avoid these costs by seeing a doctor whose practice is not owned by a hospital. "
And this is the bottom line. Allowing hospitals to own doctor practices is very very expensive and not necessary. Also, giving a hospital system influence over a doctor's pen, and therefore referrals for expensive testing ( owned by the hospital) really is the fox guarding the hen house.
17
@Mark See my comments above. Hospitals (particularly non-academic community based health systems) would prefer not employ physicians if the truth be known. Physician employment losses are significant even when offsetting facility fees and office based testing is taken into account. With few exceptions, the economic model for independent physicians is not viable.
2
As a Canadian reading this article, I feel only pity for the Americans who are blind to the advantages of universal health care operated by a freely elected democratic non corrupt government that is responsive to the needs of its citizens. I have never been charged a facility fee, a doctor's fee, a medical test fee,etc . I also choose my own physicians. And my doctor never calls for permission from a government bureaucrat or an insurance clerk but makes decisions based on their own medical judgment. And that alone likely keeps the costs way down. Universal health care is a wonderful affordable thing! My taxes on a middle class income are comparable to US taxes and easily accessible universal health care in Canada is part of the fabric of our society.
64
@M
What is the process to change your primary care doctor and how many times a year can you do it?
1
@Mark There is no process. Simply go to another primary care doctor whenever you want.
Change as many times as you want.
I love how the author talks around this latest billing "scam" perpetrated by "not for profit" health care providers. This is a relatively new billing scam that I first encountered two years ago. My healthcare system offers same day appointments if you are flexible about location. I went to see a PA (no physicians are ever really available) at a dermatology clinic within a hospital to take a quick look at a skin spot that concerned me. For a five minute visit I paid my normal $50 specialist "in network" copay (GOLD PLAN) and an additional $150 "facility fee." The insurance provider (same company that owned the hospital and clinic) was "allowed" an insurance reimbursement at the discounted rate of $120. So I paid $200 while the insurance company essentially paid themselves $120 which, of course, was a fiction. Meanwhile these same insurance companies (who are creating monopolies across the country), are replacing higher paid physicians with PAs and Nurse Practitioners at a rapid rate.
31
@JGHELLER Private Wealth
"are replacing higher paid physicians with PAs and Nurse Practitioners at a rapid rate."
True. And this is part of the reason why some medical students do not choose primary care for their career and prefer to specialize.
An NP is unlikely to be drilling burr holes in a surgical suite.
9
My mom was seeing a psychiatrist at a hospital on an outpatient basis. When the bills went from around $200 to almost $500 (due to a facility fee) I reassessed and stopped sending her. She had moderate dementia, and talking to him made her happy, and Medicare was paying for it; but it stuck in my craw, as they say.
9
@R. Bartlett
The hospital may have inflated its charge, but that isn't the amount Medicare pays. Regardless of the charge, Medicare pays a predetermined, locality based rate.
1
yup this was right the charges which doctors charge as fees was so high but there was a reason behind this md ms in india the doctors were invest huge amount in his career study so they were have to get it back from their fees charges.
1
Does no one remember it is Obama’s ACA that provided incentives to consolidate health care into “systems” that would bring efficiency and continuity to patient care? The result has been lack of competition and multiplication of costs! When government thinks it can solve problems, people find ingenious work-arounds to continue pursuing their interests anyway. Only competition can solve this.
10
@Repatriate
That trend has been going on a long time before ACA. The failed healthcare system in this country is creating monopolies all by itself.
15
@Repatriate
We have a private healthcare system and it still doesn’t work well. Doctors aren’t competing against each other and hospitals aren’t competing against each other. They have to compete with the insurance companies to make enough to cover costs to run the practice and make malpractice insurance payments and have a wage at the end of it. When a patient is part of a “medical home” the primary doctor can see what the specialist is doing and vice versa. This is GOOD for the patient and it does keep costs down. Unfortunately this ACA principle applies mostly to Medicare and Medicaid.
4
Conversations about the cost of health care in the US usually focus on the end user - the person with or without insurance who is at the mercy of an opaque system designed to baffle anyone who tries to think about it. What isn't often mentioned is the *massive* amount of money spent by employers to buy and administer insurance for their people. Wouldn't they love to be free of that? Where are their voices in this? Or are they so blinded by right-wing ideology that they, too, work against their own interests. (Oh, the wisdom of the private sector.)
16
@Stevenz Those of us in the US who have logical and rational minds are in the minority. We are forced to follow the rules of people who don't even have the ability to organize a parade out of a room with one door. I have been called all sorts of names and told where I could go when I bring up efficient and practical ways of doing things. My personal favorite is being called a commie freak who should move to Venezuela.
10
The author's advice to use a doc-in-the-box for little things doesn't necessarily help. If you're going to fulfill your deductible anyhow, it doesn't make much difference. And if you want to have continuity of care with your doctor - oh, wait, this is America! You just can't get that without paying extra.
11
Hotels already charge a facility fee for parking, resort amenities, maid service, etc. The more expensive the hotel the higher the extra fee. Disney charges an extra $25 per night just to park your car on Disney property at a Disney hotel.
1
@JudyH, Ph.D. Not sure what this has to do with doctors. All those extra fees are part of travel which is generally a luxury. Healthcare should not be in the same category. These extra fees are literally killing us.
17
@JudyH, Ph.D. -- But hotels don't *add on* an amount to cover the costs of having a hotel over and above the services provided by the hotel. If a "facility fee" is a legitimate part of the cost structure then it should be included in the cost of seeing the doctor. Wasn't it always?
(I have never seen an added fee for maid service. Parking charges are for additional service, which only people with their own cars pay.)
6
Health Care as a business model instead of Health Care as a Service.
16
Only in America could we have this discussion in just about any city or town over the lack of transparency and excessive greed in our broken healthcare system and, at the same time, fret about the “electability” of a healthcare crusader like Elizabeth Warren. We are one sick country . . . in many ways.
44
I just can't wait for restaurants to start charging facility fees.
Then barber shops will follow. Maybe Uber and taxi will charge a separate fee for car maintenance and insurance.
15
@redpill
When I was using motorcycle mechanics for upkeep they would routinely charge a "shop fee". When I asked what it was for they said for miscellaneous stuff like the rags they use. This, on top of a $200 per hour labor rate, just to change the oil. Still, their fee was annoying but nothing like what we're talking about here! So far, I haven't run into the facility fees.
1
@redpill Restaurants do charge a "facility fee"; it's called overhead in this case. The costs of furnishings, salaries, decor, lighting are all rolled into the costs of a meal. Alcohol in restaurants has a HUGE markup. This is why eating at home is cheaper than eating in a restaurant. If a restaurant charged only what the cost of ingredients were to prepare a dish, the restaurant would go broke.
The biggest dead weight cost in this system is profit motive.
23
The following article and graph go a long way in explaining the impetus for facility fees:
https://fee.org/articles/the-chart-that-could-undo-the-us-healthcare-system/
4
@Rocco Ciocca
Can't imagine the bureaucracy improving under an all-government administered health care system.
@Ron A -- It works in a lot of places. Much cheaper, easier to navigate, more accountability. The last time I was in the hospital - 8 days, multiple tests, good care - I paid not one cent and filled out not one form. You can have your system with all its private sector wisdom.
15
The horror stories I have been reading in these comments are not new. I reached the conclusion quite a while ago that Americans who are dead set against universal, single-payer healthcare are irredeemably stupid. I'm surprised they can find their way to their curbside mailbox without a GPS. I may not be a genius, but I'm smart enough to resent being at the mercy of fools.
41
The article links to a fact sheet that was prepared by a hospital lobbying group and is a sad attempt to justify price gauging. I am being bilked for my regular doctor check up so the local hospital ER, itself a source of hospital profits, can be open all night? That's just laziness from the Times. Read Elisabeth Rosenthal's piece to better understand soaring hospital costs:
https://www.nytimes.com/2019/09/01/opinion/hospital-spending.html
13
How is this legal?
10
@Pat This is America, where money is king, and those who don't have it might as well drop dead.
11
Congratulations, you have discovered one of the sleight of hand billing practices that have made the US health care system immune from the supply-and-demand law of economics.
This is one of the traps of the seemingly cheaper “high deductible” plans that have lower premiums and which purport to keep health consumption “low” by making you have “more skin in the game,” which is supposed to make pricing more competitive, as you “shop around.”
But go to the doctor FOR ANYTHING and these hidden fees will blow right through your deductible. When you look at a plan, you might as well add in the cost of the deductible into your overall yearly insurance costs, add all the year’s premiums plus the deductible, because you almost certainly will pay the whole amount. And God forbid you should get sick when traveling and need out-of-network care. But worse still is when your surgeon invites a colleague to “assist” or give the anesthesia — and they are not in your plan’s network even though your surgeon is — guess what: they can bill you hundreds of thousands of dollars and your insurance won’t pay one dime.
These are the scams that are forcing Americans to pay DOUBLE for Health care compared to Europe, Canada and Japan.
The doctors, hospitals, drug companies and insurance companies are all Stone.Cold.Crooked.
52
It’s gets even worse-many plans don’t cover doctors office facility fees so they don’t even hit your deductible!
7
@Lora S wow— unbelievable. It’s like a racketeering extortion scam.
12
@Toms Quill Americans complain about what a racket healthcare is and in the next breath say Elizabeth Warren is nuts.
13
Isn't this "drip pricing"? That's illegal.
Madness! Absolute third-world madness. Diagnosis: America has malignant Capitalist cancer and it’s killing her citizens. This profiting from hospital and healthcare would never be allowed in Norway. America’s unregulated billionaire-owned, for-profit corporate healthcare “industry” is frightening. Better hope Sanders or Warren is the next president.
21
When do fees end and larceny begin?
18
This is no way to run a health system!
“Markets” for health care just do not work. There are multiple “market failures” in every “transaction.”
This is no way to run a health system.
Single-payer for all!
13
I have to explain the facility fee to my patients and explain that it is simply the hospital extracting more money. Hate it!
11
The ingenious of the GREED is vomitous and will eventually be it's undoing. WHY, Congress, do you permit this to go on?
8
@minu Campaign contributions, doncha know.
5
@minu as long as less than 50% of eligible voters participate in any given election, these and other consumer ripoffs will remain the norm. Citizens will continued to be cheated as long as they show they are too weak and lazy to care to do anything to stop it.
3
And yet, they get away with it because we are a country ruled by greed where people are nothing more than esources to be used and abused.
12
Another option is vote for Medicare For All and end this abuse once and for all. You will never have to think about it when Universal Health Care is a reality in the US. Until then, this abuse and new ones will Never Stop.
15
My Basic Medicare plus Supplemental Plan F covers the facility fees. But I think the fee idea stinks.
9
I'm an American living in Sweden. I pay higher taxes but have virtually no medical costs. Even my $25 co-pay on doctor office visits stops after about $100 in a year. The propaganda lies that Americans swallowed when the medical industry fought the ACA made you its present victims. I only dread my visits to the US. Anywhere else in the world I would be safer from pirating hospitals, and anywhere within the European Union I would pay nothing. Get smart and vote right. The media is acting as if Warren is radical, but her proposals are normal everywhere else in the world.
47
Good luck finding a doctor who isn't a hospital employee.
I think the "facilities fee" is obscene. How were these buildings and facilities being maintained previously? Do billionaires just pay for new buildings to be built, and then the patients have to pay to maintain them??
My conclusion is that the money is going to the C-suite execs at the hospitals. Greed rears its ever-uglier head in health care.
14
It's a scam, albeit a legal one. The doctor's fee normally includes his or her own "facility", but the hospital uses this arcane rule to charge more. Pure skimming; there is normally no additional cost to the provider (the doctor's office could be anywhere), just profit for the hospital. Some insurances protect you so only those on the margins get the add-on charge; this makes it more of a scam and shows how fake the charge is - only to be charged to the indigent and those with weak insurance. Get angry and change doctors to someone who doesn't do this, and remember this when someone tells you people want to keep their current insurance plans. No one does. We may want to keep our doctors, but no one wants their insurance plan because the insurance companies and hospital are behaving immorally.
9
Unfortunately, it may not be as simple as changing to a different provider that is not employed by a hospital. My parents live in a small town where the only non-hospital employed provider is the local pediatrician. My 89 year old parents would have to drive 40 miles to the closest major city to find a provider that is both non-employed and accepts their Medicare Advantage plan. I don't think anyone believes that this would be a good idea. I agree that this system is greatly flawed and that facility billing practices should be discontinued. My only concern is that in doing so, my parents and others like them, will be left in the cold with no providers in their area to care for them.
8
How do you think hospitals pay for all those computers and the EMR that is owned by a billionaire? All the staff to comb through records in order to make sure “providers” are making their RVU? All the advertising and administrators? Never mind the CEOs with their million(s) dollar salaries and retirement packages.
Private practice is a thing of the past because individual doctors can’t afford all this so most physicians are now salaried employees. Patients want to know what the charge is? It’s not medical care it’s a transaction between businesses. The insurance company trying pay their shareholders and the hospital system giving bonuses to upper management.
10
The surest way to get socialized medicine is to permit unleashed capitalism to bilk the population. The right wing media can’t explain away high medical bills much longer.
11
Good luck finding a doctor that is not part of a hospital or corporate owned group. And that takes your insurance/Medicare/Medicaid. And that is taking new patients. While you are at it, please find the fountain of youth. Going to freestanding care centers is a poor option - most people need coordinated care for the best health outcome.
