Patients are paying more for routine health care without knowing why
Hospitals buy up independent clinics and the charges start piling up
The price of everything goes up, often with no explanation. Streaming video, eggs, gas, you name it. And now you can add routine medical care to the list.
While it’s always been true that the band-aid you get in a hospital setting costs you about a zillion times more than the one your doctor slaps on you, those sky-high hospital charges are steadily popping up on the bills patients get from their physicians and clinics.
Why? Hospitals.
A new study finds that as hospitals buy independent clinics and private practices, those offices start adding hospital-style fees to the tab, in part due to a lack of regulation of these charges. It’s an unanticipated side effect of hospitals gobbling up private practices and it’s changing the face of U.S. medical care.
In 2012, about 60% of physicians worked in physician-owned private practices. By 2024, that share had fallen to 42%, an 18-percentage-point drop — reflecting a large shift away from truly independent practices and hospitals buy up private practices and bring big business accounting practices with them.
“Facility fees” are at the heart of the problem. They were originally intended to cover the high overhead costs of hospital settings. When hospitals buy independent clinics, they can start charging facility fees, even when those clinics don’t incur hospital-specific costs. You’re paying for access to an MRI machine even when the closest one may be miles away at the hospital that now owns your local clinic.
According to Outpatient Outrage 2026, a report released recently by U.S. PIRG, state governments can stem this growing problem by taking measures to limit these “facility fees” and other unjustified medical bills.
The report is subtitled “Hospital prices for care outside hospitals,” because that’s basically what’s happening.
“People are going to the same doctors they’ve been seeing for years for something as basic as an annual physical, but now they’re paying more for no legitimate reason,” said Patricia Kelmar, a co-author of the report. “It’s absurd to be charged hospital prices for routine care simply because a hospital now owns the doctor’s practice. If I’m seeing my regular doctors in their offices, I shouldn’t have to pay extra as if I’m lying in a hospital bed.”
States look the other way
U.S. PIRG found that less than half of U.S. states have some protections against hospital charges imposed simply for receiving care at a hospital-owned facility. And no states guarantee “same service, same price” standards, so many patients pay more for the same treatment at a hospital versus at a clinic or doctor’s office.
“States like Connecticut are now well aware of these issues and trying a wide array of policy solutions to contain health care costs,” said Noah Austin, a co-author of the report. “Some state policies currently in place are too narrow in scope to actually protect patients. This report should help legislators weigh stronger options they can implement to help their constituents.”
What states should be doing
To better protect patients and lower costs, the report recommends that states adopt several reforms, including:
Establishing payment standards so patients and payers don’t pay more for the same care based solely on site ownership or setting
Requiring honest billing practices to distinguish sites of service within hospital-owned systems
Restricting or prohibiting facility fees for routine care
Requiring advance patient notice of add-on charges before visits
Improving public data collection to measure the impact of facility fees
“We’ve heard from dozens of patients around the country who are frustrated with their medical bills. Americans pay high costs for health care. For that, they deserve high value,” said Manasvi Reddy, a co-author of the report. “Our hospital-dominated health care system has evolved, but our payment policies haven’t. It’s time to ensure that medical professionals do what they say they do: put patients first.”
You can find a full copy of the PIRG report here.