Facility Fees
The Infrastructure Behind Patient Care
Hospitals in North Carolina operate around the clock as a healthcare safety net – providing emergency, specialty, and complex care for anyone in need of them, including patients who cannot pay. That requires care teams, equipment, and clinical infrastructure to be ready at all times, whether a patient arrives or not.
Facility fees pay for that degree of readiness – and they’re at risk of being eliminated.
THE FACTS
Facility fees support the clinical staff, technology, and infrastructure necessary for patient care (AHA).
All healthcare providers have facility costs. Independent clinics can bundle them into global bills. Only hospitals and hospital outpatient departments (HOPDs) are required by Medicaid, Medicare, and some private insurers to bill them separately.
HOPDs treat patients who are more medically complex and more likely to be medically underserved than those seen in independent clinics (King Health Consulting).
WHAT INSURERS DON’T TELL YOU ABOUT FACILITY FEES
Insurance companies call facility fees unnecessary. Some call them a money grab. But hospitals don’t get to decide whether care infrastructure is optional.
Hospitals still have to:
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Staff emergency departments, trauma centers, and behavioral health services.
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Support skilled care teams of nurses, medical assistants, and technicians.
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Maintain equipment and technology needed for care.
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Meet regulatory and safety requirements.
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Care for all patients regardless of their ability to pay.
And yet, insurers do not cover facility fees in full. When reimbursement falls short, hospitals absorb the difference. Over time, that pressure can mean fewer services, fewer staff, and fewer local care options – and patients feel the impact first.
THE PROBLEM WITH SITE-NEUTRAL PAYMENT
The push to eliminate or restrict facility fees in North Carolina is closely tied to federal site-neutral payment proposals that would have insurers reimburse the same rates for services regardless of where care is delivered.
Site-neutral payment assumes care costs the same everywhere. It doesn’t.
Hospital-based care requires more resources, stronger infrastructure, and higher readiness standards than independent clinics. When reimbursement drops, the consequences are predictable:
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Less funding for care teams and equipment
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Pressure to cut services or staffing
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Clinics in rural and underserved communities becoming harder to sustain
Paying hospitals less doesn’t reduce the cost of care. It reduces the resources available to deliver it.
Keep Care Within Reach
Facility fees help sustain the people, technology, and infrastructure hospitals rely on to care for their communities.
Without the fees, access to care becomes harder to maintain – especially in rural areas where hospital-based services are often the only option.
Protecting facility fees helps ensure North Carolinians can get the care they need, when they need it most.
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Stop financial harm to hospitals and providers. Hold insurance companies accountable. Protect care for every community.