Opinion: Hospital “facility fees” are essential to health care access

House Bill 23-1215 has been introduced by the Colorado General Assembly to eliminate “facility fees” that are charged by hospitals and clinics, claiming it will decrease the cost of health care for patients. The reality is eliminating these fees will make it difficult for many patients, especially those covered by Medicaid, to access the care they need in a timely manner.

All clinics charge for facility fees and are reimbursed for nurses, staff members, supplies and operations costs. Community-based clinics are allowed to combine those charges with the physician’s fee into a single, global bill. By contrast, federal billing requirements force hospital-based clinics to separate these charges into two separate bills: one for the doctor’s time, and another, the facility fee, which covers everyone and everything else. This is often because the doctor is not employed by the hospital or clinic. HB 23-1215 seeks to prohibit the facility fee.

The bill was heavily changed in its first committee hearing as supporters tried to limit the negative consequences of this bill. But even with those welcome changes, what remains will still impact clinics providing primary care, preventive and telehealth services from being reimbursed for their staff members and the important health care they provide. Clinics and services across our state will be at risk of closing.

I am a licensed clinical social worker with UCHealth University of Colorado Hospital. I see patients on their worst days. These patients have been involved in orthopedic traumas. They are undergoing treatment for bone cancers such as osteosarcoma. They are undergoing limb salvage and reconstruction. They are undergoing extremity amputations. My work within these clinics requires a multidisciplinary approach – these patients are complex and multifaceted, often facing limb-threatening conditions that require attention from a variety of specialties.

The facility fee pays not just for my services but for all of the non-physician care patients in these clinics receive, including from nurses, athletic trainers, case managers, social workers, smoking cessation specialists, phlebotomists, medical assistants, interpreters, pharmacists, security officers and others. Many of these services are provided via telehealth, allowing patients to speak with behavioral health counselors, social workers and others from the comfort of their homes. Facility fees also help ensure that all patients have access to necessary medical services, regardless of their ability to pay.

In today’s health care economy, it is becoming more difficult to find independent physicians operating stand-alone clinics. Increasing expenses, IT requirements and regulatory burdens are putting extreme pressure on independent clinics, and many physician practices are joining health care systems so they can provide more efficient care with broader resources. Hospital-based clinics offer important services for patients, and a law that would outlaw facility fees for this care would, for all practical purposes, dismantle access to that care for hundreds of thousands of Coloradans.

Hospital-based clinics serve large numbers of Medicaid and uninsured patients. A great portion of the patients I serve are underinsured or uninsured, and I am concerned that an already vulnerable population may lose access to the care they need if hospitals can no longer keep those clinics open and adequately staffed.

As a social worker “in the trenches,” I am all too familiar with the financial constraints facing the patients that I serve. The financial, physical and mental health of my patients has only worsened since the pandemic. We help patients through these challenges with financial counselors, therapists and behavioral health staff – people who are all supported by the facility fee.

Rather than eliminating facility fees, we should be discussing why Colorado is ranked third-worst for adults with unmet behavioral health needs, sixth-worst for suicide deaths, and fifth-worst for alcohol-related deaths, according to the Commonwealth Fund. All of these issues can be treated expertly within an outpatient clinic or telehealth setting, freeing up capacity in our emergency departments.

Eliminating the facility fee runs a serious risk of depriving patients of health care services, especially access to specialists via telehealth for those in rural communities. One result will be more reliance on the emergency room, and more hospital admissions. This will ultimately drive up health care costs for everyone.

Yes, health care is expensive, and we all need to work on lowering costs and reducing insurance premiums. But instead of banning facility fees outright, efforts should be made to increase education and transparency. Let’s make sure patients understand the large number of staff members and services supported by facility fees, and that nothing from the physician’s bill goes back to a hospital-based clinic or its staff. Let’s make sure patients know how to get accurate estimates for their care and that financial assistance may be available.

And while we’re at it, let’s ask Congress to revisit the decades-old federal law that requires hospital-based clinics to bill in this way, with one bill for physician services and another for everyone and everything else. HB23-1215 would put Colorado hospitals in a predicament: either eliminate facility fees and leave Coloradans with less access to primary, preventive and telehealth care, or violate federal billing requirements.

Meanwhile, here in Colorado, the answer should not and cannot be eliminating the fees, rendering thousands of my colleagues, and myself, out of a job – not to mention leaving my patients without a dedicated and expert treatment team to help them during their darkest times. As one of my colleagues recently stated, “This is a misguided approach that will only intensify access-to-care challenges.”

Why would we want to implement any law that hurts Coloradans’ ability to receive quality health care in a timely manner?

Kristine McGuire, of Aurora, is a licensed clinical social worker with UCHealth University of Colorado Hospital’s orthopedics clinic. She is also a regional advocacy ambassador with the Amputee Coalition, a national nonprofit dedicated to promoting state and federal legislation impacting those with limb loss and limb difference.