We can all agree that healthcare costs too much these days. As a small business owner, I have seen my premiums spike for my employees and I’m running out of options. Year after year, the costs go up, and it feels like I have fewer choices and less control. I want to support my employees and their families, but the rising costs are simply out of control and it’s getting harder to keep up.
What could be the reason for this? Dishonest billing. It’s a deceptive practice used by large hospital systems to pad their profits at the expense of patients, families, and small businesses. Here’s how it works: hospitals acquire independent physician practices, then bill routine outpatient services like blood tests, x-rays, or check-ups at much higher rates typically reserved for care delivered in a hospital. The service doesn’t change. The location might not even change. But your bill? It skyrockets.
According to Sage Transparency data, St. Francis Medical Center is charging commercially insured patients 415% more than those on Medicare, and the facility has received an overall rating of two stars. This just proves that higher costs do not always equal better care.
This kind of pricing structure doesn’t just affect patients—it’s putting a real strain on small businesses like mine. Many of us are forced to make difficult choices: reduce benefits, raise employee contributions, or go without coverage altogether. That’s not right, and it’s not sustainable.
We need transparency. We need accountability. And we need leaders who will stand up to outdated, unjust billing practices.
Worse, the number of corporate hospital system-owned doctors’ offices is rising. A recent National Bureau of Economic Research study found the share of physician practices acquired by hospitals rose by 72 percent between 2008 and 2016, and physician prices increased 15 percent in the two years after a hospital acquired the practice.
This is not just a paperwork issue; it’s a pricing shell game that drives up premiums, deductibles, and out-of-pocket costs, resulting in people skipping important visits, ignoring warning signs, or delaying care in fear of a bill they cannot afford. That’s not a coincidence, it’s a business model. And it’s working exactly as corporate hospital systems intend, while the rest of us foot the bill.
At the heart of the solution is a simple concept: site-neutral payments. This reform would require Medicare, and eventually other insurers, to pay the same amount for the same service, no matter where it’s performed. Whether it’s in a hospital outpatient department or a community clinic, a routine procedure should carry a routine price that is consistent across locations. This would immediately curb overbilling and eliminate the incentive for hospitals to exploit billing loopholes.
Legislation needs to be put in place to protect small business owners, working families, and residents across Missouri from these inflated, unnecessary costs. Site-neutral payment policy would level the playing field and allow patients to get back on their feet without being buried in medical debt.
Missourians deserve a healthcare system that prioritizes people over profits. Lawmakers like Rep. Smith should lead the charge by advancing policies that end dishonest billing, embrace site-neutral reform, and push for a more transparent, more affordable future. Because when healthcare works fairly, everyone benefits, not just the big hospital systems.
Owner and co-founder of Keyser Enterprises
