By NextBestFitBan facility fees for off-campus clinics
No facility fees for office-type care outside a hospital campus.
Draft decision:RejectedConfidence: high · not yet reviewed
Covered by site-neutral pay.
Review ledgerHow this path connects
This path
Ban facility fees for off-campus clinics
Creates or worsens
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Ban facility fees for off-campus clinics
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Facility fees: the same service costs more in a hospital-owned building
Banning facility fees for office-type care away from hospital campuses ends surprise facility fees for office visits. The rule is simple to understand.
What it creates or worsens
- Solves only part of the problem
The off-campus fee ban reaches less care than full site-neutral payment.
- U.S. prices are far higher than in other countries
Hospitals may respond to the fee ban by raising professional fees.
7 paths soften this
All-payer rate settingU.S. prices are far higher than in other countriesChosenCap commercial prices at a multiple of MedicareU.S. prices are far higher than in other countriesChosenRestore competition and leave prices to marketsU.S. prices are far higher than in other countriesRejectedGlobal budgets for hospitalsU.S. prices are far higher than in other countriesChosenFee-for-service at public fee scheduleU.S. prices are far higher than in other countriesChosenCapitation for primary care and integrated systemsU.S. prices are far higher than in other countriesChosenSingle public payer for everyoneTens of millions of people have no coverageChosen
Who's affected
Who gains
- People with unaffordable deductibles or coinsurance
- Facility fees: the same service costs more in a hospital-owned building: Hospital ownership adds a facility fee to the cost of the same clinic visit.
- Health insurers, brokers, and their shareholders
- Facility fees: the same service costs more in a hospital-owned building: Hospital ownership adds a facility fee to the cost of the same clinic visit.
- Taxpayers and public budgets
- Facility fees: the same service costs more in a hospital-owned building: Hospital ownership adds a facility fee to the cost of the same clinic visit.
- People with ongoing or specialist care needs
- Facility fees: the same service costs more in a hospital-owned building: Banning facility fees for office-type care away from hospital campuses ends surprise facility fees for office visits. The rule is simple to understand.
- Hospitals and specialist groups with high private prices
- U.S. prices are far higher than in other countries: Providers with pricing power earn more per service.
- Drug and device makers
- U.S. prices are far higher than in other countries: U.S. prices are well above those in peer countries.
Who loses
- Hospitals, clinics, and care organizations
- Facility fees: the same service costs more in a hospital-owned building: Hospital systems collect facility fees on top of physician fees.
- People with employer coverage
- U.S. prices are far higher than in other countries: Private plans pay the highest prices, passed on through premiums.
- Taxpayers and public budgets
- U.S. prices are far higher than in other countries: Public programs pay more than peer countries too.
Where it has been tried
- Connecticut, Colorado: State bans on some outpatient facility fees.
- Connecticut: A 2025 study found that Connecticut's 2017 facility-fee ban was associated with a 6.91% relative decline in outpatient charges' share of total hospital charges.Sources: Health Affairs Scholar (2025)