CLEVELAND — You get a bill from your doctor, but then notice an added cost called a “facility fee.” Patients have seen an increase in them in recent years, and they can cost even more than the medical care itself.
There’s a growing concern among patients and politicians about these. Experts told us a lot of this boils down to hospital consolidation, where medical facilities have been purchasing doctors' offices and bringing them into the “hospital system,” but some states are fighting the fees.
“I just feel flabbergasted, really,” said Beth Davis from Mentor while looking at her recent medical bills from University Hospitals. “There just needs to be transparency about this, and that is not existing right now.”
GOT SHOTS, GOT BIG FACILITY FEES
She told us during one November visit that she got a cortisone shot in her wrist at a University Hospitals location in Beachwood. In December, it was three shots in one visit at the same office.
“I walked in, sat with him. He gave me the shots. I walked out. Ten minutes tops,” Davis said.
When the December bill arrived, she said she received a facility fee from UH for more than $ 2,400. She said she called UH and it initially wouldn’t budge on the cost.
She then contacted agencies like the Ohio Attorney General’s Office, the Ohio Department of Insurance, the Consumer Financial Protection Bureau and more for help, but no luck.
In fact, she said UH then looked at her November appointment again.
“After I started to be a squeaky wheel, they went back, pulled that up and said, ‘Whoops! We forgot to charge you for this one. Here’s another $314 facility fee for this visit,’” Davis said.
Same office, but $314 this time, and no clear-cut reasons for the different dollar amounts.
“It just seems that the amounts are indiscriminate, unrelated to the cost of the service,” Davis told us.
EXPERT: 'VERY CONFUSING, VERY FAST'
“It gets very confusing very fast,” said Cheryl Damberg from the Rand Corporation, which has been looking at the impacts of facility fees nationally for years.
She said that, in general, U.S. hospitals have been acquiring independent doctors' offices recently.
“When they do that, our research has found that they shift the site of care where people receive their services,” said Damberg. And she told us that it often means more buildings where facility fees can be charged.
STATES ARE ADDRESSING FEE CONCERNS
“There’s no federal guidelines. There are no state guidelines about what these should be,” said Maureen Hensley-Quinn from the National Academy for State Health Policy, which works with state legislators nationwide.
“In some cases, states are aiming to just make sure consumers are aware that these facility fees may be billed and it goes all the way to prohibiting facility fees,” Hensley-Quinn said.
Eighteen states have so far started addressing facility fee concerns, according to United States of Care. In 2024, Ohio passed a law prohibiting facility fees for telehealth services when consulting with a doctor via a screen and never stepping foot in a facility.
Hensley-Quinn said some state and federal politicians are looking at enacting site-neutral payments— one price, no matter where you get your care.
“It’s… this is the payment for this service regardless of a site. I know there’s a lot of interest in states to pursue that,” she told us.
HOSPITALS, ASSOCIATIONS DID NOT DO INTERVIEWS
For the other side of this story, we reached out to UH, the Cleveland Clinic, MetroHealth and major hospital associations. Not one would go on camera and answer questions. Not one.
According to the American Hospital Association’s website, facility fees are necessary for a wide range of costs.
Metro sent a statement saying “…In an outpatient setting, fees are charged for specific procedures like Xrays, MRIs and laboratory tests.”
Cleveland Clinic’s statement said, in part, it’s following “…strict quality standards… (and there’s) significant added costs…of complying with these standards…”
UH referenced “accreditation standards” in its statement and said facility fees help “…allow us to provide the highest quality of care for our patients….”
However, for Davis, the UH facility fees have had a chilling effect.
“I don’t know if I should have my mammogram,” she told us. “I don’t know if I should go to the doctor and see him because his office is in a facility that does surgery.”
Davis said UH eventually agreed to let her pay $500 in fees for the two cortisone-shot visits instead of $2000+, which illustrates the current rollercoaster ride of facility fees.
“I think it comes down to hospital finances,” said Davis. “I think they need to figure out how to manage their finances without charging unreasonable fees.”
News 5 Investigators have done extensive reporting on the new hospital price transparency law that passed in Ohio. One of the co-sponsors told us he wanted to put facility fees in that law, but other lawmakers pushed back. However, he said there’s still interest in Ohio to address facility fee concerns.
Statement from UH:
“Like many healthcare systems throughout the country and in our region, University Hospitals does charge a facility fee at outpatient hospital locations.
Certain services are provided in outpatient hospital settings in order to allow us to provide the highest quality care for our patients in the most appropriate setting. It also enables us to enhance and standardize clinical operations, adhere to more rigorous accreditation standards, improve training and provide the equipment that keeps pace with rapidly changing technology.
In some cases, this designation results in higher bills and out-of-pocket expenses for some of our patients. We are always conscious of the rising cost of healthcare in the United States, and constantly focus on improving quality, lowering the cost of care we provide and ensuring the highest value of care to our patients.”
Statement from Cleveland Clinic:
“Provider-based billing means that hospitals have met specific Medicare regulations to have their outpatient doctors’ offices and clinics classified as hospital outpatient departments, also called provider-based facilities. When a patient receives care in a provider-based setting, the patient will see two charges (bills): the charge for the medical care (professional fee) and for services provided by the hospital facility (facility fee).
This billing indicates that patient care was delivered in a location that follows The Joint Commission’s strict quality standards. It also represents the significant added costs to hospitals of complying with these standards, such as common electronic medical records (between the hospital and the physician practice or clinic) and certain quality and patient-safety programs, which are not required of non-accredited physician practices. The Joint Commission is an independent, not-for-profit organization that accredits and certifies U.S. healthcare organizations and programs.
The way a patient's insurance company covers the hospital service part of the bill varies. Cleveland Clinic has financial counselors available to all patients."
Statement from MetroHealth:
“MetroHealth does not charge a general facility fee for inpatient care. In the outpatient setting, fees are charged for specific procedures such as Xrays, MRIs, and laboratory tests.”
