Hospital facility fees and their impact on healthcare costs were the focus of a North Carolina General Assembly oversight hearing this week, as lawmakers examined how the charges affect patients across the state.
The hearing centered on facility fees added at hospital-owned physician practices that operate outside of a hospital’s main campus.
When hospitals own outpatient facilities or acquire independent practices, patients are often billed an additional facility fee on top of the cost of care — including physician services, nursing care, and procedures. These charges are typically added simply because the practice is owned by a hospital system, even though the care is delivered in a standard outpatient office. The quality of care is not enhanced as a result of the fee, and outcomes are not improved.
Lawmakers have increasingly scrutinized the fees as consolidation in the healthcare market accelerates.
“Each year, more independent practices are consolidated into large hospital systems,” said Peter Daniel, Executive Director of the N.C. Association of Health Plans, during testimony before the committee. “As consolidation increases, facility fees become more common, and routine care becomes more expensive.”
Legislation passed the North Carolina Senate in 2025 that would eliminate facility fees at non-hospital outpatient settings, but the proposal stalled in the House.
Supporters say the policy would meaningfully reduce healthcare costs for North Carolina families.
By conservative estimates, eliminating these fees would save patients, employers, and taxpayers more than $200 million per year.
During the hearing, lawmakers from across the state shared concerns about how the charges affect their constituents.
Senator Ralph Hise raised concerns about patients in rural areas being billed hospital facility fees even when the main hospital campus may be many miles away and not realistically accessible for routine care.
Senator Jim Burgin shared the story of a constituent who saw the impact firsthand after a local practice was purchased by a hospital system.
“The first visit he went, it hadn’t been bought,” Burgin said. “The next visit it had been bought. They had a $100 fee on there — a facility fee. He said nothing has changed. I saw the same PA, the same practice, and I had to pay a $100 facility fee bill.”
Advocates say those experiences are increasingly common as hospitals continue acquiring physician practices across the state.
“If a patient walks into a neighborhood doctor’s office for routine care, they should pay for the care they receive — not an added fee simply because of who owns the practice,” Daniel told lawmakers. “North Carolinians are asking us to make healthcare more affordable. This is a clear, targeted step you can take right now to do exactly that.”
More than 20 states have adopted policies addressing hospital facility fees in recent years, with several prohibiting the charges in certain outpatient settings.
North Carolina has an opportunity to join those states and reduce unnecessary healthcare costs while protecting access to routine care.
.jpeg)
