Congress must put people first, bring transparency to health care

Opening a medical bill to see the final cost of your care can be agonizing. As a mom with two young children, in the middle of peak flu, RSV, and stomach bug season, I am always anxious about the cost of caring for my family. It’s terrifying not to know what expenses are coming your way for seemingly routine health care services, and the high cost of health care is compounded with a lack of transparency into how much the services we need cost.

I imagine most people feel this way. But I also happen to be a health care advocate, so I know the statistics behind the feelings. Health care costs are continuing to rise, and the main drivers for these increases are pricing distortions and unfair medical billing that large corporate hospitals and health systems level on patients and families. Our hospitals and health systems are a lifeline that our communities rely on, but as we hear in our listening work, people are scared to get the care they need because they aren’t sure what unexpected fees or hidden charges they might be stuck with.

Among these costs are “facility fees,” or additional expenses that can far exceed the actual cost of care and often aren’t covered by insurance. Patients pay these fees in addition to what they pay for their health care service simply because the provider they went to is owned by a corporate hospital or health system. To add to the burden, these fees typically come as a surprise. Let’s say you go to your doctor for a routine ultrasound, but the clinic your doctor works at was recently purchased by a larger hospital system. You pay your usual co-pay and go home. Shortly thereafter, you receive an additional, unexpected bill in the mail containing a fee that is 70 percent higher than the cost of the ultrasound with an accompanying title — “facility fee.” All of that increased cost just because you sought care at a hospital-owned clinic.

To add to the confusion, facility fees can even be charged for virtual visits, leaving many of us wondering what “facility” these fees are paying for. For example, a Colorado mother’s child met with a speech therapist for an hourlong appointment over video chat. She was ultimately billed $676 for the visit, plus another $874 for a facility fee charge. Neither she nor her son had ever stepped foot in a facility. 

Voters and a growing coalition of advocates and stakeholders are overwhelmingly in favor of bringing transparency in medical billing and requiring the same price for the same service, regardless of where a patient seeks care. A United States of Care poll reveals that 74 percent of voters support banning facility fees everywhere for outpatient, same-day services regardless of the service or where care is being provided, and 81 percent of voters want more transparency through medical providers disclosing their facility fees upfront to patients before they are seen.

Taken together, this sweeping bipartisan support for requiring greater transparency and addressing facility fees should give policymakers in Congress and across the country confidence in advancing these policies. It’s a commonsense solution; one that strikes at the core of what people fear when they step into the doctor’s office — being uncertain about if they can afford the bill.

To be clear, limiting or restricting facility fees will not mean your care will get worse or take money out of your doctor’s pocket. The professional fees we pay when seeking care already cover the services we receive and pay the providers we count on. Facility fees represent just one part of the larger problem posed by our broken fee-for-service system that prioritizes paying providers for the quantity of visits a patient has rather than the quality of care. By putting people into an assembly line health care experience, fee-for-service leaves people with more fees from more visits. As we work to move away from paying for each service and toward a patient-first care approach that focuses on health outcomes, these reforms are targeted, commonsense solutions to give people much-needed relief and peace of mind.

Efforts to address facility fees and the lack of transparency around them have been gaining traction in recent months. In December, the House of Representatives passed the bipartisan Lower Costs, More Transparency Act, which would require hospitals, insurance companies, and other health care facilities to publicly list the prices they charge patients, including facility fees. The bill includes a reform that would require the same price for drug administration under Medicare at an outpatient setting, a policy known as “site neutral payment,” which could save thousands of dollars for patients who need drug infusion treatments (e.g., cancer patients). Meanwhile, states continue to take up legislation targeting facility fees, with at least 13 having successfully passed legislation establishing limits or restrictions. Passing these reforms will make a meaningful difference for everyday people struggling to afford their care.

By passing reforms in the Lower Costs, More Transparency Act, Congress has the opportunity to bring about fairness and transparency in billing and prices  — and move us one step closer to a health care system we can all understand and rely on.

Lisa Hunter is senior director for Policy & External Affairs at United States of Care, a nonpartisan organization that seeks to ensure everyone has access to quality, affordable health care.