What many patients don’t recognize is that it’s not just the cost of drugs, or insurance inaccessibility that’s driving up costs for everyday Americans–it’s also the strategic greed of large hospital systems taking over independent practices, adding up to hundreds of billions of dollars for patients and taxpayers.

Like so many people needing care nationwide, my ER patients in West Michigan are regularly faced with an impossible choice–either pay the high price tag and exorbitant fees demanded by these monopolized hospitals or forfeit the treatment they need. This is especially true in rural areas like mine, where health care consolidation is driving up the cost of care for my patients.

I’ve seen this too often over the last two decades, and it’s heartbreaking to me, not just as their doctor but as someone who has taken an oath to alleviate suffering. Some patients have told me that they stopped getting critical and potentially lifesaving tests because they just don’t know whether they’ll get slapped with hundreds, even thousands, of dollars in hospital fees. Often, their conditions worsen, becoming more emergent and more painful. They wind up in my emergency department for issues that could have been prevented.

As other doctors across the country know, these types of stories are becoming increasingly common in health care. And they’re costing all of our patients dearly.

Procedures as routine as an ultrasound can cost twice as much depending on where you go–to an independent physician’s practice office, which are becoming few and far between, or to a “hospital outpatient clinic”–administered by the same type of medical professional. 

Here’s what’s happening: Large hospital systems are buying up independent physicians’ practices–in fact, over half of physicians are now employed by hospitals and health systems. They change the sign on the door, then offer the same health care services at the same location, but charge more. On average, when a doctor’s office is acquired by a hospital system, prices increase by 14.1%.

On top of these higher prices, hospital systems can also charge additional “facility fees.” Even though the office may be nowhere close to the hospital, patients can get a higher bill. Remember the patient getting a routine ultrasound? Their price increases from $164 to $339 when the hospital sends them to an outpatient clinic. With other routine procedures, like biopsies, the price can skyrocket from $146 to $791, and the price for just a general office visit increases from $118 to $186.

As doctors, we know that these increased costs don’t mean increased quality of care. An MRI or a checkup at an office owned by a hospital isn’t any better than one owned by a physician. It just costs more.

The good news is that Congress has a unique opportunity to tackle this problem with site-neutral payment reforms.

The Lower Costs, More Transparency Act would take on the anti-competitive and predatory behavior of hospital monopolies that is leading to higher health care costs and affordability issues for my patients. This legislation would require all hospitals to publicly disclose the underlying price of procedures, services, and medications, as well as tackle the site-specific payment discrepancies that cost my patients. By doing so, it would reduce government spending and save taxpayers billions of dollars.

The U.S. House of Representatives passed the Lower Costs, More Transparency Act in December of 2023. Now, as leaders in Congress negotiate health care spending legislation ahead of the March 8 deadline, they have an opportunity to include the site-neutral payment provisions of the Lower Costs, More Transparency Act in their package.

This is a true bipartisan issue. Reducing these unfair payment discrepancies is common sense. Congress has an opportunity–and an obligation–to save American patients and taxpayers money by advancing site-neutral payment reform. For the sake of my patients, I hope they’ll seize this opportunity to ensure that the same health care service costs the same.

Rob Davidson, M.D., is the executive director of the Committee to Protect Health Care and a West Michigan Emergency Room physician.

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