Saturday, July 20, 2013

Hospital Facility Fees from the Patient’s Point of View
You can really never understand a person until you understand his point of view.
Harper Lee (born 1926), American Novelist, author of To Kill a Mocking Bird
You have just returned from your doctor’s office for a routine visit.  It was the same office,  same equipment, same location, same office staff, same doctor as before.   As far as you are concerned, in other words, it was the same O same O.
Then comes the bill. It is not the same. It comes  in two parts: one, the bill for the office visit, two, the bill for “facility." The facility fee is three times the office visit fee.
Puzzled, you call the doctor’s office to ask what “facility fee” is for.   The reception tells you the local hospital,  five miles away, now owns your doctor’s practice.   Medicare considers the practice a “facility” of the hospital.  And the hospitasl charges for using its "facilitiies," no matter how far physically removed from the hospital.
Being a curious sort,  you look up “facility” in the dictionary.  It says, “Something designed, built, installed, to serve a specific function or perform a particular service, as in transportation, educational, or healthcare facilities, having  the quality of being easily, or conveniently done, or performed.” 

This doesn’t make sense for you since nothing has changed, except ownership of the practice.  From your point of view,  the same new so-called " facility " has "facilitated" nothing.
Unsatisfied, you press on  by looking up “hospital facility fees” on the internet.  
You learn:
·         Medicare has ruled hospitals can charge “facility fees” for properties they own, including physician offices. 

·         A government agency called The Medicare Payment Advisory Commission has found “facility fees” have driven costs of the 15 minute office visit by 80%.

·         Hospitals now employ 50% of physicians, a number likely to reach 75% by 2015.

·         Hospitals charge “facility fees” to offset expenses of being open 24 hours a day,  of maintaining emergency rooms,  of hiring hospitalists at all times of the day and night,  of compensating for losses in money-losing services,  of covering the debts incurred for covering unerpaying Medicaid, Medicare, and non-paying  non-insured patients.
·         Hospitals worry about covering the costs of physician practices they have acquired, and whether, once acquired, physicians will be as productive as when they were in private practice.

You wonder.

What does this have to do with me and for me? 

These are factors beyond your control.  
Why can’t the doctors do something about these “facility fees”? 

Doctors, being hospital employees, tell you  they can do nothing.  The hospital is the boss.
Why can’t the government intervene”?  It turns out that  the health reform law, all two thousand pages of it,  has so far done little to control costs.  If anything, its rules, mandates, taxes,  fines, and fees have driven up costs.   
But, you ask, if Obamacare is going to cover 32 million more uninsured,  more underinsured, and more underpayers  by paying for their hospital stays, why won't  hospitals be happy with this new source of government revenues to buttress their bottom lines?  
Because, say hospital chief financial officers,  government is not specific about their plans to pay (Rene Letorneau,  HealthLeaders Media,  July 18,  “Healthcare CFOs Sing Reform Blues)”.    
The physicians themselves, in an article you read in in the 6/30/18 Forbes Magazine,  written by two top executives at the Physicians Foundation,  predict that health costs may explode ( Louis Goodman and Tim Norbeck,  “Why Health Care Costs Are About to Explode,” due among other things, they say,  to Obamacare, the aging population, new technologies, escalating hospital facility fees,  forced use electronic health records by  physicians , relentless rises in regulations, fees, fines, mandates,  taxes, and a long history of government-induced health care cost inflation).

When hospitals charge you for using a facility,
Just because they own a new piece of realty,
Just because the doctor is their employee,
That shouldn't call for an added practice fee,
This act adds to your sense of rip-off futility.
After all, If nothing new is added,
Your bill shouldn’t be padded.
Tweet:  From the patients’ point of view,  facility fees for visits to hospital employed physicians, are difficult to understand and to justify.

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