9
I am a doctor and was in private practice for many years. I had to quit private practice because, as a solo practitioner, I had no negotiating power to affect rates of reimbursement from insurance companies (and I accepted all patients including Medicaid patients). Because of this, private practitioners have been joining group practices and selling their practices to hospitals and other health care financial institutions which, are not just out to make a profit but are obligated to do so. Doctors who sell their practices are rarely happy. All of a sudden, they work for employers who demand productivity at the expense of a satisfactory doctor patient relationship. As long as we have a system of “fee for service” with large corporations benefiting when reimbursement is high, there will be no improvement in this situation. We must move to a Medicare for all (with supplemental private insurance) system but must do so carefully. First, people should be given a “public option“ and, if they like it, they can choose this over private insurance. It should be considerably cheaper than private insurance because Medicare is nonprofit and far more efficient than private insurance as they do not employ legions of people to fight reimbursement. Hopefully, over time, private insurace will be only for supplemental plans which cover that portion of medical care that is not covered by Medicare. However, this will take time, as people have been inherently distrustful of government programs
55
@LAM People are not inherently distrustful of government programs. Medicare as it presently is (which has many holes) is generally supported. What we have is an orchestrated campaign by the insurance and drug industries (joining the AMA which has opposed universal single payer systems for decades) to instill mistrust and fear in people of the changes needed to join the rest of the world in seeing healthcare as a human right not a profit center. I'm sure, as a physician, you are familiar with Physicians For a National Health Program which has more than 20,000 medical professionals as members and has been fighting for a universal single payer system for a very long time. I suggest you join them and join the fight for a workable system.
4
“One can avoid these costs by seeing a doctor whose practice is not owned by a hospital.”
Exactly. MDs in private practice do not charge this kind of fee. Only very large group practices attached to hospital chains and universities push a facility fee, because they can.
It gets worse. Large hospital group practices have already used their market power to force plans to pay 2-3 times the going rate of what Medicare pays for the exact same procedure. See the CA atty generals lawsuit against a Sutter previously reported in NYT.
Want to pushback? Yell at the hospital system group practice for milking the system, with no transparency. (Good luck getting a quoted facility fee pre-visit.) Even better, go see a private practice MD. They don’t charge facility fees.
Those of you blaming health plans are shooting the messenger. Blame the university/hospital owned group practice execs who exist to bake up these schemes. And blame the hospital practice MD who also benefits indirectly from the facility fee. The money all goes to the same trough. These MDs should be pushing back from the inside and being stewards of expenses.
13
I got nailed by facility charges at Cobre Valley Medical Center in Globe, AZ a month after visiting an outpatient clinic there. Turns out it's a CAH (critical access hospital) located in a rural area and with fewer than 100 inpatient beds. The usual Medicare cost controls don't apply to CAH facility charges, so in addition to physician copay of about $30, the hospital started billing me for about $200 per visit in facility copay. Excellent standard of care from the professional staff, but hospital's gouging left me determined to avoid using that facility again.
16
@fred Plan to drive a long distance to find the next hospital in rural America. They are closing across the country at startling rates even with the federal Critical Access Hospital supplements and excessive facility fees (as you described). No easy answers. . . .
1
God, I'm lucky to live in Canada!
I've never paid a cent for a visit to the doctor, for a medical test or procedure of any kind, or for surgery. Yes, we pay taxes to help cover these things, but they aren't onerous in any way (contrary to what many American nay-sayers have to say on the subject of universal health care).
How on earth will Americans ever change their health care system which obviously destroys lives?
64
To be fair, your Canadian insurance isn't the perfect plan either.
1
@canadamoose And of course should you need a CAT scan because of a suspected brain tumor, your turn for the free exam will occur about six months after you're already dead, unless, of course, you know how to grease the right palms and get to the front of the line.
1
@Urban.Warrior I never said it was perfect. But I will say that absolutely no one in Canada has been bankrupted by medical expenses.
18
I believe that facility fees can only be charged by hospitals and outpatient surgical centers and only for surgery. Maybe for other procedures. I question whether they can charge a facility fee to see the doctor. It might depend on whether the insurance company allows a charge for that. If you pay a flat copay for the procedure they might not be able to tack on more charges.
@Dora Smith From my experience, facility fees can definitely be charged for office visits. I was referred to a hand orthopedist and a rheumatologist at a large Boston Hospital. I checked with Anthem in advance and I was told I was covered. I went to the appointments and I *only* had to pay the $50 co-pay for a “specialist” visit. Then a few weeks later I received bills for a facility fee for both doctors ($300 each). My insurance didn’t pay this. I did. I’m fully insured and had to pay $700 to see two doctors that were in-network.
Our system is broken. Time for M4A. With the enormous bargaining power of a M4A system big hospitals will not be able to get away with this.
25
Hospitals charge arbitrary exorbitant nominal facility and other fees that get adjusted by contracts with insurance companies. A patient without insurance gets charged full fee. A poor patient may have it waved. BUT the “non-profits” then present the full fee as a charitable donation- a nice trick to get a huge tax deduction.
9
@kagni Your were spot on until the last sentence. . . the hospital systems in Urbana, IL are tax exempt and do not qualify for charitable tax deductions. For profit hospital systems do write off charitable care and reduce their tax liability.
1
IF we had truth in advertising, these charges would be called "Hospital Executives' Enrichment Fees."
I think they got the idea from theaters. When you buy a theater ticket, there's now always a "facilities fee" which should, in all honesty, be called the "Keep [theater owner's name] Rich Fee."
Both surcharges are scams, but the difference is I can choose not to go to the theater, but I can't avoid all medical care.
21
As a family physician who is incredibly disturbed by my patients receiving unnecessary or unexpected bills, I will tell you that everyone should get really familiar with what their insurance plan will cover. Things have really changed in the past 3-4 years. It’s like the insurance companies have lost their greedy minds. I tell people all the time to check with their insurance companies because there is literally no way for me to know if their plan has different coverage than the next person’s plan. And the insurance companies are constantly changing what they will cover. I’m at my wit’s end and am contemplating how I can transition to a pay for service model, just to get away from these immoral insurance companies. Direct Primary Care might be the answer. I don’t know, but this whole issue takes way more of my energy than it should. It makes me livid on a daily basis. I am morally offended by what the insurance companies are doing. I’m angry for my patients and for myself. The system is broken.
144
Ditto your comments. I’m changing as we speak to fee for service, with no insurance billing. That doesn’t mean patients won’t be reimbursed; they may submit their superbill for reimbursement directly to the patient, not to me. I can no longer afford a billing department of five full time employees begging and pleading for patients to be covered for even the simplest of treatment plans. Insurance has become a shakedown operation right along with hospitals and corporate clinic systems. Patients have been very understanding and as there is only one full time doctor other than myself left in our town, they don’t want to lose us both. The nearest other doctor is 25 miles away and they are corporate operations billing room and facilities fees, plus fees for each cotton ball, swab, and needle. Patients should be revolting against this.
35
@Ess MD Good points, but the article was about "hospital" charges, not insurance. Doctors' offices are merging into so-called hospitals in order to fleece the patients. So you should be complaining about that.
As for health plans: mine has denied every substantial claim from my regular doctors, who are in plan. The claim sits there for over a year. One provider is sending me the full bills. When I spent hours on the phone with the healthplan, it turned out they had every bit of information needed to process the claim and pay the provider. They just didn't. Their tactic is to deny every claim (thus increasing overhead tremendously), then wait to see whether some doctors give up, or some patients just pay when billed. Even if not, the healthplan gets to keep the money for over a year. It's corrupt, it's a scam and a con. So yes: the system is broken. The ones who broke it are not patients. They are doctor businesses, hospitals, healthplans, and all the hanger-on consultants and billing services they use who advise them of new tricks like facility fees.
3
@Ess MD Anyone who thinks the system is broken suffers from the delusion that the system exists to provide health care for patients. From that mistaken perspective, the system is beyond repair. It regularly fails too many who need health care, leaving them without care or bankrupt.
The system actually exists to provide wealth care for executives and investors of the corporations that make up the system. Many of those corporations collect enormous revenues for bureaucratic or administrative services, but provide no health care. Pharmaceutical benefit managers and insurance companies themselves are examples. Our system encourages the proliferation of those parasites.
Once you recognize that the system has evolved to provide wealth care for executives and investors rather than health care for patients, it's obvious the system is not broken at all. It works extremely well at its sole purpose, to generate more wealth for wealthy investors. What appear to be "failures" in terms of effectiveness and cost-effectiveness of health care are features, not bugs. Every dollar spent on health care is stolen from investors' pockets. Administrators do everything they can to prevent that theft.
The real question is whether We The People want to continue with a wealth care system that intentionally fails us, a capitalist approach every other country has rejected. Unfortunately, the people the system serves so well always answer that question for us with their campaign donations.
3
Thank you for this. I just learned about facility fees and needed such an explanation. Oy vey, what next to keep me and others from seeking medical care unless we are in dire straits?
12
@Lynne Shapiro I checked out a specialists I just visited. and they did charge me a facility fee for my visit at an office at a hospital building even though no special hospital equipment was used. The tiny office could have been anywhere. I also saw a resident and didn't get great care.
However, I see my Medicare C Advantage plan did cover the $218 facility fee charge this time, but what about other times?.
This is scary as some of us older adults who don't drive need to go to medical offices in hospitals that are transit reachable as this one was. Facility fees like this especially for those many of us no longer with fixed pensions and with wiped out 401K plans in 2008-2009 will really be harmed financially.
17
I am oh so glad I moved to Canada.
27
You will find that your new plan has it's own special kind of shortcomings.
2
@Urban.Warrior I invite you to spend a week with me in Canada and see for yourself.
1
This is extortion pure and simple. As a pensioner in a rural area of NZ, I pay $28 to go to the doctor and all x rays, blood tests etc are free, and if it is an accident, the ACC pays. Admittedly we have long waiting lists for non-urgent surgery but if you are really ill or in a life threatening situation, you are given top-grade care, straight away, free in a public hospital. (Private insurance is expensive and really only an option for those on high salaries and means that they do not need to wait for non-urgent surgery.) Taxation at its' best.
36
@Robin A lot of Americans have to wait for medical care too. When my brother had his leg amputated below the knee his stump got badly infected. The surgeon's office wouldn't give him an appointment for over two weeks. He went to the ER and the doctor said that if he had waited for two weeks he would have lost the rest of his leg. I waited two years for a hip replacement and had to endure such incredible pain I could barely think straight. I couldn't even get any adequate pain medication because of our arcane laws that assume everyone is a raving drug addict.
12
Surely everyone loves this healthcare system, it’s so transparent and not at all stressful! What better time to shop around than when you’re sick I ask?
21
We are all fools when it comes to healthcare. We are the customer!!!! We need to demand to know the cost of the service prior to the exam or procedure and what portion is not covered by the insurance. What other business can’t give you a price before you spend the money? Where else can a doctor claim to accept your insurance, then send you a bill because the insurance doesn’t cover the procedure they knew they were going to provide? The doctor literally does these procedures over and over again and they don’t know if it is covered by insurance but you, who have probably never had the procedure and have no clue what health insurance covers, are responsible for uncovered fees? It’s absurd.
15
@Billy Bobby Vote for Warren and make sure every one you know does the same. Also, vote for democrats for the senate & house as well. As long as republicans are calling the shots - everything will be more expensive, unless you are a corp or super rich. If you add up what insurance costs with co-pays, pharmacy, dental, etc. everybody paying more in taxes will be much cheaper in the long run.
23
@Billy Bobby Except that there's a good chance the doctor doesn't know (and can't find out) how much you'll be charged. Also, unlike most other services, it's not clear just what'll have to be done in many situations.
8
The insurance companies play a shell game, constantly changing what they will cover and how much they will cover. It is literally impossible for doctors who take insurance to have any idea what the patient will be billed. As a doctor who is incredibly upset by the bills my patients receive, I am daily trying to figure out a way to get away from dealing with insurances and still give care to all who need it. The stress and unhappiness makes me sick in my heart.
22
The article ends with advice to use walk-in clinics as a way to avoid facility fees for minor health problems. However, there are many many “walk in clinics” that are owned by hospitals and that also charge facility fees. No matter whether a location calls its self a “walk in clinic” or an “emergi-center” or an “urgent care center” always check about facility fees and if the place is owned by a hospital, find out if it will bill your care as an “out patient procedure” ($$$).
15
Are they going to start charging for parking in the lot that the building owner also owned?
5
@Joe Schaal. In Houston we already have to pay for parking at most Dr. offices. I have paid up to $17.00 to park in the Medical Center. That is in addition to co-pays and facility fees.
2
@Joe Schaal People have to pay for parking in many places. For some who need to make regular visits to a health care facility for services like chemotherapy it can cause great hardship. But, as we are constantly told Americans don't want the government to come between them and their doctors. We all just love our private insurers.
13
I appreciate you irony...
1
Welcome to my my home! But before you enter, I'm going to need you to give me the $20 facility fee I will use to redo my kitchen.
(Though a wonderful example of how ridiculous this system is, this one is more honest because I am asking for it upfront.)
10
Another example--as if we needed more examples--of the insanity and dysfunction of the health care "system" in the United States, where costs multiply in order to compensate administrative middlemen, where costs bear no relationship to quality of care, and where every party (patients, providers, payers, government, employers) think the other parties should bear the costs. And yet, better and simpler systems, whether that is the Affordable Care Act or more radical single-payer proposals, are criticized for being too expensive or too complex, as if everyone (or anyone) was well-served by the current state of affairs.
