Facility Fees

A bill under consideration by the state legislature – House Bill (HB) 23-1215 – would ban hospitals from collecting “facility fees” for outpatient care. This could decimate Coloradan’s access to care. Specifically, the bill:

  • Will have catastrophic consequences – Half of Colorado’s hospitals, in both rural and urban areas, are operating with unsustainable finances. This bill would cut $9 billion more from hospitals and health systems, making 96% of hospitals financially unsustainable.
  • Disrupts gains in patient care – Colorado has invested heavily in an integrated model of care and is starting to see the benefits of that, with lower per capita hospital costs, and patients getting care at the right time and right place.
  • Threatens access and adds expense – This could include all outpatient care, including on-campus and off-campus locations, and charges not labeled as a “facility fee.” Removing all payment for outpatient care beyond the doctor will force locations to close and will result in more emergency department usage and inpatient care, driving up health care costs for everyone.

What are facility fees?
A “facility fee” is better described as an outpatient care payment. It has little to do with the actual facility, and pays for the nurses, techs, environmental services, interpreters, security personnel, and many others that help provide care in outpatient clinics.  

When a patient seeks outpatient care, their bill will have two components. The first, known as a provider fee, pays the doctor for their time. The second is a facility fee, which may or may not be labeled as such on the bill. Any charges for an office visit and/or procedures will include a facility fee. Those charges are what pay the staff that provide care. 

What is outpatient care?
Outpatient care is simply any care or procedure that requires a stay shorter than 24 hours, even if it happens overnight or within the walls of a hospital. The majority of outpatient care is provided in community clinics where patients can get primary care, behavioral health care, cancer infusions, and many other kinds of specialty care. 

Outpatient care is more affordable, accessible, and comfortable for patients. Hospitals have worked hard over the years to shift more care to outpatient settings instead of more expensive care locations. This model, known as integrated care, ensures patients can access the right care at the right time.

How does Colorado compare?

Coloradans enjoy some of the best, and most affordable, hospital care in the country. 

# 50

in the country for lowest percent of household income spent on hospital care (Commonwealth Fund)

# 50

second best state for avoidable ED use (Commonwealth Fund)

# 50

third best state for avoidable hospital use and cost (Commonwealth Fund)

What else?

But there’s more work to do

Unfortunately, Colorado continues to score poorly on access to behavioral health care: 

Coloradans desperately need access to outpatient behavioral health care, and many hospitals have begun integrating behavioral care into their outpatient clinics. If those clinics are forced to close, Coloradans will have even less access to behavioral health care.