LANSING, Mich. (WOWO) — Michigan’s largest hospital systems are refusing to disclose how much money they collect through facility fees, charges hospitals say help cover the cost of patient care but critics argue are driving up healthcare expenses.

The refusal is drawing scrutiny from state lawmakers seeking to limit the fees, which can be added to bills for outpatient services at hospital-owned clinics, doctors’ offices and other facilities. State Rep. Curt VanderWall, a Republican from Ludington who chairs the Michigan House Committee on Health Policy, said hospitals should provide financial evidence to justify the charges.

“If these (dollars) are necessary, then prove it to us,” VanderWall said. “Open your books and let us see.”
Bridge Michigan contacted 10 of the state’s largest healthcare systems and three rural hospitals, asking how much they collected in facility fees last year and what the money paid for. Several systems described expenses the fees help cover, including cybersecurity, electronic medical records, specialized equipment and round-the-clock emergency staffing.

None of the 10 largest Michigan-based health systems disclosed to Bridge Michigan how much it collected.
Henry Ford Health declined to provide further information, while McLaren Health Care said it would not comment. Detroit Medical Center did not respond to repeated inquiries sent by email, voicemail and text, and its Texas-based owner, Tenet Healthcare, also did not return messages.

VanderWall has introduced legislation that would prohibit hospitals from charging facility fees for routine care at hospital-owned outpatient locations, certain outpatient services delivered inside hospitals and telemedicine appointments. Hospitals could still collect some facility fees when traditional care is provided in a hospital.

VanderWall said the lack of financial information makes it difficult for lawmakers to determine the scale of the charges, assess their effects on patients and understand hospitals’ claims that the revenue is necessary.
He acknowledged that opening hospital finances to scrutiny could be uncomfortable but argued that transparency is essential to balancing hospitals’ financial needs against the costs patients face.

“Everything we’re going to do is going to be uncomfortable for all of us. But we have to make changes in healthcare and be willing to work to get to what is right,” he said.

Facility fees have long been part of hospital billing, but they have become more controversial as hospital systems have acquired outpatient services, including physician offices and laboratories, and expanded the use of the charges beyond traditional hospital visits.

Hospitals argue the fees help pay for infrastructure and services that extend beyond a physician’s time with a patient. The Michigan Health & Hospital Association says facility fees are crucial to hospitals’ survival as they face inadequate reimbursements and uncertainty surrounding future Medicaid cuts.
But neither the hospital association nor the state tracks the total amount Michigan hospitals collect through facility fees.

A federal estimate illustrates the potential financial stakes. The Congressional Budget Office has projected that addressing facility fees under Medicare Part B alone could save the nation $157 billion over 10 years.
Among the 10 major systems contacted by Bridge Michigan, Scheurer Health in Michigan’s Thumb region was the only hospital to disclose how much it expects to collect.

Chief Executive Officer Ross Ramsey said the rural hospital anticipates receiving about $125,000 in facility fees this year. That money would help support the hospital’s $125 million budget and cover services and equipment that must remain available even when they are not used regularly.

Ramsey cited a “telestroke robot” that allows an off-site specialist to connect with a team treating a stroke patient, along with equipment used to communicate with patients who do not speak English.
The responses from Michigan’s largest hospital systems varied in detail, but none provided the requested total revenue figures.

Bronson Healthcare Group said facility fees are not recorded as a separate revenue line item, making it unable to provide a total. A spokesperson said the charges are incorporated into the system’s overall operating budget rather than reserved for specific expenses. Bronson directs patients to online billing information and cost-estimation tools and recommends contacting the system for an estimate tailored to their insurance, location and expected services.

Corewell Health, Michigan’s largest health system, also declined to disclose its total. A spokesperson said facility fees help pay for the operation of outpatient clinics, including specialized equipment, technology, care coordination and hospital-level quality and safety standards. Corewell encouraged patients to contact their insurance providers about coverage and out-of-pocket costs.

Detroit Medical Center did not acknowledge repeated follow-up messages after initially directing Bridge Michigan to submit its questions by email. Tenet Healthcare, which owns the eight-hospital Detroit Medical Center network, also did not respond.

Henry Ford Health, which is undertaking a $2.2 billion expansion, declined to discuss the amounts it collects and referred questions to the Michigan Health & Hospital Association.

McLaren Health Care and MyMichigan Health also declined to comment.

Munson Healthcare said its facility fees help pay for nurses, social workers, building maintenance and high-tech equipment. The system said its prices are available through a publicly accessible pricing and shoppable-services resource on its website, but it did not provide a total for facility fee revenue.

Trinity Health, which operates 10 Michigan hospitals, declined to provide additional comment.
The University of Michigan Health System and U-M Health-Sparrow also withheld dollar figures. A spokesperson said insurance reimbursements do not always cover the full cost of care and described facility fees as a longstanding part of hospital outpatient reimbursement nationwide.

The spokesperson said those charges support clinical staff, laboratory and diagnostic services, patient safety programs, care coordination, security, information technology, equipment and facilities.
“In other words,” the spokesperson wrote, “an outpatient hospital visit involves substantially more than the physician’s time with a patient.”

For VanderWall, however, the central question remains unanswered: how much money hospitals collect through facility fees and whether those charges are justified by the costs they are intended to cover.
Without consistent financial reporting, lawmakers have limited information to evaluate the fees’ impact on patients or determine whether new restrictions are warranted.