FH Healthcare Indicators and FH Medical Price Index: 2020 : an annual view of place of service trends and medical pricing
- Collection:
- Health Policy and Services Research
- Series Title(s):
- White paper (FAIR Health, Inc.)
- Contributor(s):
- FAIR Health, Inc., issuing body.
- Publication:
- New York, NY : FAIR Health, Inc., March 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Facilities and Services Utilization -- statistics & numerical data Facilities and Services Utilization -- trends United States
- Genre(s):
- Technical Report
- Abstract:
- This is the third annual edition of FH Healthcare Indicators and FH Medical Price Index, two measures developed by FAIR Health to provide clarity in a rapidly changing healthcare environment. Drawing on the independent nonprofit's national database of billions of privately insured healthcare claims--the largest in the country--these two measures apply different approaches to illuminate different aspects of the national healthcare sector, including, among other factors, trends in the place of service and billed and allowed amounts for professional services. FH Healthcare Indicators analyze trends involving the place of service, or setting (e.g., office, inpatient hospital, retail clinic, urgent care center, telehealth, ambulatory surgery center [ASC] and emergency room [ER]), for healthcare in recent years. Focusing on alternative places of service--retail clinics, urgent care centers, telehealth and ASCs--as well as ERs, FH Healthcare Indicators evaluate changes in utilization, geographic and demographic factors, diagnoses, procedures and costs. In the new edition, all time frames shift forward one year from the previous edition. For example, if a chart last year showed usage trends from 2012 to 2017, this year's chart shows 2013 to 2018. These are some of the key findings: (1) Growth in utilization continued in recent years but at a slower pace across all the places of service studied for growth in utilization. For retail clinics and telehealth, there was growth in 2013-2018, but at a slower rate compared to 2012-2017. For urgent care centers, ASCs and ERs, there was growth in 2009-2018, but at a slower rate compared to 2008-2017. (2) For three places of service, there was a decrease in utilization from 2017 to 2018: urgent care centers (11 percent), ASCs (12 percent) and ERs (15 percent). For two places of service, there was a rise in utilization in that period: retail clinics (10 percent) and telehealth (12 percent). (3) For three places of service (urgent care centers, ASCs and ERs), rural and urban utilization both decreased from 2017 to 2018. But in two places of service, retail clinics and telehealth, that period saw an increase in utilization in urban areas accompanied by a decrease in rural areas. (4) Nationally in 2018, as in 2017, the percentage of all medical claim lines attributed to retail clinics was less than 0.1 percent; the percentage attributed to urgent care centers was more than 1 percent and that attributed to ERs more than 2 percent. (5) In 2018, as in 2016 and 2017, claim lines were submitted for women more than 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. (6) The most common diagnostic category in 2018 in retail clinics and urgent care centers was acute respiratory infections. But in telehealth and among individuals over 22 years of age in the ER, it was digestive system issues. (7) In retail clinics and ERs, the 51-60 age group had the greatest share of claim lines in 2018. But in urgent care centers and telehealth, it was the 31-40 age group. (8) In 2018, the median charge amount for a 30-minute new patient office visit (CPT1 99203) ranged from $129 in a retail clinic to $211 in an office to $222 in an urgent care center. FH Medical Price Index tracks the weighted average growth in median procedure charges and median imputed allowed amounts2 in six procedure categories. This report does not consider facility fees. The categories are: (1) Professional evaluation and management (E&M; excluding E&Ms performed in a hospital setting); (2) Hospital E&M (excluding E&Ms performed in a professional setting, such as typical office visits); (3) Medicine (excluding E&Ms); (4) Surgery (procedures for which the physician would bill); (5) Pathology and laboratory (including both technical and professional components, i.e., both equipment and professional services); and (6) Radiology (including both technical and professional components). May 2012 is the base month, to which values in later periods are compared; therefore, FH Medical Price Index establishes a consistent point of reference that makes it easy to identify and compare shifts. In the first edition, FH Medical Price Index presented an overview from May 2012 to May 2017, which was extended in the second edition to November 2018. In the new edition, the indices are extended to November 2019. Findings include the following, all for the period November 2018 to November 2019: (1) Of the six procedure categories, hospital E&Ms had the greatest percent increase in charge amount index, nine percent, and the second greatest percent increase in allowed amount index, seven percent. (2) Surgery had the greatest percent increase in allowed amount index, nine percent, and the second greatest percent increase in charge amount index, seven percent. (3) The radiology charge amount index decreased one percent, the only decrease in either charge amount or allowed amount indices. (4) Pathology and laboratory, and radiology, had the lowest percent increases in allowed amount index, each one percent. (5) The professional E&M charge amount and allowed amount indices increased five percent. (6) The medicine charge amount index grew six percent and allowed amount index four percent. (7) The pathology and laboratory charge amount index increased three percent.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (54 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101774948 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101774948