Rising Health Expenses: Hospital-Physician Mergers Lead to Heightened Patient Costs
Revamped Exposé: The Hidden Cost of Hospital-Based Billing
For five long years, Caren Blanzy underwent treatments to ease her debilitating neck pain. The Michigan resident frequented the same clinic, met with the same doctors, and received the same medical care - all covered by her insurance without a dime out of her pocket. That is, until February, when an unexpected $1,100 bill landed on her doorstep, categorized as a hospital facility fee.
Turns out, the clinic had fallen under the umbrella of a sprawling Michigan health system, which began billing patients for outpatient services. This charge, saddling unsuspecting patients with medical debt, is what experts call "hospital-based billing" - a growing issue that has become a significant worry for patients like Blanzy.
"For them to change the way they bill it, and say it's a hospital service, as an outpatient - it just didn't make sense to me," Blanzy voiced her confusion.
According to a report by InvestigateTV partners KFF Health News, the number of physicians working for hospitals or practice networks owned, at least partially, by hospitals or healthcare systems has surged from 29% in 2012 to 41% in 2022. In light of this trend, it's no surprise that hospital services are increasingly expanding into outpatient clinics, raising concerns about the rising cost of care for patients.
The Centers for Medicare and Medicaid Services (CMS) has an answer: when facility fees are covered by a patient's plan or coverage in connection with essential health benefits, out-of-pocket costs for those fees are subject to the maximum out-of-pocket limit. However, when such coverage is absent, patients are exposed to undue financial risk.
Blanzy, who suffers from cervical dystonia, a neurological movement disorder, needs regular Botox treatments for relief but is now struggling to pay the steep price. "For them to change the way they bill it and say it's a hospital service, as an outpatient - it just didn't make sense to me," she reiterated.
The clinic Blanzy once visited is now owned by Corewell Health, a conglomerate that rebranded outpatient facilities as hospitals in late 2023. A letter sent out by Corewell warned patients of subsequent double charges due to provider-based billing. This change means that even clinics located miles away from actual hospitals could be considered part of the hospital system, potentially offering higher charges for identical services.
Despite requests to re-bill her insurance as an office visit, Corewell Health refused, leaving Blanzy caught between a rock and a hard place.
"I'd like to see them be more transparent!" Blanzy stressed, hoping healthcare systems move towards greater openness for the sake of patients like herself.
It's a demand echoed by Dr. Elisabeth Rosenthal, Senior Contributing Editor of InvestigateTV partner KFF Health News. Rosenthal has heard countless complaints from patients undergoing hospital billing for non-hospital services. Such instances involve doctor's offices, or outpatient clinics, being rebranded as hospitals for the purpose of billing, effectively leading to higher costs for patients.
Several states, including Colorado, Massachusetts, Maryland, Maine, and Washington, are taking steps to address this issue, introducing measures such as advanced notice requirements, direct-to-consumer requirements, and site-neutral payment reforms to ensure that the cost of care is no longer the elephant in the room.
Yet, for many patients, the price of care is still a concern.
"So I think it's another one of our buyer beware warnings in healthcare," Rosenthal warned.
In a statement, the Center for Medicare and Medicaid Services (CMS) highlighted the need for transparency, emphasizing the importance of advancing estimate of benefit requirements and good-faith estimates under the No Surprises Act to prevent unexpected medical bills and ensure that patients have a clear idea of their out-of-pocket costs before receiving care.
Amidst the growing trend of hospital acquisitions and the subsequent shift in billing practices, it's clear that urgent steps need to be taken to promote fairness and transparency in our healthcare system.
- As a result of her chronic neck pain and cervical dystonia, a neurological disorder, Caren Blanzy relies on regular Botox treatments for relief.
- With the rise in hospital ownership of outpatient clinics, experts warn of increasing costs for patients seeking health and wellness services.
- In an effort to combat the issue, several states have introduced measures aimed at improving transparency and site-neutral payment reforms in healthcare.
- To manage personal finance, Blanzy is now facing the financial burden of unexpected medical bills due to the change in billing from her clinic to a hospital facility.
- Despite concerns over hospital-based billing and its impact on lifestyle, finance, and personal-finance, some healthcare systems, like Corewell Health, continue to rebrand outpatient facilities as hospitals for higher charges.
- Technology and sports-analysis can play a crucial role in identifying patterns and solutions to help mitigate the hidden cost of hospital-based billing.
- The increasing integration of fashion-and-beauty, food-and-drink, and travel industries with healthcare raises questions about the ethics and transparency in the business of treating medical-conditions, especially chronic diseases.
- In response to Blanzy's predicament, Dr. Elisabeth Rosenthal emphasized the importance of transparency and urged healthcare systems to provide advanced notice and good-faith estimates under the No Surprises Act to protect patients from unexpected medical bills.
- Homeowners and garden enthusiasts must remain vigilant about their health insurance coverage when seeking care in hospital-owned facilities to avoid any potential financial risks.
- Proponents of investing in the health sector advocate for its resilience and potential returns, but warn investors to carefully consider the hidden costs associated with hospital-based billing before making any financial decisions.
