High Stakes Healthcare · Free Tools
When a hospital owns the doctor’s office, every visit gets a second bill — a “facility fee” for walking in the door. Your plan pays it. Here’s roughly how much.
Employees enrolled in your health plan.
Employee plus enrolled spouses and children. Industry average is about 1.9.
Primary care and specialist office visits. National average runs 3–4.
Only about 25% of U.S. physicians remain in independent private practice — the rest work for hospitals and corporate owners. 75% is a realistic starting point; not every employed practice adds a facility fee, so set it to your mix — your claims data knows exactly.
Medicare pays hospitals about $130 (HCPCS G0463) for a clinic visit’s facility component. Commercial plans routinely pay 1.5–3× Medicare. $240 is conservative — set it to what your claims show.
Your plan’s estimated facility-fee spend on office visits
$0
per year — on top of the doctors’ own fees, for the same visits, in the same exam rooms.
$0
Per employee / month
$0
Over five years
$0
Added to each visit
Every dollar of it bought zero additional care.
The formula is simple: covered employees × covered lives per employee × visits per member × share of visits at hospital-owned practices × average facility fee. Nothing hidden, and every input above is yours to change.
Why the fee exists: when a hospital acquires a physician practice, it can convert the office to a “provider-based” hospital outpatient department. The same visit then generates two claims — the doctor’s professional fee, plus a hospital facility fee — even though nothing about the visit changed but the tax ID on the building.
What this doesn’t count: facility fees on imaging, labs, infusions, and procedures done at hospital-owned sites — which are frequently larger than the office-visit fees. Treat this number as the floor, not the ceiling.
Honest caveat: independent-practice visits price the professional fee slightly higher than hospital-based ones under Medicare’s site-of-service rules. That difference is small; the facility fee is not. This calculator estimates the fee itself.