Patients peeved sbout Cleveland Clinic 'facility fee'

A fee for patients at Cleveland Clinic is upsetting some patients who are complaining to the Ohio hospital, their insurance companies and even members of Congress. They say they can't afford the expense in the current economy, according to The Plain Dealer.

The Plain Dealer reports: "Facility fees, as their name implies, help hospitals pay for overhead costs including building maintenance, equipment, supplies, staff salaries, streamlined transfer of records and subsidized care for the poor." The paper notes: "The reason the fees are an issue now is that as of March 1, the Clinic began adding them to bills for outpatient treatment at nine of its 15 family health centers." The paper reports that "health-care experts say patients can avoid the fee by choosing doctors in private practice instead of those in hospital-owned practices." It also notes: "Insurance rules vary, but what often happens is that patients with private insurance end up paying all of the facility fee until they reach their deductible."

"The fees are becoming more common as hospitals take over more and more medical practices which must meet the hospitals' higher standards," The Plain Dealer reports. "The fee is rooted in regulations that govern Medicare -- the federal government's health-care plan for the elderly. It's designed to reimburse hospitals for their overhead costs. Medicare has paid it for years... (but) Medicare won't reimburse a hospital for a fee charged to its patients unless the hospital charges that fee to non-Medicare patients, too. ... So if hospitals don't bill everyone for facility fees, they can't collect them from Medicare patients." However, others argue that hospitals are using the facility fees as another way to generate more money. Alan Sager, a professor at Boston University School of Public Health, says there are understandable reasons why hospitals are adding the fees: "Hospital margins are down. Their investment income is down and some of their patient revenue is down because there are fewer insured people and fewer paying customers" (Suchetka, 6/16).