OHS Releases Annual Facility Fee Trend Report

Press release from CT Office of Health Strategy:

Oct. 6, 2020

The Connecticut Office of Health Strategy (OHS) today released the Annual Report on the State’s Facility Fee Trends. The Facility Fee report examines revenues certain hospital outpatient centers generated from facility fees in Calendar Year 2019, the medical procedures that generate those fees, and five-year trend data.

“The cost of healthcare continues to rise, adversely impacting state residents and employers, and once again that trend is reflected in data reported here,” OHS Executive Director Vicki Veltri said. “These reports provide insight into the cost residents and employers bear depending on who provides services and where they are received; they also help policymakers identify specific cost-growth areas.”

“OHS will continue to scrutinize healthcare costs and quality of care through benchmarks established within the framework of Governor Lamont’s Executive Order No. 5.” Veltri added.

Key findings from the Facility Fee Trends report:

· Outpatient facility fees are up 3.4% to $437.2 million; patient visits generating facility fees increased 11.4% in that same period.

· In calendar year 2019, digestive system and cardiovascular procedures generated the most facility fee revenue, nearly $54.2 million.

· Sixty percent of the facility fee revenue was paid by employer and commercial health plans on behalf of policyholders; these health plans also paid the highest average facility fees at $426 per visit.

· The top three provider locations generating the most facility fee revenues were Tully Health Center at Stamford Hospital; the Naugatuck Valley Surgical Center (St. Mary’s Hospital); and Hartford Hospital’s Eye Surgery Center.

· The top three medical services generating facility fees: Yale New Haven Health evaluation and management established patient outpatient visit, Hartford Health cataract surgery, and Stamford Health colonoscopy.

Connecticut General Statutes section 19a-508c requires hospitals and health systems to report facility fees. The facility fee data OHS receives is net revenue, therefore an average facility fee for a specific procedure or a specific location is available. The statute does not require a hospital or health system to report an exact facility fee for a specific procedure at a specific provider.

State law prohibits hospitals, hospital facilities, and health systems from charging facility fees for outpatient evaluation and management of medical conditions except in two cases: 1) unless a previous contract allows the fees, or 2) a satellite emergency department is delivering care. For uninsured patients, these fees may not exceed the Medicare rate. Additionally, hospital-based off-campus outpatient centers must give written notice to patients that they could charge a facility fee and must identify that as separate from any professional fee.

These reports are compiled by the OHS Health Systems Planning Unit.

This press release was produced by CT Office of Health Strategy. The views expressed here are the author's own.