Health care expenses are complex, and one of the least understood costs is what’s known as a “facility fee.”

When you think of a facility fee, you might think of a building. But facility fees are actually “people fees.” They cover the expenses for all of the people who make clinics run, from nurses to lab and X-ray technicians to parking attendants, security and pharmacy staff members. The facility fee pays for the people who care for patients. (For more information about facility fees, click here.)

Proposed legislation in the Colorado legislature, House Bill 23-1215, would bar facility fees. If successful, the bill would imperil countless clinics and health care jobs throughout the state. Those clinics would have no funding to pay for the dedicated staff members who care for patients, and many would be forced to close.

To help you understand what facility fees are and how they work, we consulted with Angela Zurun, the operations manager for UCHealth Plastic and Reconstructive Surgery – Colorado Springs, exactly the type of clinic that could be impacted without funding from facility fees.

In addition to threatening vital clinics like the one Zurun manages, attacks on facility fees also could undermine valuable programs and people including:

• Social workers and care coordinators who help reduce homelessness and keep unhoused people healthier.
• Behavioral health specialists who are working to combat Colorado’s growing mental health crisis. Health systems fund a variety of behavioral health programs from new psychiatric beds for people in crisis to embedded therapists in primary care clinics.
• Security staffers who keep patients and staff safe from growing threats of crime and violence.
• Workforce development experts who are working to train future nurses, social workers, lab techs, nursing assistants and others who keep all of us healthy.

Zurun works with three highly skilled physicians who restore vital function for people who have suffered severe trauma or cancer.

When a patient goes in for an appointment in a clinic, there’s a big team of people taking care of the patient, not just the doctor. For certain types of clinics known as hospital-based clinics, the provider’s bill must, by law, be separate from the bill for the rest of the patient’s care team.

So, when you get a bill from your provider, that bill only covers the time that the doctor or advanced practice provider spends with the patient. The facility fee covers everyone else: nurses, nursing assistants, behavioral health therapists, social workers, care managers, pharmacists, housekeeping, security officers, front desk staff, supplies, equipment and more.

In Zurun’s clinic, the work is not about cosmetics but helping people heal from malformation or devastating injuries, such as gunshot wounds to the face or reconstructive breast surgery after a double mastectomy.

The three surgeons in this sophisticated medical clinic are supported by nine additional employees: three physician assistants, four medical assistants and two administrative employees at the front desk.

“That’s probably a minimum amount to run a clinic for three surgeons,’’ said Zurun, who has worked in health care for more than 25 years, including for two decades in the Air Force.

The facility fee covers the salaries of these employees, and each plays a vital role in patient care.

In this clinic, physician assistants assist surgeons in the operating room. They visit patients in the hospital and see patients during follow-up visits in the clinic. Patients are not charged for follow-up visits within what is called the “global period,’’ 90 days after surgery. Physician assistants also place orders in the computer during surgery, answer in-basket messages from medical assistants and patients who communicate through My Health Connection, UCHealth’s online patient portal.

“The physician assistant’s job is to make sure that the surgeons are able to spend more time in the operating room,’’ Zurun said.

Medical assistants also support patients. For instance, in clinics, they assist with wound care, staple removal, drain removal and more. Before reconstructive breast surgery, for instance, a medical assistant helps with tissue expansion. Medical assistants also schedule surgeries, review and request medical records (along with the physician) and answer any patient questions that they can. All other questions are sent to the physician assistant.

Employees at the front desk schedule all patient clinic appointments, manage templates for providers and check patients in and out of the clinic.

Facility fees also cover supplies such as ointments, bandages and dressings.

“We use a lot of supplies for patient care. Many of our patients walk out of the clinic perhaps with two or three Ace bandages. You can see when they leave the room that it’s filled with empty packages of supplies that have been used,’’ Zurun said.

In addition, the facility fee covers clinical engineers who check machines to make sure they’re working properly; information technology experts update software for the medical records system and medical assistants uses materials to sterilize instruments used in the clinic setting. Lab work is also essential.

“It takes a lot of work and people to run a department, to make sure the patient is seen, scheduled, has surgery, and comes back for follow up. It’s lots of work and that is for one patient,’’ Zurun said.

Colorado lawmakers are considering legislation that would prohibit facility fees. The proposed law, House Bill 23-1215, would undermine care that patients receive in clinics where patient safety and quality are top priorities.

Eliminating facility fees also could cost Colorado jobs and reduce federal funds that help cover care for patients with Medicaid coverage.

The goal of health care is to keep patients healthy, and providing excellent, preventive care in outpatient clinics has helped Colorado reduce health care costs. The Commonwealth Fund currently ranks Colorado No. 2 in the country for the lowest percent of household income spent on hospital care, and third best state for avoidable hospital use and cost.

Prohibiting facility fees will cause patients to lose access to their clinics and providers, resulting in increased emergency room visits and higher costs for all.

For more information on the facility fee bill and this legislative session, please visit the Colorado Hospital Association.