"Facility fees" originally meant to help struggling hospitals keep emergency room doors open 24 hours a day are now being applied to outpatient services and between 2017 and 2022, the fees cost Colorado patients and their insurers more than $13 billion, according to a new report mandated by Colorado lawmakers.

Priya Telang, communications manager for the Colorado Consumer Health Initiative, said the hidden fees are being piled onto health costs many cannot afford to pay.

"Patients are not going to seek care and health outcomes are going to be worse," Telang contended. "They are going to have to seek a higher level of more expensive care by avoiding those smaller, outpatient procedures."

Telang noted the state's critical access hospitals, which are more likely to experience financial struggles, are not responsible for the bulk of fees charged. The report showed 80% of fees went to 10 of the state's largest hospital groups. UC Health, which took in one-third of all fees, is urging lawmakers not to act on the report's findings. UC Heath said there was not enough time, data or participation from stakeholders for it to be reliable.

Telang noted facility fees, which are separate from fees charged for doctor care, have proliferated in recent years as hospitals consolidate and gain more marketplace power.

"As we see these huge hospital systems buying up smaller providers and expanding their reach, we're going to see more of these facility fees being charged, because they can," Telang asserted.

UC Health, which has $6 billion in reserves, has grown from owning five hospitals to 14 across Colorado in the past decade. Telang believes action at the state and federal level is needed to protect consumers.

"It's our lawmakers' duty to help their constituents not be saddled with immense medical debt that is crushing and they can't afford," Telang stressed.

Holiday travel is in full swing and for many, so is the stress. The American Heart Association of Missouri has health tips for anyone with heart disease or other chronic health conditions.

Medical professionals emphasized holiday travel requires planning. They suggested starting with a checklist: Consult your doctor, stock up on medications and prepare any medical equipment.

Dr. Georges Chahoud, cardiologist with SSM Health and board president for the American Heart Association-Metro St. Louis, offered advice for travelers with pacemakers and similar devices.

"If they are traveling, especially on an airplane, they have to make sure that they have enough time because they have to go through a special security check, since they have those devices," Chahoud explained. "It's recommended that they don't go through the metal detector; they can be 'wanded.'"

The American Heart Association also noted flights over four hours increase blood clot risk, so wearing compression socks is recommended. Research shows 6% to 7% of travelers deal with some kind of illness during or after their trips.

In a Heart Association survey, 69% of respondents said they struggle with eating healthily during the holiday season.

Chahoud, who is regional director of the Heart Failure Clinical program at SSM Health-St. Louis and Southern Illinois, and director of Cardiology Services at SSM Health-St. Joseph Hospital in Lake St. Louis, emphasized the problem can be exacerbated if you are traveling.

"They may indulge more in alcohol use, which can induce some heart problems, especially with irregular heart rhythm and A-fib," Chahoud pointed out. "Diet is quite important for patients with heart failure, especially as it pertains to those patients that don't watch the salt in their food."

He stressed the importance of seeking immediate medical attention if you experience symptoms of heart issues, such as chest pain or shortness of breath. Check for medical facilities available at your destination and know your health insurance coverage.

Maryland is facing a significant shortage of behavioral health professionals and a new report from the Maryland Health Care Commission offered some suggestions to fix the problem.

All but two counties in Maryland are labeled as a partial or complete mental health shortage area. Years of underinvestment and high rates of burnout for behavioral health specialists has caught up with the state. The report found a 50% shortage in the number of professionals needed to adequately care for Maryland's population.

Tiara Fennell, assistant clinical professor and clinic director of the Center for Healthy Families at the University of Maryland-College Park, said behavioral health professionals have long been undervalued, which can lead to burnout. The COVID-19 pandemic, she added, is also partly to blame.

"A lot of it has nothing to do with their intent or their desire to help people," Fennell explained. "It's because of their desire to want to be able to take care of themselves. One of the major things that is a deterrent is people not getting paid enough."

The report showed 45% of behavioral health professionals currently working in Maryland are expected to either retire, leave the state or exit the profession in the next five years.

To tackle the shortage, the Maryland General Assembly passed a Behavioral Health Workforce Investment Fund in 2023 and commissioned a report on how to spend the money. The report recommended focusing on investments in behavioral health. It suggested implementing more "earn while you learn" programs, with paid apprenticeships, fellowships and stipends to lessen the costs of college. More flexible schedules and mentorship programs were also recommended to address the nonfinancial issues of burnout.

Fennell pointed out many behavioral health internships are unpaid and she believes efforts to increase pay and reduce work loads for these professionals will boost recruitment and retention.

"That would make a huge difference getting people interested in this type of work," Fennell contended. "Also, maintaining that workforce -- and having people want to be there long-term, and spend the majority of their employment history -- however long that will be, working in this space."

The Behavioral Health Workforce Investment Fund will allocate more than $148 million over the next five years.


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The excitement of the holiday season is celebrated with family get-togethers. But for Alzheimer's patients, large groups can produce fear and confusion. The disease causes brain cell deterioration and the ability to rapidly process information diminishes daily.

Macie P. Smith, a licensed social worker and gerontologist, advised paying attention to nonverbal cues when a patient appears agitated.

"If you're going to have a small, intimate gathering, I also recommend doing name tags," Smith suggested. "Go ahead and put the person's name and the relationship to the person on the shirt, so that way they won't have to guess and wonder and try to figure out who this person is. It just helps with the ease of engagement."

Reminiscing over the family photo album is a traditional holiday favorite. Despite the best intentions, Smith explained, asking an Alzheimer's patient to identify a relative can be frustrating. The questions cause them to use brain cells that are severely impacted and could produce combativeness and aggression. She recommended singing or playing music as better choices.

The Alzheimer's Association Illinois chapter reported 311,000 caregivers cook meals, assist with basic hygiene and monitor medication intake. The needs of patients are unpredictable, leaving them with sporadic break times.

Additional stress from gift shopping and work obligations underlines the importance for a caregiver to routinely nurture their physical and mental well-being. Smith advised using a calendar for scheduling enjoyable activities.

"I've asked caregivers, 'So, what do you like to do?' They don't know, or they don't remember, because they have been so engulfed with caring for someone else and depleting everything that they've had, they've lost a sense of self," Smith observed.

For unmanageable situations, Smith recommends contacting a professional respite care service through your local department on aging. The agencies offer vouchers to pay a certified person to sit with your loved one. Another choice is asking for help from a church member, trusted neighbor or a Medicare or Medicaid-funded adult day service.


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