16
The most effective thing we can do to control costs is require all medical providers to publish their prices for visits and services and procedures. This idea of it all having to be closely guarded secret revealed only after such are provided is the worst kind of fraud.
27
@Homer D'Uberville A straightforward app - enter diagnosis code and procedure code and read out the copay/coinsurance $$.
2
This is just crazy. I just don't see why state-side Americans put up with the US health care system. I live in France. When I go to my GP, it costs me €25 (about $28). Some weeks ago, I broke my little toe, and since it was the weekend, my regular physician wasn't available, so I went to the emergency room at the nearby hospital. (I would have ignored it except the toe was sticking out sideways). X-rays confirmed the fracture, and I was sent home with a prescription for anti-inflammatory drugs, pain reliever, and a special shoe to keep my toe elevated. Total cost : €10 (co-pay for the shoe).
Of course we pay higher taxes here, but it's a progressive scale where the more you earn, the more you pay. And it still works out much, much cheaper than in the US. Most costs are covered by the national health care system, which includes hospitalization, about 65% of prescription drugs, most doctor's visits, lab work, etc. I pay about $170 for supplemental insurance that covers both my wife and I, with no deductible and no or very small co-pays; it covers things like 100% of prescription drugs, private room for hospitalization, and a significant portion of eye glasses and dental work.
Get with it, America! Learn from how other countries handle the right to health care!
83
@John Matthews I should have specified: my insurance payment is $170/month
2
@John Matthews Its not all doom and gloom. My employer offers great health insurance plan, $25 office visits, free tests, $10-25 for meds, no surgery or hospital fees (I think ER trip may be $100). I have kids and each coat $55 to $100 total. I pay about $90/week for family plan. One PROBLEM is that this is not available to all and my company (non profit) chips in a great deal of the costProbably a major reason they have little turnover. I just wish everyone had my option. My state was the leader and first in Affordable mandated insurance for all, I have never had a bad option.
Other problem is that private insurance companies take a large chunk of HC dollars, they need to make money. Government just has to break even.
3
@Momsaware
Look up what the top exec's make at the top 100 healthcare companies and insurers. You can see where the bulk if the money goes. Compare that to what is paid out in other industrialized countries
13
Beware the doctor who offers you a vaccination for something you can get at any drug store. The list is long and includes most vaccines. At this time of year beware the parting offer of a flu shot. Doctors' offices tack on facility fees and doctors' fees even though the nurse gives the shot. They may or may not stick their head in the door. I have heard may seniors complain of this scam costing them a lot of money when the local drug store takes your insurance payment, medicare included and that is it.
11
You’d like to think we get reimbursed for vaccinations but we generally do not. I’m sorry it’s that way. I certainly invite you to go to pharmacies for services covered there. We also are not paid what we bill but increasingly a vanishingly small portion and often with flat out refusal to pay at all. I’m not kidding.
6
Another article that reminds Canadians that while there are things we don't like about our system, we certainly wouldn't want one that's more like the one in the US.
For Americans that don't know, up here we don't directly pay anything to see a doctor, whether that visit is in hospital or an office. We don't pay for labs or imaging. We don't pay for an ambulance. In the province where I live, we do pay for medications, but only if family income is high enough to afford them.
Perhaps that why people live longer here!
36
This article and the comments are misdirecting our frustrations and anger. Doctors and hospitals aren’t the ones making excessive amounts of money off of this fraudulent business model—the insurance companies are! Stop blaming doctors and hospitals for the fact that our for-profit insurance companies have taken over.
28
Ask my brother in law how much he makes as a hospital administration stooge. He gets rewarded for cutting costs and raising fees, and his annual compensation rivals that of specialty physicians. So yes, hospitals are sometimes making hand over fist. And some doctors are. I think we can point fingers at many in our medical system, not just insurance companies.
32
@LM I actually think they're all to blame.
2
These fees have nothing to do with health insurance!
4
Sounds as if it is time for Medicare for All or Universal Healthcare
41
I have a diabetic relative that gets an annual eye exam (paid by Medicare) by an opthamologist. During this exam, a technician also checks her eyeglass prescription and eyesight. This office will not give out the eyeglass prescription, but instead, requires another appointment to do the same exam (for another fee). The double-dealing, greedy and excessive fees that medical offices charge are complete wastes of patients' money. No other country in the world spends so much or wastes so much $$ on frivolous spending on healthcare.
28
Get a new doctor
6
Sounds like yet another scam surprise billing that is out of one's control. How are you supposed to know to ask about a facility fee if you do not read about it in The NY Times? It's like buying a car where they have a long list of ADP (Additional Dealer Profit) items - like advertising, rust proofing, etching, etc. Maybe car dealers will add a facilities fee too! At least you can walk away from a dealership.
I have confronted recent surprise bills from all kinds of businesses after the fact and without warning. There should be a law!!! We should not be forced to pay a bill we were not warned about BEFORE getting the alleged service, giving us a chance to opt our or find another solution. Imagine if nytimes.com suddenly added a cyber fee for accessing one's subscription online the previous month!
15
ANOTHER SCAM being perpetrated on unwitting patients. Are you kidding - a "facilities fee" - should we now request our exam take place in the parking lot? I've never seen such a thing in our area - Doesn't the fee you pay the hospital, clinic etc cover everything - including overhead? What's next - airline style pricing - it costs x dollars to walk into the door, the x if you actually want to see a doctor, and then x dollars if you want surgery in an actual operating room...and on and on. This is madness.
29
This facility fee is only a way to increase the hospital's revenue. Case in point. My wife was seeing a pulmonologist in Ft. Lauderdale who had a private practice in a building owned by Holy Cross Hospital. The bill she received was for a standard existing patient offic visit until -- until he sold his practice to Holy Cross Hospital. Now I do not know how much he sold it for but from that point onward, he was a hospital based physician and not in private practice. I assume the hospital paid his salary and then began charging facility fees. It must have been a good deal for him because he no longer had to pay rent on the office space, he no longer had to hire employees (they become employees of the hospital), he no longer had to bill insurance companies (the hospital took care of all of that). So, this is really what is happening. A few months later, my wife's cardiologist also sold his practice to Holy Cross Hospital and you can guess what happened. Now, also you should consider that I know all about this scam because I ran a medical billing company for 20 years.
35
What is being missed by all the comments blaming greedy doctors is that the facility fee does not go to the doctors and is not charged by the doctor. This was implied by the article but not explicitly made clear. Private doctors cannot charge you a facility fee. Facility fees are charged by the hospital to the patient for using their facility in addition to whatever is charged by their employee doctor. The facility fee is charged by the hospital and the money goes to the hospital. The doctor has no say in it and does not receive it.
As a physician I stopped performing procedures at a local hospital owned procedure suite because of the 1000s in facility fees that were being charged my patients.
I started performing the same procedures in my own office where I do not have the benefit of a facility fee to purchase and maintain the equipment and hire the staff. Even though it is expensive to do it in house rather than allow the hospital to charge a facility fee to provide that facility to the patient I would rather I cure the cost and do that rather than have my patients made responsible for thousands of dollars in expenses.
So to all the commentators who are decrying greedy doctors please have an understanding of the system and fee being discussed here and realize that it is a hospital charging you a fee independently and without any benefit to the Doctor who is seeing you
68
I’ve consulted many physicians in France over the years. Most practice out of an office that is really an apartment unit in a residential building. One of the rooms functions as the waiting area, another the consultation room/office. There is no receptionist, no nurse. Just the doctor, who makes her/his own appointments, takes vitals at the beginning of the visit, listens to the problem and then makes a diagnosis, writes prescriptions, and collects the fee (23 euros) at the end. I’ve never encountered a ‘facility’s fee’. This is why I appreciate French medical care, and why I am completed turned off by the layers upon layers of administrative bloat that we have added in the United States.
36
@Concerned Citizen
Primary care doctors, pediatricians and geriatricians average no where close to that amount. This partly accounts for the relatively small percentage of medical students going into those fields.
3
@Concerned Citizen
Insurance CEOs make $60,000,000 [Aetna], Hospital administrators [MBAs, not doctors] make $12,000,000 [Mount Sinai, NY], Plaintiff malpractice lawyers several million [difficult to find documentation], News anchors $36,000,000 [Hannity].
Perhaps a physician, after 7-12 years of postgraduate education, taking 24 hour call, visiting patients on an emergency basis, making decisions which are constantly subject to second-guessing and threat of litigation making a few hundred thousand is not overpayment, relatively speaking. Suppose your physician was as effective as your congressman, how would that be?
8
I had a hernia repair in a surgical facility in North France in 2014. I was scheduled for surgery a week after I first consulted the surgeon. I arrived very early in the morning, was prepped and taken to to operating room, then returned to recovery, and since I was doing well by 7:00 pm, discharged that evening. There was a facility fee for the operating room, but the total bill — surgeon, anesthetist, nursing staff, pharmaceuticals and everything else — was less than 2000 euros, about $2200. That was the entire bill, not my portion after the insurance paid its part, and it included all follow-up visits to the doctor and the cost of a nurse who arrived at my apartment every evening to check the incision and change the dressing. It goes without saying that I had no complaint about the facility fee.
29
During an annual wellness check, Medicare, I made two mistakes. 1) I asked the doctor a question to which I received a one sentence reply: ka-ching - $75 facility fee; 2) the nurse asked if I had received a seasonal flu shot (no, may as well save a trip): ka-ching - $75 facility fee; the inoculation was covered by Medicare. So, two "facility fees," $150 charge during my "free" annual wellness check.
54
@Craig51 That's appalling. Medicare doesn't cover these fees? I have not run into anything like that in my part of the country.
1
It is not only hospitals. My internist belonged to a group practice. The practice recently sold-out to Caremount, not a hospital. I received this a few weeks ago [I am covered by Medicare.} :
"Medicare pays 100 percent of the cost for this visit with no out-of-pocket expense to you. However, please keep in mind the AWV is not a head-to-toe physical because it only includes certain preventive and screening services; this means if you ask your doctor about any aches, pains, or other illnesses during your wellness visit, you may have a copay or deductible."
You have to love this. To top if off, Caremount did not include all my past test on their so-called patient portal: no longer am I able to look a past blood test results.
23
@Alan: Regarding past test results, I ALWAYS get a hard copy of every/any tests (bloods, x-rays, etc.), and a copy of the surgical report for any procedure I have - I scan it into MY OWN COMPUTER. By doing this, I have most of my medical records available to me, 24/7, for free. (You could just keep all of it in a file folder in a drawer if you don't want to put it on your computer.)
Let me add that I do not trust any "patient portal" in the least. The whole game is rigged, as far as I'm concerned. How long until there's a "patient portal fee"?
10
This is yet another medical practice scam. Doctors should pay their own rent. Whether they work in their own office or one in a hospital, the doctor should pay for the use of the premises. As usual, the patient can't find out in advance about the price. Why is medicine the only business that doesn't have to tell the customer what the cost is before they buy the product?
22
For me, a retired General Internist, the outrage I feel is twofold. First, as a patient I consider this unconscionable double billing. Second, as a retired private practice physician I feel this represents an unfair business practice as I could never add on an extra charge for my medical services to cover the cost of my office. I was expected to pay for this from my professional fee. It is no wonder that I am no longer an isolated physician who feels it is high time for comprehensive national health insurance. One additional thought— a rhetorical query of sorts. Who among you Republicans opposed to Medicare for all but you, yourself, on Medicare would abandon it for the private Health Insurance you used to have with all its Byzantine regulations & costly premiums? I never saw a single patient of mine willing to do so. We should consider that when we’re wondering about the health care our children, grandchildren and greatgrandchildrer will have.
87
The facility fee was originally designed by Medicare to compensate hospitals for the added cost of outpatient care in that setting. They then broadened the definition to include hospital outpatient settings far removed from the hospital. Medicare also required the facility to charge that fee to all their patients, if they charged it to Medicare patients. Basically a huge and unjustified rate increase in which Medicare was instrumental, now loved by hospitals who are buying up practices as fast as they can so they can impose the facility fee on top of their usual charge. Hospitals grow fat and rich as patients are gouged and impoverished. I bailed out of this increasingly rotten system and went to work for the VA, where I can watch things with clean hands and a clear conscience. Bring on Elizabeth Warren.
74
The sad thing is that the “facility fee” does not get included in inflation, even though our costs have gone up. Yet, it is included in GDP, even though nothing new has been created.
Same with all user-pay fees - airline baggage and other charges, toll roads, bank charges, school supplements, etc.
Symptomatic of our value extraction economy, where you are viewed as creating value even if all you do is rip off others.
22
Seriously? The medical establishment is cooking up more ways to make health care more expensive in the US? What don't they get?
Ask your doctor to meet you at your car in the parking lot.
In what other countries do doctors charge "facility fees"?
Is this like the "resort fee" that Waikiki Hotels started charging several years back?
(Seriously, Waikiki, have you measured the size of your swimming pool? Now compare your pool with the one at the Shangri-La Ocean Grove Road in Singapore. With the "Swimming Pool Rule" I rest my case. With all untreated drug addicted alcoholic homeless people living on the street right in front of your hotel, Waikiki is the last place I would label a "resort", more like an upmarket urban jungle with a scenic beach.)
What if the Dry Cleaner starts adding "Resort Fees"? I digress, I mean "facilities fees".
Ask your doctor if higher fees are right for you.
They're definately not right for your doctor, and they or their employer need to start posting their prices upfront out front. If the coder's list is way too long, a pdf version on the internet will do.
