NY coalition proposes first-in-the-nation cap on hospital clinic bills

A broad coalition in New York is backing state legislation that would impose a first-in-the-nation cap on medical bills — aimed at hospitals that own or house outpatient clinics and charge higher rates than private practices.

Under the “Fair Pricing Act”, patient billing costs would be capped at 150% of rates set by the federal Medicare program for procedures for senior citizens.

A joint committee consisting of the powerful building workers union Local 32 BJ and an arm of the Real Estate Board of New York is bankrolling a seven figure media ad blitz to build support for the bill.

“Two patients walk into their local doctor’s offices for the same procedure but pay a very different price. This is happening all over New York because big hospitals are taking over independent doctors’ offices and driving up the cost of routine procedures,” the 30-second TV ad says.

“Health care shouldn’t cost more because a hospital owns the building. The same procedure should cost the same fair price.”

The ad — paid for by the 32BJ Labor Industry Cooperation Trust Fund — gives examples showing glaring disparities.

Currently, the bill for a child’s flu shot at a doctor’s office could be $23, but at a hospital outpatient clinic, it’s $183, advocates say.

Administering IV fluid to a senior patient at a doctor’s office is $566, less than half the $1,719 charged at a hospital-run outpatient clinic.

An MRI to check for stomach pain is $1,308 at a hospital clinic, more than double the $659 at a doctor’s office.

Among the groups backing the proposed law include the NAACP, Hispanic Federation, Asian-American Federation and NY Immigration Coalition.

“Big hospitals are treating routine medical services like a game of monopoly, where every time a patient lands on a building they own a higher price is charged,” said Manny Pastreich, president of Local 32BJ of the Service Employees International Union.

“Our members count on being able to go to their local doctor’s office to take their kid for a flu shot, get an MRI for a balky knee or an IV bag for dehydration and they shouldn’t have to pay inflated prices just because a big hospital took over that facility.”

State Sen. Liz Krueger (D-Manhattan), who chairs the influential finance committee, just introduced the “Fair Pricing Act.”

“We cannot let Big Hospitals become the next Big Oil or Big Steel, with monopoly control over everything and people forced to pay more for the same basic procedure. By capping the cost of outpatient services through the Fair Pricing Act we can level the playing field and ensure that patients have access to the same fair price wherever they go for their healthcare needs,” said Krueger.

Aside from the hard cap, the measure would ban adding facility fees to routine outpatient services, thereby preventing excessive payments to hospitals for doctors’ office services

State agencies — including the state attorney general — would enforce the caps and impose penalties for law-breaking and “deceptive practices.”

Advocates said the lower medical expenses for patients and insurers like state and local governments and union health funds will make medical care more affordable.

About 60% of doctors’ practice are hospital or corporate owned and nearly 80% of physicians are employees of hospitals or corporate entities, Local 32 BJ said.

The bill, if enacted, would impact major hospital networks such as New York Presbyterian, Northwell and NYU Langone Health.

The lobbying group for hospitals opposes “the terrible bill.”

“Hospitals and doctor’s offices are not the same. Only hospitals deliver care 24/7 and accept any patient who walks through their doors. Hospitals are also subject to myriad regulatory requirements that doctor’s offices are not,” said Greater New York Hospital Association president Kenneth Raske.

Rakse said the bill “ignores” financial pressures hospitals face.

“Does 32BJ have a magic wand that will eliminate severe Medicaid underpayments and staggering numbers of payment delays and denials by for-profit insurance companies?,” Raske asked.

“If the goal is to force New Yorkers to seek their care in Philadelphia, this bill would do it. Rather than push harmful public policy, the bill’s supporters should join the hospital community in fighting for higher Medicaid payment rates and pushing back on health insurance companies’ abusive practices.”