Outpatient outrage 2026: Hospital prices for care outside hospitals

Imagine going to the same doctor for years – annual physicals, testing for strep throat, and writing your prescriptions to control your high cholesterol. For each of these visits, you’ve paid your $20 copay and gone home. 

Now imagine going to the same doctor for this year’s physical, paying your copay, and a few days later getting a second bill for $100. You’ve never gotten this charge before, so you’re confident that it’s a mistake. You call the office to get it corrected, but are told to contact a hospital billing department for help. You patiently explain it must be a mistake because you didn’t go to a hospital for care. The billing clerk informs you that the doctor’s office was recently purchased by the hospital and the bill is for the hospital’s “facility fee.” You realize you’ll be on the hook for an extra $100 every time you visit your doctor. 

Now you’re an outraged outpatient – and unfortunately, you’re not alone.

In addition to facility fees, the same care often costs more when conducted in a hospital-owned facility rather than an independent one. Even for simple outpatient procedures, hospitals use their own billing codes that are reimbursed at a higher rate. 

There is no evidence that shows charging hospital fees for outpatient care improves patient outcomes, but there are studies that show how much these fees raise prices for patients and their health plans. Consumers are particularly frustrated when these fees are unavoidable, either because they weren’t told about them in advance or when all local practices are now hospital-owned and charging facility fees. 

States are enacting laws to protect patients but more can be done.

Outpatient outrage 2026 updates our 2024 report. Since then, six additional states joined the 15 states that had some level of protections from unjustified facility fees, bringing the total to 21. We should be paying for what care we receive, not where we receive it. This is the idea behind site neutral payments, where patients are charged the same amount for care, regardless of where it’s provided. This 2026 analysis evaluates both facility fee reform and the concept of site neutral payment policy as a way to eliminate payment disparities for care in different settings. To best illustrate the problem, we’ve included narratives from patients across the country, explaining their frustration and concern.

PIRG recommends states take a comprehensive approach to eliminate location-based payment differentials for health care.

States should enact comprehensive policies to curb hospital charges for outpatient care. Patients should pay the same price for care that is safely and routinely done outside of a hospital, regardless of location.