Also post the deals and side deals you cook up with the insurance companies. Rubber pricing in the medical industry depends on their cozy relationship with the Insurance Industry to keep it afloat. What you pay depends on who you are. Medicare for all means truth in pricing, no third party profiting off your misfortune.
20
This is not medicine, this is just another scam. Another way to get your money while pretending that these charges are legitimate. 
46
(Ahem.) Universal Health Care.
24
This is nothing more than a "regional sports fee" tacked on to a cable or satellite bill. It's a fabricated fee and shouldn't be allowed to be passed on to the consumer/patient.
How outrageous is it that hospitals feel they can make up fees and expect patients to pay them? They seem to feel patients are hostages to their demands. Not so. We have the choice to fight back and make them remove these monetary gouges.
12
Costs must be capped in all sectors of healthcare, including insurance, and especially pharmacy. It’s absurd and untenable, and people are getting hurt. I can’t believe anyone even goes to the doctor anymore unless it’s life or death.
12
about 5 years ago i switched from my primary care doctor(due to what thought was his incompetence) who was an internist, to a PA in the same medical group and practice. His charges were about $125 per visit if i remember correctly. That same year the local hospital bought out the medical group. The PA charged me a whopping $275 per visit afterwards!! Go figure that. i did. it was due to the hospital buyout and their desire not only to recoup their money but to increase their profits even though they are supposedly non profit. i ended up dumping my PA who was even more clueless and incompetent. When I lived in Eugene, Oregon some 10 years ago, the local supposedly non-profit hospital, Peace Health, built a brand spanking new hospital costing over $300 million . A non profit building such a hospital? Where did they suddenly find all of that money? Our health care system isn't health care. It's a money grab. HCINO. Health Care in Name Only
27
Non profit and/or not for profit has nothing to do with what they charge for services. It is a license to have extra agent facilities and high or overpaid staff and doctors. Why be conservative with costs when you have to spend it all anyway.
As a while the US needs to do away with All of the various ways to not pay taxes starting with all 501c3 companies.
2
"The decision should be based on one's finances..."
No, it should not. This is what is wrong with doctors and medicine today. Just this past week my PPO insurance company redirected me to a surgeon who even they admitted "rarely" does the procedure I need because he is in-network. It's a very ugly thing.
33
A fee for maintaining the premises. This sounds like another line item scheme added to extract more $$ from patients. In ANY other business your cost of goods sold INCLUDES maintaining your premises. The American medical system is corrupt, opaque, and the costliest in the world. Get politicians and lobbyists out of the medical business and let the free market determine which facilities are providing the best outcomes for their patients.
Until Americans stand up and demand a fully transparent cost for service rendered, aka menu, in plain English there will be more of these creative money grabbing scenarios perpetrated upon us.
26
glad I'm on Medicare advantage. No big surprises
3
@ed Except when you have to change doctors because they no longer consider last year's doctor in-network. I've seen people go through that.
4
@ed I'm on Medicare Advantage, and I just got an extra $1300 facilities fee from the hospital almost a year later. Watch out.
12
The advice given in the article is terrible and points to the ways the system is broken. Doctors' practices are being gobbled up by hospitals. Your options for independent practices are decreasing. And walk in clinics are fine for strep or conjunctivitis but useless for ongoing issues. The advice to consider based on finances is necessary.... but points to how our insurance system is tiering healthcare.
Meanwhile deductibles and coinsurance are rising so I have to pay more and more of these facility fees for visits. One of my kids' specialists is part of Johns Hopkins, which has outrageous charges (remarkably, Blue Cross pays almost all of the charged fee). Because she's a specialist and we had to travel over an hour to see her in the first place, it's not easy for me to just switch.
21
In at 11am, out by 7pm, hip replacement surgery which took about an hour with no complications. Cost was $67,000.
How is anyone going to afford getting medical treatment without health insurance?
Donald Trump and the Republicans couldn't care less.
100
@JM When did this start? Only since January 2017?
5
@JM But, if you have Medicare, the providers probably get less than 10K for the surgery. I supposed it's for tax purposes, but hospitals, doctors, etc. all bill far more tan they receive from the insurance company of Medicare.
For example, my last Mammogram was billed at over 1000 dollars, but less than 100 was paid by Medicare. I'm not responsible for more than what Medicare pays, so I can only assume that the remainder is used as a tax loss.
As a former nurse, I was involved in billing for supplies used on Medicare recipients. The same thing went on then.
5
@JM
Hospital charges are a grossly inflated sum which Medicare, Medicaid, and insurance companies ignore, paying instead the allowed or contracted amount. The only people who get stuck for the full amount are those who make just enough to be excluded from Medicaid, while unable to afford private insurance. Their only option is to declare bankruptcy with all the adversity that entails. Is it any wonder that foreigners think we are either stupid or insane?
Trump and the Republicans have promised us a really, really stupendous alternative plan which they decline to divulge. Bring on Elizabeth Warren.
11
My child used to see a doctor in a teaching hospital in Boston and the faculty fee was high. He had appointments available in a suburban office a few days a month and we moved all of our visits there. No facility fee, no traffic and no parking fees.
31
If you don’t want to scammed by the facility fee stay away from medical practices that are part of a hospital system.
22
@Sasan Yasharpour Good luck with that. In our market, all of the practices are owned by hospital systems. I don't think there's an independent practice left.
13
Facility fees also pay for services that patients are not billed for, like social work, nutrition, phlebotomy, and clinical pharmacy consultations. Insurance companies understandably want to keep their padded margins fat; but that shouldn’t come at the expense of added services for patients.
9
@alex
Read the article again. Insurance companies do not charge facility fees, hospitals do.
5
“Imagine if other businesses could behave like healthcare”? As a physician I say bring it on! “Other businesses” have the ability to set charges based on overhead costs and quality of service. Not so in healthcare where both private insurance and Medicare/Medicaid dictate charges. When your overhead is subject to normal forces of capitalism (i.e. rent, wages, supplies) but collections are essentially fixed, I promise you it is more than a distraction in the daily struggle to practice high quality medicine while also running a small business.
4
@Lawrence Fiedler While I sympathize with running a business aspect, I have a problem with comparing a medical practice with, say Walmart. First, nobody forces me to shop at Walmart unless it is the only store in town, while my insurance, forced on me by my employer, does tell me where I must go for healthcare. There is very little patients can do in selecting where to get services. Even then, it is all very confusing and very exhausting, much less when one is sick already. The stress of seeking care might kills us all as a result.
31
Cry me a river! You can always opt out of insurance services of you don't like the prices. So, don't pretend you have no choice in pricing. The truth is, nobody can afford your service without insurance. Your business is overpriced. And yes, in the other businesses I know price before hand, but to get prices from doctors is impossible.
11
No one is objecting to doctors making money or being able to pay their overhead costs. It’s the surprise nature of medical billing that is driving all of us batty. If you have to make up charges to tack on to customers’ bills in order to make money, you are not running a small business, you are running a scam.
24
Try asking your doctor how much your visit will cost. Chances are they have no idea (and many don't seem to care). But our financial security is clearly related to physical health. Why don't doctors act as if it matters? I will not go to a doctor whose office charges hidden fees, or who personally seems not to care about my financial needs.
22
I am a doctor in the Netherlands.
Facility fees don't exist here.
Can anybody help me to tap in this lucrative system?
Will telemedicine reshape the system?
I am ready for this.
17
@Guido De Cock
Telemedicine will mean you pay the same, while overhead costs will be less. It means the doc doesn't see you in person--can't touch your ankles to see if you are retaining fluid and in heart failure. Can't listen to your lungs and heart with a stethoscope, can't look into your ears, can't smell a peculiar odor, e.g. one that could lead to a diagnosis of pseudomonas infection, lung abscess, or cancer.
2
Transparency is what is needed here. Hidden costs presented after the procedure should be made illegal. A restaurant provides me a menu so that I can select on what I want to dine. With the description of the food is the cost. At least I am made aware at the time of ordering what it will cost. Yes, I realize that I am paying the bill here and not some insurance company but I know the cost. Why aren't the costs, covered and uncovered made clear well prior to the appointment? I realize there has to be flexibility to support the medical provider a window to perform procedures beyond what was initially expected to be completed but there are many costs " facility fee" that can and should be detailed well prior to the actual visit. These costs are not transparent and should be.
25
Well, this explains why the so-called free Medicare wellness exam ended up costing me over $200 out of pocket, when the cost of the shots/lab was only $24.
18
@Jrb This fee was added under the Obamacare law to compensate for the fact that preventative care had to be provided free of co-pay. And, obviously, it was extended to non-preventative care once created.
Then there was the massive expansion of hospital systems to buy up all of the local practices. The hospitals wanted additional revenue to compensate for the capital investment.
O'Care was designed to make money for hospitals. Instead of reducing a families cost by reducing cost shifting, hospitals increased there prices at 3.3 times the rate of inflation. Nice work if you can get it.
13
No, this would be $0 out of pocket UNLESS you and the doctor addressed additional issues during the annual preventive visit, such as diabetes, high blood pressure,medication changes, etc. Those services are billable in addition to the Medicare wellness exam even if done at the same visit. They take more time and are not preventive in nature. You should have been informed of this policy in advance. Many patients see the wellness visit as a “freebee” onto to which they can tick on a year’s worth of concerns. It doesn’t work like that. Once a year preventive visit is free, medical management visits are subject to co-pays and deductibles.
16
@Rob Merrill. What I have learned is that you can not ask any questions during your well visit. If you ask a question, it is not longer a well visit. Why would a person go to the doctor and not ask any questions? It doesn't make sense.
15
Commercialisation and consumer driven medical practice is another profit driven industry where medical decisions are influenced by insurence companies, hospitals and incentives physicians receive . You may visit your physician for a simple problem like an uncomplicated rash or a trivial trauma, the physician may barely touch you for the problem but can document complete exam with the help of prepopulated format in the EHR which is essential for billing , sort of upcoding to get more reimbursements. It is a shame Art of healing has degenerated to art of greedy profit making. Culprits are people without medical insurence and honest physicians who want to practice within the boundary of medical ethics
5
Did not mean to say culprits. Supposed to be victims.
Why does a hospital have to charge a "facility fee" but not say, Home Depot or your local grocery store? The answer is that they can, it increases their profits, and customers cannot do anything about it.
Imagine if other businesses could behave like health care. You go to the grocery store and no prices are visible anywhere. Or if they are, they "estimates". A month later, you get a bill (which is doubled by a "facility fee") which you cannot understand or dispute, and must pay. If one grocery store did this, they'd go out of business. If they all did it, they would get richer and richer.
107
If you have to go to the doctor, hire a lawyer and forensic accountant to represent you when you walk into the door. Have the lawyer interrogate everyone you come into contact with as if taking a deposition. Have the accountant demand that he/she can look at the books and see what's going on. Even after you pay for the accountant and lawyer, you probably will come out ahead.
Medicine has become the greatest- separate people from their money- scam that has ever existed. I don't go to the doctor. If something goes wrong, I try to figure it out and give it time to heal. If it gets better and goes away, I don't worry about it.
For example, recently I had developed some severe bloating and discomfort in my stomach. Felt like I swallowed a bowling ball. Turns out, I had become gluten intolerant. Cut out the gluten and I'm fine. Probably saved myself $10,000. If it had gotten worse or not gone away, I would have gone.
People should use social networking to list facilities and practitioners who charge these outrageous fees. Out them. Yelp them. Let everyone know and boycott those places. Hit them where it hurts, the pocketbook.
Stuff like this makes me want to socialize medicine. I'd like to see a single payer option where the enrollees go to government clinics funded by tax dollars. Not for profit is a joke because operating expenses come out before profit and those expenses go into people's pockets.
23
rigged markets can be very confusing. perhaps the lack of a free market in healthcare suggests it should be nationalized.
24
@bill zorn
Better yet, how about if we get price and quality transparency and become a free market? There is no evidence that socialism has ever beaten capitalism in providing the highest quality at the lowest price.
You cannot identify a single example.
3
@ebmem
You recommend disbanding the fire department and having everyone hire their own firefighters on the open market.
You recommend disbanding the police and hiring patrolmen privately when you need.
Medical care is not a free market because when you are sick, no one knows what you will need and how much of it you will need, so no amount of transparency will allow you to price your purchase. In addition, you are often too sick to go looking around for the anesthesiologist who is offering 20% off that day. Finally, because physicians are credentialed to practice only in certain institutions and settings, you can not choose anyone - the practitioner needs to have the credentials to do what you want, where you want, when you want.
So the purchase is not for one service, but for a system with various strengths and weaknesses, and the cost will depend on what you actually turn out to require.
Finally, if the paramedics take you somewhere in shock, your purchase is already made.
2
At least the questioner could identify the facility fee on the bill. The massive, greedy health system that occupies our region sends out invoices without itemized charges. You just get a piece of paper with a bottom-line number that you’re expected to pay. When you ask for itemized charges, an excessive number of days go by before you receive a printout of bizarre items that mean little to the lay person and bear no resemblance to the figures on your insurance claims.
Another tactic of this institution has been to gobble up small specialist practices and form them into “institutes,” thereby tripling the price of a visit to your orthopedist or urologist. Much of the extra profit goes not to improved healthcare, but to exorbitant executive compensation and to expensive marketing, branding and advertising, including major sponsorships of area rock concerts.
Please do not let Elizabeth Warren’s aspirational ideas on Medicare for all prevent you from voting for her. When it comes to fighting the medical-industrial complex, she may be all that we have.
