As hospitals and health systems expand their ownership and control of ambulatory care practices, they are frequently charging new facility fees for routine medical services delivered in outpatient settings. Consumers, in turn, are facing greater financial exposure to these facility charges as insurance deductibles increase and payers develop new benefit designs that increase patients’ exposure to out-of-pocket costs, particularly in hospital outpatient settings. With support from and working in partnership with Georgetown University’s Center on Health Insurance Reforms, a team of experts published a new report analyzing current laws and regulations in 11 study states and sharing insights from more than 40 qualitative interviews with on-the-ground experts, policymakers, and stakeholders. The report findings provide a comprehensive look at outpatient facility fee billing in the commercial sector and potential policy responses. The companion issue brief provides a high-level overview of recent state action to regulate outpatient facility fees.
Issue Brief