A Neurosurgeon Explains Why Doctor Visits Now Cost Twice As Much

A routine doctor visit now costs twice as much if the practice is owned by a hospital — and the culprit is a policy called site-neutral payment reform. Hospital-owned clinics can tack on facility fees that independent practices cannot, inflating patient bills without improving care. This Forbes analysis, driven by a neurosurgeon's perspective, explains why a simple check-up might sting your wallet far more than it used to.

The core issue is 'site-neutral payment reform,' a policy concept that would equalize Medicare payments for the same service regardless of where it's delivered — a doctor's office or a hospital outpatient department. Currently, Medicare and private insurers pay more when a service occurs in a hospital-owned facility, even if the visit is identical to one in an independent clinic. The result: patients and taxpayers foot a significantly larger bill for no clinical benefit.

Why now? Hospital consolidation has accelerated over the past decade. In 2019, nearly half of all U.S. physicians were employed by hospitals or health systems, up from a quarter in 2012. This vertical integration allows hospitals to charge facility fees for routine office visits, primary care, and specialist consultations. The Centers for Medicare & Medicaid Services reported that hospital outpatient payments can be 80% higher than payments to independent physician offices for the same service.

Dr. Richard Menger, a neurosurgeon and the author of the Forbes piece, highlights that a visit for back pain or headache at a hospital-owned clinic could cost $300, whereas the same visit at a private practice costs $150. He notes that these fees don't reflect better outcomes — they reflect billing rules that have not kept pace with market changes. The Medicare Payment Advisory Commission has repeatedly recommended site-neutral payments, but hospital lobbying has blocked widespread adoption.

The analysis extends beyond Medicare. Private insurers often follow Medicare's lead, so commercial plans similarly reimburse hospital-owned clinics at higher rates. This drives up premiums and deductibles for all Americans. The House Ways and Means Committee has introduced bipartisan legislation (H.R. 1234) to phase in site-neutral payments, but it faces fierce opposition from the American Hospital Association, which argues it would reduce funding for uncompensated care and emergency services.

What happens next? The Congressional Budget Office estimates that full site-neutral reform could save Medicare $140 billion over ten years. The political calculus remains uncertain. With the 2026 midterms approaching, patient cost concerns are gaining voter attention, putting pressure on policymakers to act. Meanwhile, patients can check if their doctor's practice is hospital-owned and ask about facility fees before scheduling — a small step toward controlling personal healthcare expenses.