To provide clarity in a rapidly changing healthcare environment, FAIR Health is introducing two new ways to derive insights from healthcare data: FH Healthcare Indicators(TM) and the FH Medical Price Index (TM). Drawing on the independent nonprofit's national database of billions of privately insured healthcare claims--the largest in the country--these two tools apply different approaches to illuminate different aspects of the national healthcare sector. FH Healthcare Indicators analyzes trends involving place of service in recent years. 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 evaluates changes in utilization, geographic and demographic factors, diagnoses, procedures and costs. These are some of the findings: (1) From 2007 to 2016, urgent care centers showed an increase in claim lines of 1,725 percent--a growth rate more than seven times that of ER claim lines (229 percent) in the same period; (2) 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 the number one diagnostic category; (3) Across all places of service studied in 2016, more claim lines were submitted for women than men in every adult age group; (4) In 2016, the median charge for a 30-minute new patient office visit (CPT(C) 1 code 99203) ranged from $294 in an office to $242 in an urgent care center to $109 in a retail clinic; (5) From 2007 to 2016, claim lines for ASCs increased more in rural (127 percent) than urban (95 percent) areas; and (6) The age group 31 to 40 years accounted for the greatest percent of claim lines among patients using urgent care centers (18 percent), but among those using telehealth, the peak age groups were 41 to 50 and 51 to 60 years (each 19 percent). The FH Medical Price Index tracks the growth in median procedure charges and median imputed allowed amounts2 from May 2012 to May 2017 in six procedure categories, none of which include facility fees: (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, e.g., both equipment and physician 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, the FH Medical Price Index establishes a consistent point of reference that makes it easy to identify and compare shifts. In its first release, the FH Medical Price Index reveals, among others, the following findings: (1) Of the six categories, hospital E&Ms had the greatest percent increase in charges and allowed amounts over the five years under study: 28 percent for the former, 26 percent for the latter; (2) Charges for professional E&Ms increased 22 percent, and allowed amounts increased 21 percent; (3) Surgery charges and allowed amounts both had much lower growth rates than E&Ms in the same five-year period: three percent for the former, two percent for the latter; (4) Radiology charges and allowed amounts rose higher than surgery values in this period, but not by much: seven percent for both; (5) Medicine charges and allowed amounts both had a steep rise from November 2012 to May 2013, with the allowed amount rise (eight percent) exceeding the rise in charges (six percent); and (6) From May 2013 to May 2014, pathology and laboratory charges stayed flat--but allowed amounts fell from six percent to three percent.
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