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Why bigger is not always better (for our patients)

Updated: Mar 1, 2018

When big systems come to town, it can bring higher costs for patients and decreased satisfaction. Keeping it local has its advantages.




Many of you undoubtedly read the recent article about facility fees being charged to patients at the new Cleveland Clinic facility in Stow. Akron Beacon Journal writer Bob Dyer reported that the healthcare giant told him that "hospitals have provider-based billing (facility fees) at some outpatient facilities such as Stow-Falls."


Facility Fees Rationale

“Medicare allows hospitals with outpatient facilities to charge a facility fee to cover the costs of maintaining these facilities to meet additional standards that Medicare requires.”

This practice is not new, and patients are familiar with provider-based billing in hospitals, urgent care and other settings in which procedures are performed. What is surprising to patients is this billing in the primary care setting. The addition of more than $100 to a patient's office visit bill, charges that are not fully covered by insurance, has become a sore point for many it seems. And, as a primary care doctor myself, I wouldn't want to be on the receiving end of these patient's complaints, as there really isn't any solution I could offer them.


Independent option

It would seem, as in other industries, that a big player would have the ability to lower costs for the customer. Efficiencies of size for human resources, purchasing, contracts and the like should mean lower overall costs. In healthcare however, that hasn't proven true.


Kaiser Health News saw this trend developing more than 5 years ago, stating in a report, "...while mergers or partnerships among medical providers or insurers may improve efficiency and help drive down prices, consolidation can also have the opposite effect, allowing near-monopolies in some markets and driving up prices. Increasingly, hospitals are buying up rivals and directly employing physicians, creating larger medical systems."


Primary care physicians practicing in an independent group - and there are many still doing this - can continue to cater to patients' needs without inflating the cost of care. In contrast to the big-system approach, independent doctors are able to maintain their long-standing patient relationships in a lower-cost manner that is driven by patient-centered goals. I am one of these physicians and we operate leaner than big systems, not only because we have to, but because we are independent and have the ability to better control how we spend money. This brings value not only in lower-overall costs, but also increased satisfaction for our patients.


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