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Opinion: New Colorado report shows the urgent need to rein in hospital facility fees for patients like mine

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Opinion: New Colorado report shows the urgent need to rein in hospital facility fees for patients like mine


As a physician in Colorado, I see firsthand how high health care costs are burdening families. Insurance premiums and deductibles are already stretching budgets, but unregulated facility fees are making things worse. These hidden fees add unexpected costs to routine care, further burdening patients who are trying to access the medical services they need in the future. A new report illustrates even more clearly the need to rein these fees in.

Facility fees, which can range from a hundred dollars to over $800, are additional charges that hospitals tack onto your bill when you receive care at a hospital-owned clinic or provider. These fees are often separate from the cost of the actual medical service and can drastically increase the price of a doctor’s visit or procedure. Patients often don’t realize they’re being charged until they get the bill, leaving them with financial stress and uncertainty about getting further treatment.

Colorado recently released the Hospital Facility Fee Report, providing crucial insight into the growing problem of these fees. The 200-page report stems from House Bill 1215, passed by Colorado lawmakers in 2023. The bill created a steering committee composed of health care consumers, payers and providers, to examine the prevalence of facility fees and their impact on consumers. 

The steering committee had limited data to work with, given that differing billing practices and that the fees are generally poorly disclosed, has made researching the fees a difficult task. Still, the findings were alarming and confirmed what patients and providers alike have been experiencing for years: Facility fees are driving up health care costs without improving care.

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One of the most concerning findings in the report is that patients who see a doctor or provider affiliated with a hospital in Colorado are paying nearly double the amount in added fees compared to those who visit independent providers. Between 2017 and 2022, Coloradans paid over $13.4 billion in facility fees. Even worse, the amount of these fees has been increasing by 10% every year. These costs are unsustainable for patients and create yet another barrier to health care access.

It’s no coincidence that facility fees have risen at the same time that large hospital systems are buying up independent providers at an unprecedented rate. This consolidation of health care providers allows hospitals to charge more unregulated fees, boosting their profits while limiting affordable options for patients. As competition dwindles, Coloradans are left with fewer choices for health care, and they’re paying the price — literally.

The Hospital Facility Fee Report underscores the need for swift and comprehensive action from state leaders. Without additional protections, these fees will continue to increase, making health care more expensive for everyone. 

As a physician, I see how this directly harms patients. Many are delaying necessary care because they simply cannot afford the fees that come with a hospital-affiliated provider.

The key takeaways from the report are clear: Facility fees do not result in better patient outcomes, and they create uncertainty around health care costs, often preventing patients from getting the care they need. 

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Colorado has already taken the first step by commissioning this report, but it’s not enough. We must act now to regulate facility fees and protect patients from skyrocketing health care costs. 

Our leaders need to do more to protect patients from rising hospital costs, and consumers deserve to know what their costs are so they can anticipate their family budgets. Eighty-three percent of Coloradans report being worried about affording health care costs now and in the future.

Our legislators need to take the concerns of their constituents seriously. Coloradans support legislation that would require hospitals to provide up-front cost estimates, set standard payments to hospitals for specific procedures, impose price controls between insurers and hospitals, and create policies that drive competition. By doing so we can take yet another step toward ensuring health care is truly affordable and accessible for all Coloradans.

Dr. David Silver, MD, MPH, of Boulder, is a medical advocate whose 46-year career in emergency medicine, occupational health and primary health care was based in Colorado. The views expressed are their own and do not represent the opinions of any entity with which they are affiliated.


The Colorado Sun is a nonpartisan news organization, and the opinions of columnists and editorial writers do not reflect the opinions of the newsroom. Read our ethics policy for more on The Sun’s opinion policy. Learn how to submit a column. Reach the opinion editor at opinion@coloradosun.com.

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Type of Story: Opinion

Advocates for ideas and draws conclusions based on the author/producer’s interpretation of facts and data.



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Medina Alert issued after hit-and-run crash seriously injures motorist in Denver

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Medina Alert issued after hit-and-run crash seriously injures motorist in Denver


DENVER — Authorities issued a Medina Alert Sunday following a hit-and-run crash that seriously injured a motorist.

Police said the driver of a gold 2008 BMW X3 SUV struck another vehicle at the intersection of Sheridan Boulevard and W. 17th Avenue in Denver around 4:37 p.m. Saturday.

The crash left the driver of the victim vehicle with serious bodily injuries, according to the Colorado Bureau of Investigation.

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The BMW driver fled following the crash, traveling northbound on Sheridan Boulevard, CBI said in a bulletin.

The gold BMW X3, with Colorado license plate ECB F17, sustained heavy damage on the driver’s side from the collision.

If seen, call 911 or the Denver Police Department at 720-913-2000.

This was the second hit-and-run crash and Medina Alert in Denver on Saturday.

Earlier Saturday, a pedestrian in a crosswalk was seriously injured after being struck by a 2010 white Toyota Corolla, Colorado license plate EDM U42, at the intersection of Federal Boulevard and W. Kentucky Avenue.

