Connecticut has been a national leader in trying to curb some fees that patients receive for medical care.
So-called facility fees help hospitals cover their overhead — the expense of providing care around the clock. They show up on your bill as an individual line item, separate from the physician's charge.
Hospitals can collect facility fees for certain kinds of care when patients are treated in an office owned by or affiliated with a hospital or health system.
But critics say these fees have become an important source of revenue, inflating bills and increasing the overall cost of the nation's health care system.
Lawmakers in Connecticut have responded with moves to rein in these fees. The state now restricts them for certain types of routine treatment.
But these safeguards have limited utility without strong oversight. Connecticut Public's investigative reporting unit recently explored whether that oversight has been sufficient, and what it will look like in the future now that the state's Office of Health Strategy has been disbanded.
In recent years, Connecticut hospitals reported data on facility fee revenue to OHS. The agency was empowered under the law to issue penalties for improper charges.
However, as we reported last month, the state collects limited information that isn't detailed enough to determine whether certain charges are prohibited. OHS told us it has yet to find any violations.
If anything looks off, analysts ask hospitals to provide more information. But even that process isn't conclusive. State officials said they don't have access to the contracts that govern billing at each hospital. Reviewing them is necessary to determine whether the newest restrictions have taken effect.
OHS can also investigate charges when a patient files a complaint alleging a potential violation. But few complaints are received each year. Records provided in response to a Freedom of Information Act request show OHS has documented only a handful in the recent past. One state official told us most patients are probably unaware the option exists.
The oversight process is undergoing a shakeup this month. OHS was dissolved in June as part of a reorganization enacted by state lawmakers. The Connecticut Department of Public Health is taking over responsibility for overseeing facility fees. Staff from OHS who previously handled the program have moved to DPH.
The transition comes as hospitals in Connecticut face a July 1 deadline to report how much they collected in facility fee revenue last year.
Hospital representatives told us facility fees are necessary to keep functioning. The charges support not only the staff needed for a hospital, but also technology, safety standards, infrastructure and care coordination.
The forthcoming data will provide more insight into how hospitals responded to new restrictions adopted in Connecticut, which limit fees on outpatient visits to evaluate, assess or manage a patient’s health.
But as one state official told us, the state may not see fee revenue decline.
"The prices are going up, and there's increased utilization too," she said.
