A bill under consideration by the state legislature – House Bill (HB) 23-1215 – would ban hospitals from collecting “facility fees” for some types of outpatient care. This could harm Coloradan’s access to care.
As amended, the bill could still have a detrimental impact on access to outpatient care for Coloradans, and CHA opposes any prohibition on the facility fees because they are what pay clinic staff for the care they provide. CHA is supportive of efforts to ensure health care billing is transparent for patients and supports the idea to study the broader environment of facility fees.
Carve Outs Don’t Fix Bad Policy: Rural communities rely on partnerships with urban hospitals, and every facility that has been carved out of the bill has signed onto this letter urging the General Assembly to allow urban hospitals to continue charging facility fees so their patients have continued access to higher level care.
What are facility fees?
Facility fees are best described as “care-team fees” — they pay for the people (other than doctors) involved in outpatient care and for the clinic itself. These payments have little to do with the actual facility, and pay 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.
- Colorado hospital costs were $692 per person lower than the U.S. average (CMS National Health Expenditure Data)
- Coloradans spent 4.1% of household income on hospital care – the second lowest amount in U.S. (CMS National Health Expenditure Data)
- 7th lowest benchmark insurance premiums (2023 data)
- 11th lowest of 46 reporting states in hospital prices (Commonwealth Fund)
- 12th best on multi-point ranking (Commonwealth Fund)
But there’s more work to do
Unfortunately, Colorado continues to score poorly on access to behavioral health care:
- 3rd WORST for adults with unmet behavioral health needs (Commonwealth Fund)
- 6th WORST for suicide deaths (Commonwealth Fund)
- 5th WORST for alcohol-related deaths (Commonwealth Fund)
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.