Background
As hospitals focus more on “whole person care,” population health, and keeping people healthy and out of the hospital, typically only the very sickest patients receive care as an inpatient at a hospital. Payment for patients who are hospitalized are made based on the patient’s diagnosis and the care received, which is known as a diagnostic related group (DRG).
Patients who receive care at an outpatient setting or physician’s office are charged for care differently. Those charges typically fall into two buckets:
- Professional fee, for the doctor and/or physician’s assistant
- Facility fee which pays for everyone and everything else
These hospital-owned departments may charge facility fees, which are typically based on the intensity of the care provided:
- Emergency department
- Outpatient surgery center
- Specialty clinics and care (e.g., cancer centers)
- Diagnostic imaging center
- Physician offices
Why are these fees important?
Facility fees in settings outside the “four walls” of the hospital have supported the shift to an integrated model of care that emphasizes preventative, whole-person care prioritized by policymakers.
Transparency of facility fees
Hospitals are held to strict transparency standards by the state and federal governments, which include the posting of facility fees as part of the charge master and price transparency postings.
