If you walked into your cardiologist’s office this January and noticed a new logo on the door, you might want to check your wallet. In 2026, the biggest driver of medical inflation isn’t the cost of medicine or the doctor’s time—it is the change in ownership. As hospital systems and private equity firms aggressively acquire independent physician practices (a trend that has accelerated despite new FTC thresholds), they are legally permitted to reclassify standard doctor’s offices as “Hospital Outpatient Departments” (HOPDs). This administrative flip allows them to charge a “Facility Fee”—effectively a cover charge for walking into the room—that can increase your bill by 300% or more. Here are the seven specific facility fee hikes tied to ownership changes that are hitting patients in 2026.
1. The “Provider-Based” Clinic Conversion
The classic “bait and switch” remains the #1 threat. When a local hospital system buys your primary care doctor’s practice, they often reclassify the building as “Provider-Based.” According to the 2026 Medicare OPPS Final Rule, while CMS is attempting to cap payments for some off-campus drug services, “clinic visits” at many grandfathered or on-campus locations are still eligible for dual billing. You will receive two bills: one for the doctor (Professional Fee) and a separate one for the “room” (Facility Fee). For a simple 15-minute checkup, this new facility fee often ranges from $150 to $300.
2. The “Private Equity” Management Surcharge
It is not just hospitals. In 2026, private equity firms have pivoted to buying specialty practices like dermatology, gastroenterology, and orthopedics. As noted in PitchBook’s 2026 Healthcare Services Report, these firms often implement “Management Service Organization” (MSO) fees. While not technically a Medicare “facility fee,” these appear on patient bills as “Administrative Facility Charges” or “Room Usage Fees” in contracts with private insurers. Because these practices are private, they often fall outside the “Site Neutral” regulations that constrain Medicare pricing.
3. The Urgent Care “ER” Flip
A major trend in 2026 involves hospital systems acquiring independent Urgent Care centers and rebranding them as “Free-Standing Emergency Departments” (FSEDs). This ownership change allows the facility to bill under “Emergency Department” codes rather than “Urgent Care” codes. A treated sprained ankle that cost $150 at the old Urgent Care now triggers a “Level 3 Emergency Visit” facility fee of $1,200, even if you never set foot in the main hospital.
4. The “Infusion Center” Markup
Oncology practices are prime targets for acquisition. When a hospital buys a cancer center, chemotherapy administration fees skyrocket. While the CMS 2026 Final Rule did cut reimbursement for some off-campus drug administration, hospitals have responded by moving patients to “On-Campus” infusion suites to protect their revenue. If your doctor moves your chemo appointments from their satellite office to the main hospital building (ownership change), your coinsurance can jump from a flat office copay to 20% of the hospital facility rate, costing you thousands.
5. The Telehealth “Originating Site” Fee
Ownership changes are now affecting virtual care. If your doctor’s practice is bought by a large health system, your telehealth video call might technically “originate” from the hospital’s server. In 2026, patients are seeing “Hospital Outpatient Clinic” facility fees attached to Zoom calls. The hospital argues that because the doctor was sitting in a hospital-owned building during the call, the “overhead” of the hospital applies—even if you were sitting on your couch.
6. Diagnostic Imaging “Split Billing”
Independent MRI and CT centers are disappearing. When a hospital acquires these centers, they switch to “Split Billing.” Instead of a global fee of $400 for an MRI, you get a “Technical Component” (Facility Fee) of **$2,200** and a “Professional Component” (Reading Fee) of $100. Many insurers will apply the Facility Fee to your deductible, meaning you pay the full $2,200, whereas the old $400 global fee might have been covered by a fixed copay.
7. The “Trauma Team” Activation
Finally, ownership changes in emergency medicine groups are driving aggressive billing protocols. When private equity-backed staffing firms take over hospital ER management, “Trauma Team Activation” fees have spiked. Even for minor injuries (like a bad bike fall), if the ambulance radioed ahead, the new owners often automatically bill a “Trauma Response Fee” (ranging from $3,000 to $10,000) simply because the surgical team was “alerted,” even if they never treated you.
The Sign Didn’t Change, But the Price Did
The most dangerous aspect of these fees is their invisibility. The doctor is the same, the waiting room is the same, but the Tax ID number on the receipt has changed. Before you book an appointment at a familiar clinic, ask the front desk: “Is this location billed as ‘Provider-Based’ or a ‘Hospital Outpatient Department’?” If the answer is yes, ask for the facility fee estimate in writing, or find an independent clinic nearby.
Has your local doctor’s office suddenly added a “Facility Fee” to your bill after a merger? Leave a comment below sharing the name of the hospital system—we are tracking the most aggressive billing changes of 2026 to help warn other patients.
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