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The driver of the Corolla left the scene—heading northbound on Federal Boulevard.

No arrests have been announced.

A Medina Alert honors the memory of Jose Medina, a 21-year-old valet driver who was killed by a hit-and-run driver in 2011.

A taxi driver witnessed the event, followed the driver, and gave the police the license plate number, leading to the capture and arrest of the suspect.

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Coloradans making a difference | Denver7 featured videos


Denver7 is committed to making a difference in our community by standing up for what’s right, listening, lending a helping hand and following through on promises. See that work in action, in the videos above.





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Denver shelter working to end homelessness for at risk youth, funding at risk

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Denver shelter working to end homelessness for at risk youth, funding at risk


Urban Peak is working to help Colorado youth have safe housing and support, and the organization says the community need is growing. They say 90% of the youth they assisted have been able to find safe housing and, even with funding cuts looming, it will continue to help those in need.



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GUEST COLUMN: Principles for Guiding River Water Negotiations – Calexico Chronicle

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GUEST COLUMN: Principles for Guiding River Water Negotiations – Calexico Chronicle


Next week is the annual gathering of “water buffaloes” in Las Vegas. It’s the Colorado River Water Users Association convention. About 1700 people will attend, but probably around 100 of them are the key people—the government regulators, tribal leaders, and the directors and managers of the contracting agencies that receive Colorado River water.

Anyone who is paying attention knows that we are in critical times on the river. Temporary agreements on how to distribute water during times of shortage are expiring. Negotiators have been talking for several years but haven’t been able to agree on anything concrete.

I’m just an observer, but I’ve been observing fairly closely. Within the limits on how much information I can get as an outsider, I’d like to propose some principles or guidelines that I think are important for the negotiation process.

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  1. When Hoover Dam was proposed, the main debate was over whether the federal government or private concerns would operate it. Because the federal option prevailed, water is delivered free to contractors. Colorado River water contractors do not pay the actual cost of water being delivered to them. It is subsidized by the U.S. government. As a public resource, Colorado River water should not be seen as a commodity.
  2. The Lower Basin states of Arizona, California, and Nevada should accept that the Upper Basin states of Colorado, New Mexico, Utah, and Wyoming are at the mercy of Mother Nature for much of their annual water supply. While the 1922 Colorado River Compact allocates them 7.5 million acre-feet annually, in wet years, they have been able to use a maximum of 4.7 maf. During the long, ongoing drought, their annual use has been 3.5 maf. They shouldn’t have to make more cuts.
  3. However, neither should the Upper Basin states be able to develop their full allocation. It should be capped at a feasible number, perhaps 4.2 maf. As compensation, Upper Basin agencies and farmers can invest available federal funds in projects to use water more efficiently and to reuse it so that they can develop more water.
  4. Despite the drought, we know there will be some wet years. To compensate the Lower Basin states for taking all the cuts in dry years, the Upper Basin should release more water beyond the Compact commitments during wet years. This means that Lake Mead and Lower Basin reservoirs would benefit from wet years and Lake Powell would not. In short, the Lower Basin takes cuts in dry years; the Upper Basin takes cuts in wet years.
  5. Evaporation losses (water for the angels) can be better managed by keeping more of the Lower Basin’s water in Upper Basin reservoirs instead of in Lake Mead, where the warmer weather means higher evaporation losses. New agreements should include provisions to move that water in the Lower Basin account down to Lake Mead quickly. Timing is of the essence.
  6. In the Lower Basin states, shortages should be shared along the same lines as specified in the 2007 Interim Guidelines, with California being last to take cuts as Lake Mead water level drops.
  7. On the home front, IID policy makers should make a long-term plan to re-set water rates in accord with original water district policy. Because IID is a public, non-profit utility, water rates were set so that farmers paid only the cost to deliver water. Farmers currently pay $20 per acre foot, but the actual cost of delivering water is $60 per acre foot. That subsidy of $60 million comes from the water transfer revenues.
  8. The SDCWA transfer revenues now pay farmers $430 per acre-foot of conserved water, mostly for drip or sprinkler systems. Akin to a grant program, this very successful program generated almost 200,000 acre-feet of conserved water last year. Like any grant program, it should be regularly audited for effectiveness.
  9. Some of those transfer revenues should be invested in innovative cropping patterns, advanced technologies, and marketing to help the farming community adapt to a changing world. The IID should use its resources to help all farmers be more successful, not just a select group.
  10. Currently, federal subsidies pay farmers not to use water via the Deficit Irrigation Program. We can lobby for those subsidies to continue, but we should plan for when they dry up. Any arrangement that rewards farmers but penalizes farm services such as seed, fertilizer, pesticide, land leveling, equipment, and other work should be avoided.
  11. Though the IID has considerable funding from the QSA water transfers, it may need to consider issuing general obligation bonds as it did in its foundational days for larger water efficiency projects such as more local storage or a water treatment plant to re-use ag drain water.

Much progress has been made in using water more efficiently, especially in the Lower Basin states, but there’s a lot more water to be saved, and I believe collectively that we can do it.





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