I didn't understand that facilities fees were new but that they were not revealed to the patient consistently. This article discussed it.
Bill would make hospitals disclose facility fees
David Wahlberg | 608-252-6125 | [email protected] | Posted: Wednesday, December 23, 2009 4:50 pm
Dale Scott needed to see a dermatologist and had a choice of where to go: UW Health's East Clinic or a UW Health clinic just west of Downtown.
Scott, who lives on Madison's North Side, picked the East Clinic, off American Parkway, because it has better parking and is on his way to work.
But the convenience came with a little-known price: a $95 facility fee.
Hospital-owned clinics, such as the East Clinic, frequently charge the fees on top of their regular bills to recover overhead costs. Doctor-owned clinics, including the one on Park Street that Scott could have gone to, don't charge the fees.
"If they would have told me about it, I definitely would have driven to Park Street to save $95," said Scott, 48, who works at Schumann Printers in Fall River.
A bill before the state Legislature would require hospitals to tell patients at the time an appointment is made if a facility fee will be charged and provide an estimate.
The bill, sponsored by Rep. Chuck Benedict, D-Beloit, a retired neurologist, is one of only two efforts nationwide to make hospitals disclose facility fees, Benedict said. A similar measure is being debated in New Hampshire.
Patients are increasingly paying a bigger share of their medical expenses directly through higher deductibles and co-payments, said Cheryl DeMars, chief executive officer of The Alliance, a Madison-based group of 160 employers that collectively purchase health care.
They should be told if they will be charged facility fees, she said.
Most hospital-owned clinics in south-central Wisconsin charge the fees at least some of the time, at an average of $117, DeMars said. Patients who are aware of the fees can sometimes avoid them by going to other clinics, she said.
But most patients don't know about the fees, and some learn about them only after receiving their bills, DeMars said. "It's confusing and frustrating to people who are trying to be good health care consumers," she said.
Pam Charles, of Beloit, said she went to the Park Street clinic complex next to Meriter Hospital to get second and third opinions on whether she needed surgery.
For both visits, she said, she parked in the same lot and used the same elevator. On one visit, she turned right. On the other, she turned left.
Her bill for the first visit, at a clinic owned by UW Health's doctor group: $216. The bill for the other visit, at a clinic owned by Meriter: $423, including a $157 facility fee from Meriter.
"If they had told me that was going to happen, I would have chosen another doctor," Charles said.
Recovering hospital costs
Hospitals have been allowed to charge facility fees under Medicare rules for years, said Connie Kinsella, vice president for revenue at UW Health. She said the fees enable hospitals to recover some of the costs of their equipment and of meeting requirements that doctors' offices don't face, such as patient safety standards.
Extra costs incurred by UW Hospital also include doctor training, Kinsella said.
The clinics located at UW Hospital and six other Madison-area UW Health clinics -- those owned by the hospital -- charge facility fees ranging from $15 to $600, with an average of $137, she said.
The fees are usually charged for routine office visits and when an unscheduled procedure, such as a mole removal, is performed during a clinic visit. If the procedure is scheduled beforehand, a facility fee won't be added, Kinsella said.
The fees increase if caregivers spend more time with patients and if more equipment is involved, she said. Specialty clinics, such as otolaryngology, ophthalmology and bariatrics (weight-loss surgery), generally charge higher facility fees, she said.
Meriter Hospital charges facility fees at five clinics it owns, said spokeswoman Mae Knowles. The fees range from $60 to $250, with an average of $89, she said.
St. Mary's Hospital charges facility fees at its renal clinic, for patients with kidney problems, said spokesman Steve Van Dinter. The fees range from $25 to $200, he said.
UW and Meriter have signs, brochures and letters explaining the fees, but none of the Madison hospitals tell patients about the fees when appointments are made, the hospital officials said.
That would change under the bill, first introduced by Benedict four years ago. He said the measure has a better chance of passing this legislative session. The Assembly Committee on Public Health, which held a hearing on the bill this month, could vote on it next month, he said.
The fees shouldn't be charged at all, Benedict said, but if they are, they should at least be disclosed.
"It's like you're going to buy gas at the gas station, and they charge you for parking there," he said.
Paying out of pocket
The bill would also require insurance plans to tell members if they cover facility fees.
At First Supply, a Monona-based plumbing supply company that provides its own insurance plan, employees must pay all of the facility fees until their deductibles are met, said Mark Kindschi, human resources director. After that, they must pay 20 percent to 30 percent of the fees.
"They expect to pay to go to the doctor, but they don't expect this other fee," he said. "The first they hear of it is after they're billed."
Tom Neuman, who works at Schumann Printers, the same place where Scott works, was surprised to get a $189 facility fee for each of two visits by his 18-year-old daughter to a clinic at UW Health's American Family Children's Hospital.
He had to pay half of the fees, and his insurance paid the rest.
"Why should there be a fee for the room she was in? She was just going to see a doctor," he said.