NEW YORK, NY--March 22, 2018--From 2007 to 2016, private insurance claim lines for services rendered in urgent care centers grew 1,725 percent--a growth rate more than seven times that of emergency room claim lines (229 percent) in the same period, according to an analysis of places of service in the new FH Healthcare Indicators™. FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information, unveiled this report, along with the FH Medical Price Index™, in a just published white paper. Both reports are based on FAIR Health's database of over 25 billion privately billed healthcare claims--the largest such repository in the country.
FH Healthcare Indicators: Focus on Places of Service
FH Healthcare Indicators reveals trends and patterns in the places where patients receive healthcare. These have seen dramatic changes in recent years as alternative places of service--including urgent care centers, retail clinics, telehealth and ambulatory surgery centers (ASCs)--have become more widespread. Based on the study results, different places of service are associated with different diagnoses. For example, in retail clinics and urgent care centers in 2016, acute respiratory infections, such as the common cold, were the number one diagnostic category--but in telehealth, mental health-related diagnoses were number one.
Places of service differ in cost. In 2016, the median charge for a 30-minute new patient office visit ranged from $294 in an office to $242 in an urgent care center to $109 in a retail clinic.
FH Medical Price Index: A New View of Medical Pricing
The FH Medical Price Index reports shifts in costs and permits useful comparisons among medical prices in six procedure categories:
- Professional E&M (excluding E&Ms performed in a hospital setting);
- Hospital E&M (excluding E&Ms performed in a professional setting, such as typical office visits);
- Medicine (excluding E&Ms);
- Surgery (procedures for which the physician would bill);
- Pathology and laboratory (technical and professional components, e.g., both equipment and physician services); and
- Radiology (technical and professional components).
The current categories emphasize professional fees and related costs and do not reflect facility fees.
The average median billed charge for professional evaluation and management services (E&Ms) provided in a hospital setting increased 28 percent in five years, from an index value of 1.00 in May 2012 to 1.28 in May 2016, according to the FH Medical Price Index. The index also shows that five-year growth for allowed amounts for professional E&Ms in a hospital setting--reflecting the maximum amount an insurer will pay for a service--was slightly lower: 26 percent, from 1.00 in May 2012 to 1.26 in May 2017.
By contrast, the index for professional billed charges for surgery shows growth of only three percent in the five-year period, and the surgery allowed amount index shows growth of two percent. The relative flatness of the surgery indices compared to those for professional E&Ms in a hospital setting may be due to a number of factors, including hospitals buying physician practices, new technologies that lower prices and hospital surgeons needing to keep their prices competitive with ASCs.
"FH Healthcare Indicators and the FH Medical Price Index bring a level of clarity to industry changes and medical costs not previously available," said FAIR Health President Robin Gelburd. "In a time when healthcare spending accounts for almost 18 percent of the nation's gross domestic product, and the healthcare ecosystem is undergoing rapid evolution, we hope that these new tools will inform decision making by all healthcare stakeholders, including payors, providers, government officials, policy makers and others."
As part of its mission, FAIR Health will update and reissue FH Healthcare Indicators and the FH Medical Price Index annually. In addition, FAIR Health makes available customized indicators and indices that offer specific data subsets (e.g., based on clinical category, geographic region or time period) of particular interest to stakeholders. Custom indicators and indices can be created to clients' specifications.
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About FAIR Health
FAIR Health is a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health possesses the nation's largest collection of private healthcare claims data, which includes over 25 billion claim records contributed by payors and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. FAIR Health also holds separate data representing the experience of more than 55 million individuals enrolled in Medicare. Certified by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity, FAIR Health receives all of Medicare Parts A, B and D claims data for use in nationwide transparency efforts. FAIR Health licenses its privately billed data and data products--including benchmark modules, data visualizations, custom analytics, episodes of care analytics and market indices--to commercial insurers and self-insurers, employers, hospitals and healthcare systems, government agencies, researchers and others. FAIR Health has earned HITRUST CSF and Service Organization Controls (SOC 2) certifications by meeting the rigorous data security requirements of these standards. As a testament to the reliability and objectivity of FAIR Health data, the data have been incorporated in statutes and regulations around the country and designated as the official, neutral data source for a variety of state health programs, including workers' compensation and personal injury protection (PIP) programs. FAIR Health data serve as an official reference point in support of certain state balance billing laws that protect consumers against bills for surprise out-of-network and emergency services. FAIR Health also uses its database to power a free consumer website available in English and Spanish and an English/Spanish mobile app, which enable consumers to estimate and plan their healthcare expenditures and offer a rich educational platform on health insurance. The website has been honored by the White House Summit on Smart Disclosure, the Agency for Healthcare Research and Quality (AHRQ), URAC, the eHealthcare Leadership Awards, appPicker, Employee Benefit News and Kiplinger's Personal Finance. FAIR Health also is named a top resource for patients in Elisabeth Rosenthal's book, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. For more information on FAIR Health, visit fairhealth.org.
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