81
@LIChef
The cost of Medicare inflated after Obamacare "improved" it. What would make you believe that if it became universal costs would decline? The elite executives running the system are not going to take pay cuts even though they are superior only in their own minds.
5
@ebmem
If we had government-run healthcare, like virtually every other country in the world, no insurance executive would be making a salary + bonus + stock options that adds up into the millions per person.
There's your savings, right there.
18
We all support this system by paying too much for health insurance. Can we fault doctors and hospitals for filling their coffers when the spigot is gushing money?
Meanwhile, most of us are too afraid to go without insurance. We lack the courage to face possible injury, possible death, so we allow our own exploitation to continue.
8
@Frank M
Gee, Obamacare made it illegal for insurers to get more than 15-20% for profit and overhead? What that did in effect was make insurers cost-plus contractors. The hospitals jumped in and raised their prices at 3.3 time the rate of inflation and the drug companies raised their prices at 2.4 times the rate of inflation.
The insurers added up the likely costs for the next year, added 15% for group policies and 20% for individual policies, and passed on the cost of overbillings to consumers and taxpayers.
How did it work out with Medicaid providing free opioids to able bodied childless adults? Government policy, with respect to both no co-pay for the poor and refusal to hold Mexico and China responsible for illegal drug trafficking, made things worse and the politicians are now suing the drug manufacturers.
2
@Frank M It sounds attractive to go without insurance intentionally, assuming you can afford the costs and risks. But there is one HUGE problem with being uninsured: Hospitals, doctors, drug companies, medical practices, labs, etc. have list prices that are VASTLY higher than the insurance-negotiated prices, and you to pay those extraordinarily exorbitant prices if you don’t have insurance.
If individuals could pay the same prices as the insurance companies then going uninsured, or uninsured except for catastrophic illnesses, might indeed be a wise choice for some. But this huge disparity in prices severely disrupts that logic. The problem is caused by the combination of insurance companies, hospitals, large practices, drug companies, pharmacy benefits managers, etc. Part of the kabuki dance is pretending to give the insurance companies a good deal. If all involved had to publish actual prices and stick to them for everyone, many problems would disappear. As others have said, like a grocery store or restaurant.
12
@Alexander: you are right of course. Higher prices charged to the uninsured are another lever to force people into an oppressive system. I’m fed up with it. At least for the young and healthy, the moral decision increasingly looks like refusing to participate and taking our chances.
2
As the auto retail industry gets more transparent and consumer friendly, the healthcare industry gets slimier, more opaque, and sinister
11
It's called "Overhead". "Overhead" eats into "Profit".
Doctors and hospitals aren't alone in doing this. Bullet fees are levied in Iran and China, billed to the families of executed prisoners.
Always ask your doctor, "Does my insurance cover this?" Always.
5
@Dick Ellingson
Just don't expect them to know the correct answer. One of friends has been told several times "Medicare won't cover this" when it just did a few months ago, and will this time also.
2
And they will answer, “I don’t know. You would have to check with your insurance company.”
And good luck getting a straight answer out of them...
4
@Dick Ellingson
Your insurance covers it except for the co-pay. After your deductible has been satisfied.
It's getting ridiculous. I thought about taking some college courses only to discover that the local college is now charging 35 dollars per credit hour as a "building fee." That adds $105 to each class in addition to tuition and other fees. When I went to college in the 1990's, there was no such thing as "building fees." Tuition was supposed to cover the cost of sitting in a classroom.
Now hospitals are charging fees to use their equipment when it used to be part of regular care? It's just a way of gouging the consumer, just like colleges charging students extra to sit at a desk in a classroom.
Will stores start charging us a facility fee for shopping in their building and using their lights and restrooms?
15
Quick answer: an inefficient, inhuman private healthcare system. Can’t wait til the day I won’t have to scrutinize a bill or fight an insurance company to cover it.
167
@Jason Snyder
Mexico is looking better and better for healthcare treatments. Just fly your own doctor down and use their facilities.
7
@Jason Snyder move to Canada or Scandinavia. Problem solved.
Don't hold much hope for our country joining the ranks of civilized nations. More than ever, the riches of the rich matter more to policy makers than the needs of the poor, AND the people who have contracted for so-called medical insurance.
11
@Jason Snyder Don't hold your breath.
2
I am becoming radicalized. Outrage will do that.
If you have an outpatient procedure - ambulatory surgery - paying for the OR is reasonable. If you have a gynecology annual exam in an office, it is not. That’s rent taking, literally.
I don’t pay my mechanic for the cost of his lift. I pay him a service fee for the job. I don’t pay $59.99 for a kitchen gadget, plus $25 for the cost of store renovations.
If a medical practice cannot cover operating costs, that is a failure of insurance rates and unfounded mandates, poor financial management and profiteering.
I don’t really think Medicare for All is viable as there are too many who can’t see the benefit of removing profiteers, third party administrators, and your boss from medical decision making. Charge those folks an out of pocket fee for using the elevator and bathroom and see if that changes.
11
@Cathy Medicare allows the charging of a facility fee. In fact, if your physician was in private practice and a hospital bought his practice, the hospital got to charge Medicare a higher charge because the practice was now part of a hospital system. And a facility fee.
The reason Medicare for All is a heavy lift is because intelligent, educated voters are well aware that the big medicine cronies are not giving up any of their largesse. Instead they will examine the new regulations and figure out how to increase their profits.
When you take your car in for repairs or buy a kitchen gadget, you are dealing in a free market. There are times you overpay for inferior goods or services, but are free to complain and get a refund or tell your friends and communicate. [Same if you get superior goods and services for a low price.]
There is very little visibility to quality in medical goods and services. If you see and advertisement on television, it is very difficult to figure out if a drug or service offers value. It is virtually impossible to determine if your physician lost his license in another state, if the hospital you are having a joint replacement in has a high complications rate or if the nursing home your grandmother is in has ever had a satisfactory inspection.
And it is virtually impossible to find out how much anything costs.
American medical care is about as far from capitalism as possible. The government has made a mess.
11
Soon to be followed by a "not punched in the face" fee and "not kicked in the shins" fee.
I am US-born citizen but I wonder what fee would push me to move to Canada or Europe or Asia.
18
I'm a Canadian and have never heard of or paid a "facility fee".
Think about it America.
78
Your doctor visit is more expensive because American doctors and hospitals are, on the whole, rather greedy. The "facility fee" is the medical equivalent of Miami Beach's "resort fee" -- you get to pay for the same thing twice.
30
I had an asthma attack and went to the ER at the University of Pennsylvania hospital. I received a bill for $800, which (sadly), I thought was a good deal given my horrible insurance. Come to find out that was just the facility fee! A second bill for actual services rendered came weeks later and it was for her $2000. Healthcare in this country is horrible and I have what many would consider “good insurance.” I can’t imagine the suffering that others have to go through.
279
@NA this is so frightening to me. I am hospitalized a few times a year here in Australia with Asthma flare ups. It costs me nothing. I know we pay higher tax for the privilege but I also know how much panic an attack causes and would hate to have to think about how much it was going to cost while fighting to breath. The costs in the US are insane to me!
21
@Kb Ditto for Canada. The thought of spending time fighting to determine fees before and after treatment is very daunting.
18
@NA
When you divide the E.R. overhead costs by the number of people who visit that E.R., I doubt the answer is $800 per patient ... Somebody is skimming off the excess money that is generated by this excessive fee.
9
Glad I live in the land of the free (healthcare), Canada! With an election coming up, you guys should be pushing your Reps for socialized medicine - it really is the better way to go.
46
One can only avoid these costs in the future by voting for Democrats. The Republicans have done nothing, are doing nothing, and will do nothing to bring this country into the ranks of the civilized countries, where people expect and receive services for their taxes and even poor humans have value. Our non-system is as Byzantine as it gets as anyone with experience of a system that works will tell you. It's such a shame that so many voters continue to be manipulated and fooled by people who only care about them as far as they can use them.
31
Lucky Americans and their low taxes.
17
The facility fee I was charged at an outpatient surgical clinic, for a routine screening colonoscopy, was over $11,000 in 2018. The owner of this facility is one of the 5 major medical systems in the Milwaukee, WI area. My long time PCP practices there and he was dumbfounded by that charge. What is happening is the medical systems have excess cash at the end of the year and want to use that up, so are building new clinics, freestanding surgical centers and hospitals that are unnecessary, underutilized and drive up costs unnecessarily.
23
These tactics are what makes many people including me more supportive if a nationalized healthcare system. If these hospitals, pharmaceuticals, doctors, and insurance would not try to make obscene profits that abuses everyday people, candidates like Warren or Sanders wouldn’t be so popular. They need to realize their collective greed is going to be the downfall of their long term profits.
19
@Rojo: The hospitals all have very effective & well-paid lobbyists who ensure that this collective greed is not just continued, but enshrined! They have the lawmakers in their pockets.
2
Legitimate theaters have been surcharging "facilities fees," sometimes called "theater restoration fees," for years (presumably on the not entirely unreasonable premise that, if you're already paying upwards of $200 to see "Hamilton," what's another buck or two?); a trick they learned back in the 1970s when ordering tickets by credit card became a regular thing and someone thought up the phrase "service charge." And it's only a matter of time before restaurants charge extra for table seating, and "rent" on the dishes and silverware. And what may finish off the malls for good is when stores start charging admission.
That's why we still need paper receipts, gang, and we need to be unlazy enough to look them over for questionable items. Each increasingly familiar instance of price gouging is another nail in the coffin of the American middle class.
11
The doctors allowable charge in a hospital based facility is lower too.
2
Diet and exercise are great ways to avoid these fees.
3
@Len319 Glad you never had an illness that has nothing to do with diet and exercise. So i guess you don't go for routine screenings either? They recommend that women have mammograms every year or so. Can diet and exercise avoid those? Your kid ever get hit by a car or break a bone? Diet or exercise would cure those?
12
@Len319 My daughter fell on the playground and dislocated her elbow last week. We're paying $7000 (plus $1000 a month in health insurance) for that accident. Diet and exercise would not have avoided the problem. We've got $20,000 in health care costs this year. I make $62,000.
8
Oh Len...all I can say is wait til it happens to you...
6
There is yet another way that Medical providers increase their incomes, that is to get a piece, if not all of the Facility fee. Outpatient imaging, surgery, infusion, dialysis are examples of that. The MD owns the facilities that they refer patients to. DR orders the surgery, directs the pt to his surgery center, where he gets his fee for the Surgery he ordered, extracts a facility fee if he can and gets the profits from the facility. That is a Triple Dipper. As a retired Nephrologist, I know that gimmick well. I was there when the baby was born.
18
My son had a severe allergy attack. The hospital bill was $35,000 for 1.5 day stay. When the bill arrived, it was a single sheet of paper stating $35,000 due. No description of the fees or services rendered for the cost of treatment. When the bill was later argued, the final tab was $14,000.
This is why medical care is for the well insured or wealthy only. Something needs to be done with the rampant overcharging and pilfering of Americans who are at their mercy.
Hospitals (and the corporations who own those hospitals) need to held accountable for fraud. If the final bill was $14,000, then the original bill at $35,000 was an attempt to flees their patients. How many pour souls have had their wages garnished for the full price of services rendered, when the hospital was fully aware the charges were over billed? That's criminal in my book.
Until CEO's start seeing jail time, their only concern will be the "bottom line profit".
160
We had to go to the emergency room for a concussion and we were billed a facility fee and a doctors fee.
What was really confusing was we were handed a document, while we were in the emergency room (after we had gone through a metal detector and filled out check-in paperwork), that said we would not be charged more than X amount. Apparently that was only for the facility fee, because we got charged twice that in the end.
I am about to graduate with a degree in Health and Exercise science and I have never had less faith in the healthcare industry. I am amazed everything works as well as it does, to be honest.
34
This doesn't even get into the fact that it is the insurance company rather than your doctor or therapist that may control the duration of treatment. And costs are indecipherable. I attempted to find out the actual cost of physical therapy I was getting and got a good look at the receptionist's chart showing all the different insurance companies "allowing" different numbers of visits for my issue and paying the provider wildly different amounts for the same treatments. "But what is the Actual Cost that you charge?" I ask, only to find out that there was not really any such thing. Everything was flexible, based on insurance company negotiations. The person next to me in the therapy room doing the exact same things might be paying twice as much, or half as much until the deductible is met. My attempt to be a good responsible consumer was useless.
47
@Diane Helle
I share your frustration. I've tried to find the cost for certain services and/or procedures. The medical providers can't tell you in advance: it depends on the codes that the MD/business office enters and the negotiated rate with your insurance company. The prices vary widely.
What I've noticed is that billing is "unbundling" each episode of care: Office visit; draw blood fee; lab fee for lipid panel; lab fee for CBC; lab fee for blood chemistry panel; facility fee, etc. etc. This drives up your costs, and results in you paying your "lab service" co-pay multiple times, once for each component test. That did not happen in the past.
20
@Diane Helle: "My attempt to be a good responsible consumer was useless." Which is EXACTLY how the system is designed.
BTW, remember when drug stores were supposed to prominently display a list of drug prices where all could read it? Have you seen any of these lately? Me neither.
3
Write a letter to the CEO of the hospital, send it certified, and mention the word malfeasance. A prompt response will appear in your mail box. Make sure you first consult someone who has worked in the medical field, Always save all medical bills for evidence of fraudulent charges.
19
In the Netherlands i pay 108 euro per month. It includes everything. No hidden fees. Includes meds;hospitals etc.
