Where your broken arm gets a cast shouldn't affect what you pay

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In my career as a physician, I've seen medical services and procedures, including many routine ones, shift from offices to hospital outpatient settings. This migration of services has also come with higher costs for patients. And at a time when Americans are struggling to make ends meet and even forgoing care because they simply can't afford to see a doctor, these extraneous and medically unnecessary additional fees are another barrier to care that puts people's health at risk.

Members of Congress and policymakers have an opportunity to act. Just as we strive to hold Big Pharma and insurance corporations accountable for price gouging, we must also hold large corporate hospital systems accountable for sticking patients with hundreds, even thousands, of dollars of extra fees for no other reason than that they can. And bipartisan proposals are starting to emerge to tackle this pressing problem.

Health care professionals have seen the problem unfold in recent years with the wave of hospital and health care consolidations. Today, 1 in 4 physician practices is hospital-owned, and more than half of physicians practicing in the U.S. today are hospital employees. Instead of bringing down health care costs, a talking point hospital industry CEOs like to claim, consolidation has led to the opposite: Prices have gone up an average of 14.1% when a hospital system buys a physician practice. Medicare pays a staggering 194% more for an echocardiogram in a hospital outpatient department than in a regular free-standing doctor's office. Hospitals that buy doctors' offices can also bill an additional facility fee to patients with private insurance. This creates a domino effect of rising prices.

Take, for example, a relatively straightforward cast for a fractured arm. The cost for cast application in a doctor's office was on average $141 in 2017. The same procedure by the same doctor in a "hospital outpatient department" averaged around $404 that year. A patient who got a nerve injection at a doctor's office in 2017 paid $255, compared with an eye-popping $1,225 at an outpatient department. And prices have only substantially increased since 2017. Today the differences between costs of procedures done in an outpatient surgery center or office compared with those done in an outpatient hospital setting can be hundreds to many thousands of dollars — for the exact same procedure.

Doctors try to explain these extra costs to our patients, and we often have to admit no one has a good reason for charging more money for the exact same procedure. We also can't even scratch the surface on how to advise our patients adequately on how to compare pricing. It's extraordinarily complicated. We can have patients call various locations to check on imaging costs at the different facilities and to check on procedure costs at the various locations. But then, of course, it depends on their insurance. And the extra costs of procedures that are conducted at outpatient departments have no demonstrable impact on clinical effectiveness, safety and any other quantifiable metric or data point.

On the other hand, we do know that people are less likely to get care when seeing a doctor, getting a diagnostic test or filling a prescription drug becomes too expensive and unaffordable. My health care colleagues and I have experienced pleading with patients to get an MRI that they say they won't because they can't afford it. We've cared for patients who skipped their medications to manage chronic conditions and risk adverse outcomes. We've met patients who refused to see a doctor early for chest pains because they could no longer afford rising copays and out-of-pocket costs. The extra fees that hospitals charge patients are another pain point that will keep patients from getting care, and this practice must stop.

Policymakers can start with the basic principle, called "site neutral payments," that patients should be charged the same prices for the same health care services. Democrats, Republicans and all in between should be able to agree that patients deserve this fairness.

Congress can help reduce these unfair, skyrocketing health care costs now, making sure patients are getting a fairer deal and saving them billions of dollars.

Dr. Raina Young, of Eagan, is a family physician.