For more than a decade, industry watchdog groups have questioned why hospital outpatient departments receive higher reimbursement – and, patients have higher copays – than independent physician offices. Patients at independent physician clinics receive a single bill that bundles a professional services fee for the doctor as well as overhead costs. But, those who receive care at a hospital owned clinic are generally billed for the doctor’s fee and a facility fee, which are flat rates that cover hospital’s added expenses related to providing around the clock care, specialized equipment, additional regulatory requirements and licensing costs. Facility fees are unregulated, so hospitals can charge whatever they want, and they vary widely as a result. Congress is actively reviewing legislation to expand “site-neutral” payment policies that would seek to better balance reimbursements to private practice and out-patient settings – and, potentially reign in the hospitals’ application of facility fees.
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