However they tightly control expenses. It is not single payer either. The insurance companies are usually non-profit.
It was one reason to move back to Europe.
44
The facility fee is just another ripoff by the hospital. Since the doctor is no longer paying rent to a landlord of mortgage interest to a bank, he should be paying the rent (facility fee) himself to the hospital. As it now stands, when a doctor chooses to sell his practice to a hospital, the doctor increases his profit by the lack of rent and the hospital increases it's profit by the facility fee. Akin to a 3 card monty game.
22
@impegleg: You don't seem to understand that the doctors often have NO CHOICE about this - they are usually forced to become hospital employees or else they will lose their admitting and surgical privileges.
This is about keeping doctors under the hospital execs' thumb, and keeping all available $$ in-house at the hospital. The doctor is paid a salary - and most of the good doctors I know who've been forced into being a hospital employee are planning to get out as fast as they can, b/c it's utterly changed the practice of medicine.
To the hospitals, most of us are now just an account number, and a set of metrics. We are a 'target' to be 'hit.'
5
Seek care in a Federally Qualified Health Center - there is no facility fee, they make their service available to everyone with a sliding fee scale for low-income families, providers are not pressured to refer me to specialists and hospitals in an effort to sustain hospital infrastructure and hospital executive compensation packages. Also, unlike hospital owned practices, these health centers are required to report their quality of care outcomes annually, which is then published by the Health Resources Services Administration - so you can know if you can expect good care.
14
@TJB
Wow, thanks. It's rare to actually learn something helpful amongst all the ranting.
1
IMHO, a Facility Fee is a way to steal from the patient. The cost of the physician's time, the lab fee and all other services already have a built in fee for "Overhead." To tack another fee is outrageous. I'm on Medicare. The fees approved by Medicare are sufficient for the the hospital to make a profit even though most hospitals are "Non-profit."
27
@Jeff: The hospitals may be "non-profit" but their executives sure aren't!
Those C-suite execs are raking it in hand over fist. And then they claim there's no money to hire enough nurses...
3
Ole Olsen,
I would not feel comfortable using any hospital service, rent free for a year.
We have over 330 million people to provide with healthcare and many of our wealthy have not invested in this country; they hide their money in Bermuda, Camen Islands or even Ireland or maybe Scandinavia.
Some countries win, others lose.
Go figure.
4
While the idea of a facility fee makes sense, I wish very much that hospitals were much better designed for economics. Why does the entrance way to a new hospital have to be soaring several stories in height? Why must the walls contain so much glass? Etc., etc., etc. Why can't the buildings be much more functional and economical? Enough with the fancy, artistic architecture!
18
Some overdone hospital lobbies are provided by charities associated with the hospital. Many hospitals seem to have active social/charitable arms. Still seems like a waste of money.
3
@KittyKitty7555 The reception area of the oncology center at my local hospital has a sign up thanking a pharmaceutical company for redecoration.
3
Our medical costs are due to the crazy, uncontrolled pricing. It is abusines that can create its own costs a with no controls. They often have a captive audience who have no choices, no way to understand ahead of time the costs. The costs can be added on as they go, and any cost is acceptable. A $3 bandage, a $4 aspirin etc.
A single payer system could bring this under control and make us all free of these rip offs.
23
When systems everyone depends on function like monopolies, bad things happen. Even police do not have a monopoly- there are local, county, state and federal law enforcement with jurisdiction over the same real estate. The problem with a purely public system is providers soaking the collectively wealthy taxpayers instead of often-poor individual patients.
The former seems better in the short term, but remember that public systems are very hard to change. Vulnerabilities can persist for a long time and be exploited for astronomical sums. Individuals and insurance companies are more flexible and can eventually benefit from technology, close loopholes and game the system back.
It is a pain for all involved, but it might beat the alternative, and the savings might be enormous in the long run.
1
@Alan,
What evidence do you have that healthcare financing in the US is better than the alternative? Is is our comparatively short lifespan? You like medical bankruptcy? Oh I know, you like that our terrible system costs twice as much as any other developed country.
7
This is market failure. In what other realm of economics are prices not revealed in advance, giving the consumer the opportunity to decide whether or not to incur the cost?
29
@Mimi It is far worse than that. I live in a semi-rural area with only one hospital managed but not owned by the Catholic Church for profit. Not only are the fees very steep but no doctor who does vasectomies or tubal ligations is allowed hospital privileges.
14
In my area the hospitals charge a hospital fee in addition to doctors ‘ fee; I have great insurance with the same dollar value co-pay regardless of the procedure.
Let’s face it, hospitals have to exist and pay staff, porters, cleaning staff and healthcare support staff; someone has to pay or the hospitals will close.
Yes, in big cities with hospitals associated with medical schools and colleges that have endowments maybe thee doth protest too much but I only use hospital supported clinics by choice and as responsible adults, do realize that cost must be paid to support the staff provided by the hospitals.
I was an RN in NYC for over 40 years and hospital staff are very cost conscious except that the waste and abuse is at the very top with high executive pay above what should be required to run the place: ABUSE by the higher echelons.
Many rural hospitals have closed due to cost, there is a lot of discomfort in rural area because medical care is scarce.
7
@JRS This apply to small rural and smaller hospitals but last years the big ones made billions in profits as did most insurers and of course the drug guys. Profits in most of medicine are way way high. A knee operation in USA may be $50,000 or more, in France $5,000. Drugs (same ones) in Europe 6X the cost in USA.
18
I support using the least expensive way to provide healthcare; that’s why I chose to go to hospital clinics, wait with the common folks.
2
@JRS But the hospitals charge you $20 for a generic aspirin!
“One option might be to stay with your doctor for long-term, serious health issues, but to use lower-cost venues, such as walk-in clinics, for minor problems.”
And now we see how the consolidation of hospitals and medical practices disrupts the patient-provider relationship...in addition to leading to higher costs.
This is quite the scheme and maybe is a big part of the reason health costs rise faster than inflation?
7
I recently installed a collision avoidance device on a doctor’s airplane. The doctor pulled up in a Audi sports car, and told me he recently paid $400,000 for his fixed gear, single engine airplane. He cried poverty numerous times during the 10 minutes I spent with him.
54
@Paulie $400K: that's inexpensive for an aircraft, I think.
2
@Paulie At least a couple decades ago (maybe three), the Times printed an article titled, as I recall, "Earning $650,000 and poor". Of course the economics are skewed. The point was that just because you're earning a bunch of money doesnt mean you're not spending it on private school for the kids, a house in the Hamptons, vacations in Gstaad and other exotic destinations.
So while the doc you did the work for cried poverty, he's more likely overspent than actually poor.
1
@Paulie Just wait until you get called by an insurance company or "non-profit" hospital administrator- expect him to roll up in a Rolls Royce and Gulfstream private jet.
In the end that is where most of the healthcare dollars we are all paying end up in this perverse system.
4
Elizabeth Warren preaches Medicare for all is the answer for escalating Medical costs. She's going to do that by getting rid of Insurance Companies and greedy drug Companies, but nowhere have I heard her call for reigning in the practices of Providers that are discussed in this article. Either she doesn't know or care about the source of Medical Care inflation. Soak the "rich" is her only solution for all the massive freebies she espousals. Right now, however, it is only the "greedy" Insurance Companies that reigns in the cost of Health Care. Universal Health Care only works with controls, like where, what and from whom one gets their care. No it won't be free and her proposals will lead to Medical Care Hyperinflation until it consumes most of the budget and everyone will pay. What might work is creation of a National Health service, where MDs are salaried and care is provided in NHS facilities. Role model, the VA system. That is where one must get their care. Of course, a private system will arise, made up of many large provider groups, who will opt-out of the NHS system and require Private Insurance (or Cash) to access. Role model, every country that has, so-called, Socialized Medicine.
3
@bahcom "nowhere have I heard her call for reigning in the practices of Providers that are discussed in this article"
Obviously you didn't read Kugman's review of Warren's plan where he indicates that her plan would " provide significant savings in overall medical costs ... Some of these would come from bargaining down prices, especially on drugs. Others would come from a reduction in administrative costs."
8
@Jim G oI read the article you cite. It is based on wishful thinking as are Warren's proposal.
Hospitals, even "non profit" are often the most profitable businesses around. For profit hospitals are more profitable than "non profit" due to "revenue management", not due to efficiency or costs. However, health care should be not for profit at all. Profit is a perverse incentive in illness and infirmity and "health" care. This facility fee is just another way Americans are being fleeced by the "health" care industry.
17
Live in Scandinavia. My own share for any medical treatment is abt $ 25, even if I end up in hospital for a year. Its covered over everybody’s tax bill, were those who earn the most, pay the most. Even Scandinavian billionaires would not dream of changing that, its just common sense.
167
@Ole Olsen Good point. We talk of cost to we consumers but never talk of controlling them,. Medical care is not like buying a TV no shopping at round when you have a heart attack or accident, you are at the mercy of the provider and many many thousands of dollars may be added to your bill while you are unconcous.
16
@Ole Olsen "...where those who earn the most, pay the most." Disingenuous to choose not to add: "And where those who earn the least still pay >60%."
2
@sf Not in Norway. They are presently living on their North Sea oil money. But even in Sweden without that oil advantage middle class tax rates on income, including social benefit taxes, sre roughly the same as those in NYC.
11
My last two insurance companies didn't pay for facility fees. Those fees were 100% payable by the patient. Worse, the doctors were directed to do some of their care in the hospital building just so they could collect this extra money - there was no benefit to the patients. Even worse, there is no law about how much they can charge in facility fees. Naturally, people don't go to the doctor prepared to pay hundreds of dollars extra. They were prepared - they wanted your credit card at the desk.
53
A direct result of the methods by which medical care is paid for.
This is dictated by CMS (government regulations for medicare and medicaid) and taken up by private insurers.
It has led to many changes in healthcare, primarily driving medical practice out of the hands of doctors who used to own their own businesses individually or in small groups and into the hands of larger hospitals and "healthcare systems."
As medicine becomes corporatized every nickel is squeezed out of the payors, and now with increased deductibles that payor is usually you.
You can thank the government and the big companies (which own the government). We doctors don't like it either.
12
@Victor Facility fees are NOT dictated by CMS. Yes, they allow them, and reimburse on a separate fee schedule (patient/patient's insurance carrier is liable for the rest) In fact CMS has lobbied against such fees, albeit unsuccessfully. Yes, it is a scam of sorts.
So, Doc, will you support Medicare For All as one way to eliminate this scam?
24
@LesISmore The fee itself is not dictated by CMS, but the way doctor visits, procedures, etc are paid for is. And that is a three part charge - one for physician service, one for facility charge, and one for malpractice insurance. It should surprise no one when smart business people look at this and figure out how to game the system.
As to your second question, yes by all means I would be very happy to have M4A. But unless we can figure out how to get the government to serve the interests of the public rather than that of big money - which it does now, you and I might not like the system which evolves.
1
@Victor
As a doc myself I am all for medicare for all or even better- make healthcare a public service like police, fire etc. Firemen dont have to pay for fire training schools, govt does. Same way please train all the doctors and then make then public service employee, pay salary and pension and thats it.
1
The "facility fee" is a ludicrous example of unbundling - can you imagine any other area of professional services where the hourly rate or fee for the service does not include the rent on the service provider's office, the cost of their laptop, library, etc.
I hate to agree with Donald Trump, and I have doubts about how effective it will be, but pushing for transparency in medical pricing as he did in his recent executive order, directing the US department of Health and Human services to write regulations mandate health services to present prices and fees in an easy-to-read, patient-friendly format and require out-of-pocket costs to be clearly disclosed upfront is really necessary.
The reality is that one reason we buy health insurance is to have our expert, at the insurance company, negotiate the price of the healthcare we receive, cut through the deliberate non-transparency of hospital and medical pricing to get to a fair-ish price. Hospitals are in turn engaged in a game, where they massively inflate pricing in their chargemaster, so as to have a high starting point for negotiations, but also to massively increase the write-offs they can claim for unpaid bills (which deducations helps them declare no-profits as non-profits.)
All of this gamesmanship is out of hand - most people, even lawyers and accountants cannot readily make sense of hospital bills - and routinely when challenged there turns out to be improper and duplicate charging. This needs a fix.
31
@MacK
Other businesses have started to charge for normal overhead. I recently interviewed a very expensive carpenter, who explained that in addition to the cost of the job I would have to pay 15% for his billing fees. I was stunned!
2
The facility fee smacked my husband and me after routine eye exams (what, we now have to pay for sitting in a chair?). And it wasn’t the only unexpected and undisclosed fee. The exams ended up costing double what we’d always paid before. I called other providers in the area for comparison, and at that time (2 years ago) none had ever heard of a facility fee. Moral of the story: Ask!
42
@Ebosley this is why I go to Walmart for routine eye exams.
As a private practice psychiatrist, I cannot charge a facility fee. Hospitals have bought out most medical practices so that they can add a facility fee and this has driven up the cost of medical care dramatically. Twenty years ago when I got out of residency training, the local hospital hired me and told me that they needed a psychiatrist, but that as soon as I built up my practice they wanted me to go out on my own because they were not in the business of hiring doctors. About 5 years later, everything changed and hospitals started hiring doctors and buying practices to make more money by changing the facility fee. To add insult to injury, they now tell their practitioners not to refer patients to outside specialists. Although this is a Stark Law violation, try and prove it.
