Maine lawmakers are calling for greater transparency in how hospitals and other health care centers charge so-called facility fees.

A legislative task force says providers should notify patients prior to a scheduled service if they'll be charged an added fee, and recommends the fees be eliminated for telehealth services or outpatient evaluations, including visits to a doctor's office.

Ann Woloson, executive director of Consumers for Affordable Health Care, said patients deserve to know when and how these fees are assessed.

"What is it that the facility fees are actually paying for," said Woloson, "and how much is really necessary to cover the cost incurred by hospitals that are billing these fees?"

Woloson called the recommendations "a good first step" in strengthening consumer protections, but some health care facilities say the fees are needed to cover twenty-four hour care, increased security and supplies.

Consumer advocates say facility fees can range from $15 to thousands of dollars, and are adding to the growing concern of medical debt.

Surveys show half of Maine households carry medical debt, the majority of which stems from hospital bills.

Woloson said while it's important that hospitals can remain open, consumers shouldn't bear the burden of high health care prices.

"More needs to be done to try to control costs," said Woloson, "while at the same time improving access to the health care services that Mainers, particularly in rural areas of the state, need."

Woloson said high health care costs are impacting peoples' everyday lives.

One in three Mainers report struggling to pay for basic necessities, such as food, heat, or housing within the past two years as a result of a medical bill.

And nearly one in three Mainers has recently been contacted by a collection agency about an overdue hospital bill.

The number of Medicare enrollees is projected to rise over the next few years as the baby boomer population ages. More than 2 million Illinoisans are currently enrolled in the federal health care program, according to Healthinsurance.org,

The Office-Based Facility Association, a coalition of practitioners, is calling for a change in what they view as an ineffective and unfair pricing structure of the Medicare Physician Fee schedule.

Jason McKitrick, executive director of the association, said other payers linking themselves to Medicare is one of the issues.

"When you've got ongoing cuts to Medicare, that means you've likely got ancillary cuts going on with the private side, with the Medicaid side, etc.," McKitrick explained. "It's the Centers for Medicare and Medicaid Services, CMS, ultimately, that's the agency and the federal government that sets the rates for the Medicare Physician Fee Schedule."

The association pointed out the current fee schedule addresses doctor's fees only, not the costly and necessary supplies and equipment needed for their practices. According to the Centers for Medicare and Medicaid Services data, there are 300 office-based services under the fee schedule for which Medicare reimbursement is less than the direct costs, before even considering other costs like overhead and physician work.

Dr. Sreenivas Reddy, a vascular interventional radiologist in Hinsdale, said in addition to seeing patients, he has to monitor overhead expenses such as office space and employee salaries, both affected by inflation. Not having the proper medical equipment and supplies, he added, limits his ability to perform specialized procedures and forces patients to seek care elsewhere.

"That makes these patients go to the hospital-based facilities," Reddy noted. "We have to close our offices and try to join these hospital-based models. They would love to come to the office, get the procedure done in one or two hours, versus it takes like a whole day in the hospital setting."

Reddy emphasized physicians' reimbursement, based on the current physician pay schedule, has been on the downtrend for the last five years. The group has further concerns about a decrease in the number of private practices causing more medical deserts for interventional radiology, cardiology, vascular surgery, radiation and oncology care.

Farm advocates say price gouging on meat and poultry are taking a toll on Montanans.

A farm group cites U.S. Department of Agriculture data as proof of corporate greed, and says companies are still using supply-chain issues as an excuse for inflated prices.

Companies faced massive supply-chain disruptions during the pandemic. But Ag Department data show most of those problems are gone - and food prices in Montana haven't dropped.

Groceries here are 5% higher than the national average and egg prices are up 50% since last year, according to the Consumer Price Index.

Joe Maxwell, chief strategy officer with Farm Action, said food producers are looking for ways to keep prices artificially inflated.

"And it's just a part of their doing business now," said Maxwell. "They find excuses in the markets to gouge that consumer. And one thing we want to be very clear on is that the consumer knows it's not the farmer. The farmer's getting squeezed just as much as is the consumer."

Food producers have blamed the supply chain, but also plant closures and a strain of avian flu for supply and demand issues - driving up production costs.

Farm Action is the same group which, not long after the official end of the pandemic, asked the Federal Trade Commission to investigate egg prices - which had tripled in some cases.

Maxwell said Ag Department data show the numbers did not justify the price hike, and adds corporate food producers have positioned themselves to have outsize control over the market.

"They've got that control over the farmer, not unlike oil companies have over oil fields," said Maxwell. "They now have that control because there are very few buyers of farmers' commodities, so they have that control over the farmer, the producer."

Farm Action has also been critical of large, corporate operations that raise thousands of animals in confined spaces, which have been known to pollute air and groundwater.





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A recent wave of racist texts targeting Black Wisconsinites has sparked concerns about data privacy.

The personal information people voluntarily disclose on various online platforms is often used for marketing purposes and can be sold to data brokers, who then sell it to others.

Chad Johnson, assistant professor of computing and new media technologies at the University of Wisconsin-Stevens Point, said industry estimates show most data brokers have no less than 15 data points on every American including age and ethnicity, detailed contact information and even Social Security numbers.

"Since there's no regulation over who can buy those, of course, it could be other advertising agencies, it could be other platforms," Johnson pointed out. "But there's also nothing stopping, for example, a white supremacist movement from buying that information for purposes exactly like this."

Personal data can also be stolen or leaked. Johnson added there is currently no comprehensive federal law to protects data and privacy in the U.S. However, Wisconsin's new data privacy law goes into effect next year.

The Wisconsin Data Privacy Act, passed a year ago today, includes requiring businesses to inform people if their data is being collected and the purpose, as well as the right to access their personal data and request it be corrected or deleted.

Johnson said because anyone can have such detailed information about their targets is where an intimidation factor comes in.

"It kind of sends the message, also implicitly, well what else could they possibly know?" Johnson explained. "If they have my ethnicity, do they have my address, do they have my children's names, do they have my school or my children's school? Do they have my web history, or anything along those lines? It's impossible to know."

He added until people come together to demand better regulation, little can be done to prevent cyberattacks, making individual precautions more important than ever.


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