A doctor with almost 40 years of experience has raised the alarm after falling victim to a health trend that is causing some people’s medical bills to increase tenfold.
Danielle Ofri, a primary care physician at Bellevue Hospital in New York, took her daughter to what she thought was an urgent care center in Chicago, hoping for a quick X-ray after a bicycle accident.
Weeks later she received a bill for $1,168 and discovered the clinic was owned by a hospital that charged hundreds of dollars in “setup fees.”
“It turns out I stumbled upon a lucrative corner of the healthcare market called hospital outpatient departments, or HOPD,” he told the newspaper. The New York City Times.
‘Since these centers do not necessarily have the appearance of a hospital, patients can easily be misled and end up with big financial surprises.
“I am a doctor who works in a hospital every day and I was deceived.”
Dr. Danielle Ofri was horrified when she was charged $1,168 for a pair of $100 x-rays before discovering the “urgent care center” was actually a hospital outpatient department.
The proportion of doctor practices owned by hospitals has increased from 29% to 41% in ten years
Hospital-owned clinics perform the same routine procedures as independent ones, but may charge higher prices.
The average charge for a colonoscopy is $1,383 at an HOPD, compared to $625 at a doctor’s office, according to a study by the National Institute for Health Care Reform.
A knee MRI costs 50% more, chemotherapy twice as much, echocardiograms three times as much, and prostate biopsies more than six times as much.
“Because they are considered part of a hospital, they can charge hospital-level prices for these outpatient procedures, even though the patients are not as sick as the inpatients,” Dr. Ofri wrote.
The source of income has been eagerly seized by hospital groups that have mounted an aggressive takeover campaign against previously independent clinics.
The proportion of medical clinics affiliated with hospitals jumped from 29% to 41% in the ten years to 2022.
In Maine and Ohio, four out of five medical bills for heart tests now sent to each state’s largest insurer have a facility fee added, and a report released in March found that many hospital systems now get at least half of their income from Patients who have not been admitted.
Dr. Ofri cited the case of an elderly patient in Ohio whose bill increased 10-fold for the same treatment performed by the same doctor after a hospital was allowed to charge for it.
“It’s one of the most egregious examples of hospital funding at the expense of consumers,” said Liz Hagan of the advocacy group United States of Care, which has investigated the trend.
HOPDs add large fees to facilities that charge an individual for the use of the room in which they meet with their doctor, to offset the cost of operating a hospital.
Some states have taken matters into their own hands. In Indiana, clinics located off hospital campuses affiliated with larger nonprofit health systems cannot charge fees.
‘Hospitals are at the center of a massive market failure.
“Ultimately, consumers have to pay the price for that, either through higher premiums, because hospital costs are included in premium costs, or at the point of service.”
Attempts to address this inequity have failed in Congress in the face of a fierce healthcare industry lobby that maintains that rates are the only thing protecting hospitals from “substantial and unprecedented cuts.”
Dr. Ofri has almost 40 years of experience as a practitioner and warned that if she can be discovered, anyone can too.
“The cost of care provided by hospitals and health systems (and any associated care sites operated by the hospital) takes into account the many unique services that only they provide to their communities,” the American Hospital Association said. the Guardian.
“This includes the costs of maintaining reserve capacity for traumatic events and providing 24/7 care to everyone who comes through the emergency department, regardless of their ability to pay or health status. sure”.
Some states have acted on their own initiative, including Indiana, which has rules that clinics located outside hospital campuses affiliated with larger nonprofit health systems cannot charge fees.
Colorado hospitals will join those in 15 other states in having to disclose their rates in advance to potential patients starting next month.
“It is time for Congress to protect patients from both unfair pricing schemes and healthcare deception,” said Dr. Ofri.
‘I was so furious about the charging of hospital fees for two plain X-rays that I filed a formal complaint with the Illinois attorney general’s office, which concluded that the billing was legal under federal law.
When I asked for official comment on my claim that the charges seemed excessive and that the system seemed deceptive, a representative from NorthShore University HealthSystem (now Endeavor Health) offered only a general statement.
Liz Hagan of the nonprofit advocacy group United States of Care said hospitals “are at the center of a massive market failure.”
‘That said, in part: ‘We understand that navigating the healthcare landscape, including billing, can be complex.’
‘After six months of fighting the cost, the hospital quietly canceled our bill.
I’m sure he figured this was the easiest way to get rid of an annoying patient, but that’s not what I was looking for.
“I wanted to untangle this loophole that catches patients off guard and saddles them with exorbitant bills.”