76
@dpjonesdo
There is also quotas for how many specific procedures an employee physician is required or pressured to refer each month. Example: MRI's. You might not really need that $$ procedure - but you'll get it.
27
I see the same situation here in my community. We independent physicians are becoming as scarce as hen’s teeth. I will not give up my autonomy as enticing as the extra $$$ may be.
1
You are wrong. It is not the "facility fee" that explains the extra cost. The facility fee IS the extra cost. The explanation is the out of control greed of those in the medical and health insurance industries.
71
Do these Hospitals deduct the money or public funds raised by contributions and tax, for their building programs ?
6
I’ve been fuming about this for years, ever since Mount Sinai in New York first starting charging an outrageous $250 facility fee for a visit to my internist, which is in addition to the physician’s fee and any charges for blood tests, etc...After two January visits to her office for an illness-when my deductible had just rolled over-i was outraged to see that these two visits (during which no equipment other than a blood pressure cuff was used) cost over $700! Mount Sinai has since extended this practice to other practice areas. They also reap higher fees for many in office tests and procedures because they charge you as if you received care in the hospital, which is a fiction. The billing practices for physicians whose practices are owned by hospitals is truly an example of how messed up our medical system is. Giant hospital systems-which claim to be “patient centered” blah blah blah—are really just taking the opportunity to increase their revenues without any commensurate change in the care they are providing. I believe the AMA issued a position paper against the practice of “ hospital-based practice “ billing for this very reason.
125
@Lora S
Americans need to vote. We need to demand a revised healthcare system so we're not in fear of an actual illness, in conjunction with outrageous bills.
2
@A Yes, Americans need to vote. But voting won't do anything to change a medical-industrial complex geared to provide wealth care for executives and investors rather than health care for patients. Those executives and investors wisely invest some of the money they fleece from us with their exorbitant fees in lobbyists and campaign donations. Those are the only votes that count.
So whenever We The People might clamor to change a system that consistently fails and bankrupts us, those lobbyists and campaign donations insert wads of money into the ears of our elected officials. That ensures they hear only the voices of the people who like their wealth care system just the way it is.
There is only one way can join join the rest of the civilized world that enjoys health care as a right rather than a privilege, and that keeps the health care industry on a tight leash. That way is to get rid of a corrupt campaign finance system that amounts to legalized bribery and redefines democracy as "one dollar, one vote." That would also fix many other intractable problems and inequities. Unfortunately, it seems the intervention of the Messiah is necessary for that to happen.
1
Physicians who practice in “supportive environment” are paid less by insurers than physicians who are responsible for their overhead costs.
7
I had a routine leuprolide shot at Memorial Sloan Kettering that my oncologist ordered. Because my doctor’s office is located in the hospital the shot cost $2,900. It was a generic drug, given by a nurse, and I didn’t even sit down for it so was in the office for about 2 minutes (after waiting for 1.5 hours for my scheduled appointment). I was expecting the bill to be ~$25 because I knew the drug was generic. What’s more shocking is that my doctor wanted me to get this shot every month for the next ten years! That is $350,000. You cannot trust that even the most routine, basic, or generic medical treatments will be reasonably priced and what’s worse is that they do not tell you the costs upfront. Doctors don’t know or won’t disclose and when I’ve called ahead the price quoted is always wrong. It ends up being double or triple sometimes. It’s hard to understand why the medical community gets away with this type of robbery.
300
@KFC
It's not hard to understand at all. Financial operators have taken over the entire health care industry (despite the many good people working in it), and are simply squeezing rents out of every imaginable rule and provision of the Medicare regulations.
116
@KFC This is one of the more frustrating aspects! When you, as the patient, do your due diligence beforehand to ensure everything is appropriate and adequately covered and then something 'changes' and you end up with a gigantic bill. The whole system is an absolute disaster.
32
@KFC New York State has a “No surprise medical fee” law. File a complaint with New York State. The fees should magically disappear.
12
Only Medicare and Medicaid regulations support the billing of facility fees. Private or commercial payers are not required and should not be encouraged to pay them.
8
And that cost is paid by the patient.
1
My insurance plan, administered by United Healthcare, will not pay any facility fees. The medical group that I use is owned by Adventist Health, a large hospital corporation. Their family practice does not charge a facility fee but their pain management group does. They charged me an extra $50 for the previlege of waiting almost 1.5 hours in a stuffy examining room to see the dr. for a ten-minute exam. I wonder if Medicare for All could be worse than this? No wonder that doctors and large hospital groups are terrified of getting just a flat negotiated fee instead of their current bloated rates.
115
I'm a family doctor. We are employees. We do not set or know the price for anything. We have the highest suicide rates of any white collar profession. We are all being squeezed here and I blame ADMINISTRATORS
43
I work in an independent health care private practice NOT owned by a hospital system ...yet. The reason practices are sold to a hospital (which then charges these "facility fees") is the cost of maintaining everything - staff, building maintenance, paperwork filing, is so expensive and takes so much time away from what we went into medicine to do - take care of patients. When a hospital system buys a practice, they will often take over the billing and filing part, which requires intimate knowledge of the coding requirements and fine details of documentation that result in insurance companies actually paying for your time and care, rather than one denial after another, requiring 3 times the time and energy than what you actually spent on the patient. When we can get rid of all the different requirements from multitudes of insurers - and have one form to file, one set of requirements for documentation and one formulary for medications with clear coverage information for me and my patients, we might be able to actually be independent and not become just another hospital employee drone.
91
@DJ! - Just one of the many strong arguments for Medicare for All.
29
@DJ!
I had a fantastic but elderly sole practitioner primary care doc for a while until he retired - we called him "Dr. Old," and his office was in his modest suburban split level home. It took three admin ladies to handle appointments and billing for this one small-scale doc. It was great for the patients, as he could take as much time in an exam as he felt necessary. Every doc I've had since has been in a hospital-sponsored group practice running patients through as quickly as possible. The good ones have gone to the concierge model where you pay $1500-2500 a year just to be their patient. The whole thing stinks. I'm for Medicare for All.
19
@DJ! My doctor’s group was recently purchased by a hospital. I know that a big part of the decision was the billing responsibility, since the group was employing legions of clerks to process paper for all the insurers. But I’ve also lived in France, where at the end of the consultation the doctor, not the receptionist or billing person, hands the patient the form and collects 23 euros, the entire cost of the consultation. If I were a citizen, I would have had a Vitale card, which would have streamlined the process even further. Why can we not have this in the US, and reduce this mindless and wasteful bureaucracy?
7
I have had this all too often, even with Medicare. So frustrating, and so wrong.
17
Hmm.
A large American hospitals provider brought these charges to London years ago.
Sure we have 'facilities fees' - which were usually far more than the physician's fee I charged - concurrent charges like for e.g. Band-Aid removal were common, too.
The hospital insisted that one of their nurses was present for all in-office surgeries, no matter how minor. That seemed to involve filling in paperwork (that I never got to see) on the basis of reproducing the history I had already taken regarding allergies, current medication and general health and then holding the patient's hand whilst I worked. This incurred a 'nursing charge' on top of the facilities fee which again, was MORE than my physician's fee.
NHS (state provided) hospitals in the UK also take private work into their labs. The difference in charges was - in my time - staggering: Private tissue biopsy report £(GBP) 895 (about $1120), NHS £135. Private CBC blood count and film £40, NHS £0.40 (sic) although the NHS lab would bump it up a couple of dollars to cover the office time and fax call. Actually, the NHS labs didn't need to grow this kind of work, anyhow.
I never understood why insurers would wear these fantastic rip-offs. On the occasions that I raised it with some of them, they didn't want to know. Insurer and provider had a stable arrangement and the boat wasn't to be rocked. After all, they were both doing fine - it was patients ultimately picking up the tab for this cosy carte activity.
21
Anytime cost can be passed to employers or patients the,selves, it is a sweet deal to insurer or government. They take their cut and it’s the poor patient (or employer who is paying high premiums) who pays. It’s time for Medicare for all.
5
While all of the candidates like to bash insurance companies (for underpaying) and drug companies (for overcharging), I think a closer look needs to be taken at both doctors and hospitals.
They, too, overcharge in many situations.
28
I've been seeing TV ads with a supposed doctor exhorting viewers not to allow "government rate setting" because otherwise you might not have doctors anymore! Wow, do doctors think this makes them look anything but money-grubbing shills?
11
@Anne Hajduk
You can define a price that you are willing to pay me for a procedure but you cant force me to see you for that price. If I charge a lot for something, please dont come to my office. No one can force a patient on a doctor and pay whatever they want. It is a free country and will fight this till the end.
1
@Anne Hajduk Most doctors are employed by large health systems who negotiate prices and do the billing. They are big businesses with a strong profit motive. Docs in general just want to help you and have no idea what you will be charged by the health system
2
Just another reason for (Improved) Medicare for All.
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@Charles pack ..Except that as a medicare recipient, I am also charged a facility fee..no getting around them seems.
10
@demilicious - I would bet that IMPROVED Medicare for ALL as proposed by Bernie and Warren would not allow this.
9
But Medicare covers it and private insurance doesn’t. That is one of the “wastes” that needs to be ferreted out.
2
Elizabeth Warren is continually accused of trying to raise taxes for a health service similar to those in most of the Western World. The taxes would be less than Americans pay for insurance. In Britain we pay National Health Insurance while in employment. A part of general taxation completes the payment for our National Health Service. Apart from a small fixed charge for prescriptions for those who are working it is free at point of use. The total cost is less than half the cost to Americans for a service which is less able to keep its citizens alive.. The average lifespan in the major countries of Europe is longer than Americans. I am 91.
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@irdac,
Such important points. Americans do not seem to realize that we pay at least twice as much for healthcare as other developed countries. That might be OK if we ended up twice as healthy and lived twice as long. But we are far less healthy and our lifespan is shorter. Twice as much for a demonstrably inferior product. What other industry could get away with it?
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@irdac - Here are the per capita figures for health care costs in 2016 in PPP dollars from the OECD:
US - $9507.2
UK - 4192.5
We paid 127% more.
33
@irdac Of all the candidates, I think I'm a Warren supporter, but our system is so entrenched and expensive that to make any real progress toward true affordable care, hospitals are simply going to have to less money.
Any plan will have to go through a gauntlet of being tarred as devaluing legions of democrat-voting nurses and doctors. And with hospitals as major employers in many congressional districts, it's difficult to imagine all of our lawmakers doing what's best for the country.
By the time Barack Obama's Affordable Care Act passed, there was nothing more affordable about care. I have worthless insurance: $7,000 deductible with half of the $500/mo premium paid for by the government.
10
Please consider the scope of the overhead that hospitals have that a doctor's office does not: psych holding, morgues, labs, pharmacies, discharge planning staff, cafeterias, community education events, the poor without insurance, Joint Commission accreditation, emergency rooms, training programs, research, and on and on and on.
Comparing hospital clinic based care to that of a doctor's office is comparing a pebble to a boulder.
7
@MMP Not to mention two flat-screen TVs in every patient room, faux marble flooring including in the elevators, elaborate landscaping, ginormous florist-provided arrangements in the hallways, Super Bowl ads, putting their names on concert venues and baseball stadiums, and the 8-figure salaries for their CEOs. All adds up, don't you know.
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@MMP - Then why are many procedures that could be done in a doctors office done in a hospital?
9
The hospital I work for even prints its name and logo on disposable paper coffee cups. What a waste.
8
This is a difficult social, economic and political problem with a long history, starting in the 1950's when medical billing formulas were first used. In the late 1980's, Medicare created our current system of relative value units for physicians, which was integrated into the underlying system that was treating doctors (part B) and hospitals (part A) differently.
For every medical service or test, the fee structure is calculated as direct work, (time and effort of the doctor or nurse practitioner) and an amount that is really "overhead", including office staffing, malpractice insurance, rent, heat, depreciation, cost of the equipment.
In a private doctor's office, the overhead is lower than if you go to a doctor working in a large hospital practice environment. Decades ago, most outpatient medical care was in smaller office practices and most complex tests were performed only in hospitals, so patients did not encounter major Parts A-B cost differentials. Part A (hospital) fees reflect care to indigent people and greater costs of large campuses. Now, is it common for the public to see this differential, since many medical practices compete with hospitals to provide the same service.
Medicare has worked to bring outpatient fees under Parts A and B closer, but there has been much pushback from hospitals against that on the basis that care for the broader community needs the subsidy. Also, corporations that run hospitals do not want to lose this source of profit.
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@Jeff - Actually I do not believe there is any reasonable calculation done to set medical prices. How do explain the huge seemingly random difference in prices for the same procedure? See
https://www.nytimes.com/interactive/2014/health/paying-till-it-hurts.html
4
I went to a GP practice that I loved until I moved out of state. Reasonable charges, generally available physicians. Then I moved to another state and had to find new doctors. What a shock
I visited a doctor who was part of a large hospital based practice for a simple bacterial infection. The doctor immediately recommended in-office surgery. It was too painful so it wasn't completed. A few weeks later I was admitted to the same hospital for a different issue; while there they also gave me an antibiotic to cure my bacterial infection. At discharge they said my fin'l responsibility was $875, I paid. I have Medicare A and private ins and I later found out I only owed the Medicare deductible. it took 6 months of calling to get a refund. Meanwhile their first doctor turned me over to a collection agency for an office visit charge because she didn't do the surgery.
Going to them also put me on their mailing list for every imaginable unneeded test They started mailing and emailing. I'd have to be bleeding from a gunshot wound with no other facilities available to return to them.
