NEW YORK, NY--April 1, 2019--From 2016 to 2017, private insurance claim lines for services rendered via telehealth as a percentage of all medical claim lines grew 53 percent nationally, more than any other venue of care studied for that variable in the second annual edition of FH Healthcare Indicators®. FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information, released this report, along with the second annual edition of the FH Medical Price Index®, in a just published white paper. The white paper combining both reports is based on FAIR Health's database of over 28 billion privately billed healthcare claim records--the largest such repository in the country.
Like the inaugural release a year ago, this year's edition of FH Healthcare Indicators and the FH Medical Price Index is intended to assist the full spectrum of healthcare stakeholders by providing clarity in a rapidly changing healthcare environment.
FH Healthcare Indicators
FH Healthcare Indicators reveal trends and patterns in the places where patients receive healthcare. Focusing on alternative places of service--retail clinics, urgent care centers, telehealth and ambulatory surgery centers (ASCs)--as well as emergency rooms (ERs), FH Healthcare Indicators evaluate changes in utilization, geographic and demographic factors, diagnoses, procedures and costs.
From 2016 to 2017, by comparison with telehealth's 53 percent growth rate, national usage of urgent care centers increased 14 percent, of retail clinics 7 percent and of ASCs 6 percent, while that of ERs decreased 2 percent.
From 2008 to 2017, urgent care center usage grew 1,434 percent, more than seven times that of ERs (194 percent). This was a continuation of the trend from 2007 to 2016 reported in last year's edition, when urgent care center usage growth also had been more than seven times greater than ER growth.
In 2017, as in 2016, more claim lines were submitted for women than for men in all adult age groups in the places of service in which FAIR Health studied gender-related patterns--retail clinics, urgent care centers, telehealth, ASCs and ERs.
FH Medical Price Index
The FH Medical Price Index reports shifts in costs and facilitates useful comparisons among medical prices in six procedure categories:
- Professional evaluation and management (E&M[1]; 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 reports reflect professional fees and related costs; they do not reflect facility fees.
In the first edition, the FH Medical Price Index presented an overview from May 2012 to May 2017. In the new edition, the indices are extended to November 2018. Of the six categories, hospital E&Ms had the greatest percent increase in billed charge amount index for the period November 2017 to November 2018--seven percent. Hospital E&Ms and radiology had the greatest percent increase in allowed amount indices in that period, both seven percent, while the radiology charge amount index grew six percent.
FAIR Health President Robin Gelburd stated: "The first edition of FH Healthcare Indicators and the FH Medical Price Index drew a welcome public response, as stakeholders expressed appreciation for being offered this 'macro' view into the nation's healthcare system. We hope that this new edition continues to inform decision making throughout the healthcare sector by payors, providers, government officials, policy makers, academic researchers and others."
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In addition to its annual release of FH Healthcare Indicators and the FH Medical Price Index, 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.
For the complete white paper, click here.
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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 28 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 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, providers, hospitals and healthcare systems, government agencies, researchers and others. Certified by the Centers for Medicare & Medicaid Services (CMS) as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health houses data on Medicare Advantage enrollees in its private claims data repository. FAIR Health can produce insightful analytic reports and data products based on combined Medicare and commercial claims data for government, providers, payors and other authorized users. 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 for 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.
Contact:
Dean Sicoli
Executive Director of Communications and Government Relations
FAIR Health
646-664-1645
dsicoli@fairhealth.org