New Georgetown Report and Issue Brief on Outpatient Facility Fee Billing and State Policy Responses

By: Christine Monahan, Karen Davenport, Rachel Swindle, and Hanan Rakine

Consumers are more and more being uncovered to a brand new expense after they search outpatient medical care: hospital facility charges. These charges can add lots of or hundreds of {dollars} to expenses for a single service. In a new report and difficulty transient supported by West Health, CHIR researchers discover outpatient facility charge billing within the industrial sector, together with the affect of those charges on customers and the way states are responding.

Researchers analyzed present legal guidelines in 11 research states and performed greater than 40 qualitative interviews with stakeholders, policymakers, and different on-the-ground specialists. The report finds that as hospitals and well being techniques more and more purchase ambulatory care settings, they continuously invoice facility charges for routine companies traditionally offered at a lot decrease prices in unbiased doctor workplaces and different outpatient settings. Consumers are bearing the brunt of those price differentials by way of greater out-of-pocket spending and premium will increase. This could be notably jarring for customers who, having skilled no change in care from one go to to the subsequent, all of the sudden face a brand new facility charge cost as a result of a hospital acquired their supplier or clinic.

CHIR’s analysis additionally describes how the research states are tackling these issues and identifies challenges and alternatives for policymakers. Although even probably the most modest reforms face fierce hospital trade opposition, state reform efforts have loved bipartisan assist from lawmakers in addition to a rising refrain of shopper and affected person advocates and enterprise coalitions. Some states explicitly prohibit facility charge billing for particular settings or companies. Other states guarantee some monetary safety by limiting price sharing or prohibiting stability billing for sure facility charges. And states are additionally selling better monetary transparency by way of hospital reporting necessities. Due to difficulties figuring out the place care was offered from claims information—a barrier for each policymakers pushing for reforms and researchers finding out the problem—states have begun rising transparency relating to the location of service as nicely.

You can learn the total report and difficulty transient right here.