I eventually found another independent GP. At my initial visit he asked how long it had been since I had various tests and was genuinely concerned that I not get in a situation where my ins. company wouldn't pay because of overuse or frequency. His type of practice is vanishing as they retire.
49
It’s revenue management pure and simple. Airlines charge extra for bags and choice seating in coach and hospital clinics charge a facility fee. Avoiding these fees means we all have to plan where, when and who we go to for medical care. Thanks for giving the “heads-up”, I’ll be watching and asking at my provider! It’s a shame we need to be so vigilant. Do the patient no harm, physically but not monetarily?
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My daughter doctor at a big university hospital told me that they charge these outrageous prices because there are some Cadillac plans that pay these fees or Medicare pays them and therefore they charge everyone...so that they can pick up revenue where they can
16
This answer is not, unfortunately, properly answered.
It is true that a hospital could (and has) doctors that practice in the hospital or at nearby buildings which are part of the hospital campus, taking care of patients in an outpatient or inpatient basis, based on their health needs. It is for this purpose that the facility fee exists.
However, hospital networks are now using the facility fee as a profit-maker. Many hospitals have "expanded" into office space that, contrary to a true clinic, consist of nothing more than desks, receptionists, and exam rooms.
Outside of consultations it is often the case that *absolutely no* care can occur, i.e. no emergency care, no day surgery, no health procedures, not even X-Rays or lab work, and certainly not a single bed can be found in these "facilities" which are often miles away from a hospital, though their buildings might carry the name "hospital" alongside of a disclaimer of no emergency care in the premises.
Charging a *hospital* facility fee in this case is nothing more than abuse and profit-making. A hospital chain that engages in such practices should be shunned by patients, and investigated (as they are in MA) by the attorney general. (Such fee is often not charged to Medicare, btw, as it could be tantamount to fraud).
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@Yoandel You apparently have other hospitals from which to choose. Look at cities outside major metro areas - consolidation has resulted in one hospital and often none.
3
I’ve resolved that as of January 1, I’m not going to a doctor unless it’s an heart attack. Everything else, it’s the walk-in clinic at my grocery store. Ironically, I worked in government 30 years so I’d have good health care later. But it’s dissolved into thin air.
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@Angry Person You're right. I'm a govt retiree as well. I had to stop using the prescription part of my plan because it's cheaper to use generic coverage available to the public. Under our health care plan one prescription copay went from $20 to $70 In one month. They dropped the medication from Tier I to Tier II coverage. I was able to get the medication at my local grocery store for $20. They can do this to any drug any time. The medication is not one I can be without, I need it to live.
I'll be looking closely at open enrollment weighing plan cost vs. benefits. I made the mistake of looking at drug cost and coverage last year to make a decision; I won't again.
20
This is why people do not seek health care period.
Who can afford to pay for grand pianos in healthcare facility lobbies when you’re diabetic and need to buy insulin, have a heart condition and need an echocardiogram, or in orthopedic pain and need a CT scan or an MRI?
So unfair. (and I served as an RN for decades)
287
For a recurring sinus issue, I've had to get two nasal endoscopies: one in a hospital doctor's office for ~$3500, and one in a standalone office for $220.
The procedure is essentially a few minutes of waiting for lidocaine gauze to numb the nasal passages, and then looking around with a camera for another few minutes. In the hospital, it was completed by a resident, quickly checked by a more experienced doctor. Worth noting that the resident was probably making a meager salary, which is an accepted part of the training experience.
At the other office, it was conducted entirely by an experienced physician for a fraction of the cost. My current deductible is so high, that I see every dollar of my care, so I actually shopped around this time: it took under an hour to find this doctor and ultimately save thousands of dollars for the exact same simple procedure.
I'm no Republican, but I remain wary of political candidates who simplistically vilify pharma and insurance, but leave hospitals off the hook, when they may well be the biggest culprit in our healthcare cost crisis. They should not be continually allowed to hide behind a more noble narrative.
176
I am also frustrated by the omission of hospitals and other providers from the cost discussions.
74
@Mike
When I saw that my son (who has a very good employer based plan) was charged a facility fee and his insurance company rejected it, since I use the same facility I was curious as to whether or not Medicare and my private insurance supplemental does pay it.
Sure enough my private insurance does pay it. So I asked the hospital rep where our internists practice what it was all about. (It was new a couple of years ago - they never charged a facility fee before.)
She told me that when Medicare cut how much they would reimburse hospitals, to make up for that loss, they started charging facility fees. She was frank.
So our health care system is all a shell game.
112
But pharma do charge exuberant prices for drugs, how is it different from the hospital's practice? And private insurance-based system allows these practices to exist, because apparently insurances are not fighting these charges as Medicare does. For private insurances is easier to increase the premiums and deductibles that to fight for reasonable pricing. Power of negotiation is a big plus for single-payer system, otherwise you need to introduce price control.
16
My husband makes twice yearly visits to the Christus St. Vincent heart and vascular clinic. In the past, he has begun the visit with a pacemaker check and then had an appointment with his cardiologist. But recently, the clinic has refused to put the checks together. This is not only an inconvenience to the patient, but 2 visits instead of one means two "facility" fees. This seems dishonest to me.
337
@Kathleen Adams It sort of is. The costs of health care in the USA are very high by world standards. There is no perfect system, but yours is definitely an outlier, delivering comparatively poor outcomes for outrageous costs and with many poor folk marginalised.
14
@Kathleen Adams Turn them in to your State Attorney General.
8
@Kathleen Adams
My now former hand surgeon refused to answer two questions during an office visit. He stated that Medicare would not reimburse him for answering both questions during the same office visit.
5
I have been a physician since 2000 and I feel that hidden fees and surprise bills such as described in this article are one of the major causes of distrust and loss of respect for physicians and the healthcare industry in general. I don’t blame people for going to Dr. “GOOGLE” or other dubious alternatives found on the net. I also think this leads to a cynical view that all medical providers are there only for the salary and lifestyle. Most who actually provides direct medical care would not contemplate billing practices described in the article if the transaction was solely between Doctor/NP/DNP/PA and patient. Unfortunately like our current political climate the complexity and unbalanced incentives of our healthcare system divides our profession and there is a lack of coordination and enthusiasm to fight for change within our professions. All direct care healthcare providers should demand a seat at the table and a role in eliminating predatory billing to the most vulnerable in our society.
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@JCOMD
Exactly! These fees are not caused by the many good people who actually provide health care.
They are caused by the financial tech operators, and the hedge-fund/private-equity/extractive financial industry behind them, that have turned the health care finance system in a rent-extraction mechanism for private wealth at public expense.
53
@JCOMD Soon no Senior Citizens will be able to afford their doctor visits, medicines or food since Senator Joni Ernest is talking cuts to Social Security because of huge budget deficit at town halls in Iowa.
18
@JCOMD. Glad to hear this. Perhaps all the physicians who operate out of hospitals that charge facility fees could collectively demand their removal, and strike if they are not. Patients would see that their physician is on their side, and hospital administrators would find out who really is important in healthcare. (Hint: it’s not the guy in the corner office.)
9
You can tell this is written by a doctor. He’s got all the empathy of a pet rock. Just reading this emotionless article is enough to tell you why our healthcare system is a disaster. Facility fees are nothing more than yet another money grab by hospitals. Just another version of the $100 aspirin.
330
@Mike L This is unfair. Whatever the author's empathy level, the Times printed this piece: I learned to be aware of such an absurd fee and the author had the integrity to discuss the practice. I despise the whole healthcare gambit in America. But please give the human being some human credit, please.
4
That’s a cheap shot at the author physician.. You want unnecessary empathy get a dog, or inappropriate outrage, watch Bernie Sanders. At least this article is factually accurate for the most part which is all you should expect from an article. Prior NYT articles on this subject have inaccurately reported that the doctor pockets the extra fees. At least the author here got that right. The doctors are employees and are on salary in these hospital owned practices. The article is inaccurate in stating that the practices are bought above market value because of this future increased fee. There is no way the bean counters increase their offers based on that. The buying of a private practice is based on the financials of a practice and believe me these corporations don’t cut anybody a gift. It’s a buyers market as physicians are fed up with the difficulties of managing a practice with the obstacles of hospitals, pharmacies, urgent care centers and electronic records. These facility fee arrangements were created by the hospital lobby and the Obama architects to annihilate private practices.
From one of the few physicians still in private practice.
5
@Mike L I actually appreciate getting plain information to add to my knowledge ... not everything has to be an opinion piece.
2
Does Medicare cover a facility fee?
6
No, Medicare does NOT cover facilities fees. I know that because I used to go to a practice that charged facilities fees and neither Medicare nor my other insurance covered that extra expense. (Needless to say, I've moved to another physician unrelated to a hospital, who does not charge a facilities fee.)
3
Soon they will be adding an air fee, because all patients breath air while at the hospital. Maybe they will give a slight discount to those patients bringing their own oxygen tanks.
172
What happens when your health is for-profit.
219
These fees are usually only at hospitals, most of which are “non-profit”.
4
@Steven Caplan “non-profit” is a financial accounting category that does not mean the hospital does not make a profit as normal people use the word. They can make as much money as they can manage and spend it on almost anything, including salaries (certainly including executives and administrators), buildings (which can be extremely fancy), equipment, buying more medical practices, etc. What they can’t do is pay dividends to shareholders.
16
It has become a common practice for hospitals to buy private medical practices, specifically to charge the extra facility fee, in ADDITION to the usual practice charges. The services provided are identical to what were provided before. The new facility fee income is then shared by the hospital and the prior private practice (via an inflated sale price). This is a classic example of the healthcare industry ripping off consumers by legally adding huge additional charges for the same services. Should be illegal, but it’s not.
513
@Michael Saxe, M.D. I don't think people appreciate the pace that this is happening. Hospitals who who present as noble non-profits with "small operating margins" still manage to somehow continually gobble up private practices and smaller hospitals. In areas like northern Vermont, where there's no longer a lot of options outside of the University of Vermont network, that can have uniform consequences for both patients and providers.
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@Mike the non-profit status allows these big hospital groups greater cash-flow via tax subsidies. This gives them a major advantage over businesses that actually contribute to the federal, state, and local tax roles.
We see the same thing with universities who charge top dollar, build up massive endowments, and use that to buy up local real estate pushing out others along the way.
Of course their administrators are rewarded with million dollar salaries and benefits. There should be a law that reins in this kind of predatory behavior if an organization doesn't have to pay the taxes the rest of us labor under.
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@Michael Saxe, M.D.
When Medicare started to enforce its cuts to hospitals in an attempt to lower costs, they came up with these facility fees to make up for the loss.
My son has a terrific plan from his employer but they don't pay these facility fees while my Medicare supplemental does pay them.
This is just more of the shell game of the health care industry we have. And as much as I am glad I have Medicare I pay a lot for the private insurance supplemental.
When people say they want Medicare for All, they really have no clue what they're talking about. Our Medicare system is not even remotely similar to any European or Canadian system lauded by so many.
Our politicians and presidential candidates are not telling you the truth about their so-called Medicare for All plans - which are still shell games. A true single payer system is based on taxing individuals, putting those revenues into a bucket identified as health care, and then paying medical providers out of that bucket. The fundamental purpose of single payer is to remove the cost burden on employers so that businesses can pay employees higher salaries as well as free individuals from having their health care linked to job security.
44
I was charged a facility fee of over $400 at an NYU office where my doctor works. My insurance company (Aetna) rejected this fee, making me fully responsible to pay it. I determined it was tied to being weighed and having blood pressure taken (both of which anyone can do at home or at the drug store). For subsequent visits I declined these procedures when checking in and was not charged the facility fee again. Perhaps other readers will be able to do this, worth a try.
350
@Alan Raderman- wow, thanks 4 sharing...-this is probably amazing practical advice, but it's also a completely absurd situation...
82
@Karen True that.
12
@Alan Raderman
Yes. A nurse at my doctor's office told me that they need to do at least two checks to receive full reimbursement.
This is with Medicare and, thanks to my Medicare supplement, I personally am not charged for the facility fee, but the charges show up on my statements.
On a related topic, I had orthopedic surgery this year and was provided a brace by the surgeon's office. I was billed $10 in supplemental fees; their total charge was $80 for a brace I could buy online for under $30. I complained, telling them their charges were outrageous and excessive. Explanation was that everyone in the food chain (surgeon's office, hospital, billing company, etc.) added on a fee. The complaints worked, though, and a few months later they they sent me a refund check.
As part of the follow-up, I went to a bone fracture clinic in the surgeon's office. First visit was fine. Second visit (even before they had lab results), they started pushing two very expensive medications that would cost me at least $1500 a month out of pocket with no mention of other reasonable alternatives. I never went back. The surgeon was excellent, but the practice had recently been incorporated into a large for-profit hospital system that had recently acquired the formerly "non-profit" hospital. There aren't many hospitals in rural western NC, so there aren't a lot of choices.
60
Since so many medical practices are hiring doctors , thèy are assured of a certain income and saving the cost of maintaining their private offices . The corporations can ha e many physicians in a facility and each patient who must wait to be seen until an office is ready we have no option but to be taxed (and that is what it is) to see the doctor we need. Doctor/patient relationships were always encouraged so your doctor knew your medical needs. Now it's obvious that is no more. Is this good medical care? Big corporations are forcing private physicians to join their clubs. Not every medical visit is an emergency, sometimes a follow up is necessary. So many medical conditions will get worse .....when we have to decide whether we should return for a follow up, or if we can afford to. Seeing a doctor is not like a choice.
32