Arizona opinion: End hospital price gouging for my patients

As a physician, I want my patients to get the care they need, when they need it. Unfortunately, health-care costs keep going up, and one little-known driver of rising prices is the practice of hospitals charging patients more for the same services — sometimes with the exact same health-care team — as local doctors’ offices. The discrepancy in costs can be eye-popping, but Congress can help stop it. Doctors like me are calling on them to do so.

Here’s what these cost discrepancies look like: A patient breaks an arm and goes to their doctor to get the arm treated and put in a cast. If the patient goes to the doctor at their regular standalone clinic or office, the cost would have been an average of $141. Had the patient gone to the same doctor who happened to be doing a shift at any location that a hospital deems is a “hospital outpatient department,” that bill jumps to $404. For nerve injections, the gap is even bigger: $255 versus $1,225 at an outpatient department. Take any procedure, and the cost of care between a doctor’s office and a so-called hospital setting takes a great leap.

To my patients, these astronomical fees seem to come out of nowhere. In addition to rising insurance premiums and higher prescription drug costs, they now have to pay out of pocket for these arbitrary, unnecessary and ultimately unjustifiable hospital fees. What patients and their families should know is that these extra hospital charges are no reflection of safety or clinical effectiveness. In other words, these extra hospital fees are simply not justifiable from a medical standpoint.

Congress has an opportunity to fix this unfair system. By passing site-neutral payment reforms, Congress can work across the aisle to ensure patients pay the same price for the same service, regardless of whether the location is a regular physician’s office or an “outpatient department.”

Without site-neutral payment reforms, however, this problem will persist and likely get worse. This is particularly concerning in light of the trend of hospital consolidations and large hospital systems buying physician practices.

Between July 2012 and January 2018, hospital ownership of physician practices grew by 124% and hospital-employed physicians increased by 78%. 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. For my patients, these unnecessary hospital fees can add hundreds, often thousands, of dollars to their care in out-of-pocket spending.

Physicians and health-care professionals know from our experience that people are less likely to get care when seeing a doctor, getting a diagnostic test or filling a prescription drug becomes too costly. We have seen all too often how these additional hospital fees are the straw that breaks the camel’s back, when our patients simply throw up their hands and say they can no longer afford to undergo an MRI or a scan or therapy. These tests and treatments can detect causes of an illness or injury, catch a condition before it spirals out of control, help people manage chronic conditions, even save lives. For these patients, hospitals are putting up barriers to care by gouging patients with exorbitant and unfair fees.

Some states have taken action to protect patients. Congress should act at the federal level to ensure all families can get affordable health care. 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 everyone in between should be able to agree that patients deserve a fair deal and help them save their hard-earned money. Doctors are urging our leaders of all stripes to act.