National Headlines

Retail Clinic Utilization Increased 51% Nationally (FAIR Health Report)

Sixth Annual FAIR Health Report Highlights From Press Release

  • The FAIR Health analysis added that alternative care sites are more popular among women than men, with 2021 showing more claim lines for women across most age groups.
  • The most popular states for retail health clinics in 2021 included Rhode Island, Maine, Arkansas, Connecticut, and Georgia, with FAIR Health saying these states had the greatest percentage of retail health clinic claim lines.
  • Across offices, urgent care centers and retail clinics in 2021, the highest median charge amount for CPT®2 99203 (new patient outpatient visit, total time 30-44 minutes) was in urgent care centers at $240, while the median charge for offices was $226; in 2020, offices had had the highest median charge for that code.

Telehealth Utilization Declined 76 Percent Nationally from 2020 to 2021

Retail Clinic Utilization Increased 51 Percent Nationally from 2020 to 2021, according to Sixth Annual FAIR Health Report

© Concierge Medicine Today, LLC. 2022-2023 | Industry Trade Publication | Note: Survey Data Was Organized and Accumulated by Concierge Medicine Today, LLC. From 300+ Random NEW PHYSICIAN SEARCHES Submissions Received Between February 2020 to February 2023.

NEW YORK, NY—March 29, 2023—From 2020 to 2021, telehealth utilization declined 76 percent nationally while, during that same period, retail clinic utilization increased 51 percent nationally.1 Retail clinic growth had the greatest increase among all alternative places of service studied—retail clinics, urgent care centers, telehealth and ambulatory surgery centers (ASCs)—as well as emergency rooms (ERs), in a new FAIR Health white paper containing the sixth annual edition of FH® Healthcare Indicators and FH® Medical Price Index. Like the previous editions, this year’s edition of FH Healthcare Indicators and FH Medical Price Index is intended to provide clarity to all healthcare stakeholders in a rapidly changing healthcare environment.

RELATED STORY | Source, Census.gov
Two thousand Retail Health Clinics Provided Walk-In Health Services Mostly in Metropolitan Areas

FH Healthcare Indicators

FH Healthcare Indicators reveal trends and patterns in the places where patients receive healthcare. Focusing on alternative places of service and ERs, FH Healthcare Indicators evaluate changes in utilization, geographic and demographic factors, diagnoses, procedures and costs.

RELATED RESOURCE ABOUT RETAIL HEALTHCARE CLINICS | Source: Census.gov
The Linked Retail Health Clinics (LiRHC) database

Among the other key findings:

  • From 2020 to 2021, utilization increased 14 percent in urgent care centers, while decreasing 7 percent in ASCs and 15 percent in ERs.
  • CLICK HERE TO LEARN MORE ABOUT OUR OCTOBER 2023 CONFERENCE #fordoctors #conciergemedicineforum #conciergemedicine #conciergemedicineconference #learning | Photo Credit/Source: Staff, Concierge Medicine Today | Healthcare Industry Trade Publication

    Despite its decline from 2020 to 2021, national telehealth utilization grew 5,017 percent nationally from 2016 to 2021. This high rate of growth was due in large part to widespread limits on in-office services imposed at the start of the COVID-19 pandemic in 2020.

  • Among the alternative places of service studied (retail clinics, urgent care centers, telehealth and ASCs), as well as ERs, telehealth held the highest percentage of medical claim lines in 2021, with 3.7 percent of all medical claim lines nationally. The comparable percentages for the other places of service were 1.8 percent for ERs, 1.5 percent for urgent care centers, 0.6 percent for ASCs and 0.1 percent for retail clinics. The remainder of the services were rendered in traditional places of service, such as physician offices.
  • In 2021 as in previous years, more claim lines were submitted for females than males in most age groups in these alternative places of service and ERs.
  • However, in some places of service, such as retail clinics, urgent care centers and ERs, the gap between males and females continued to narrow in some age groups. For example, whereas the female share in the 19-30 age range in retail clinics had been close to 70 percent in 2019, it was 64 percent in 2020 and 60 to 63 percent in 2021.
  • In 2021, the five states in which retail clinic claim lines constituted the greatest percentage of medical claim lines were (from greatest to least) Rhode Island, Maine, Arkansas, Connecticut and Georgia. Minnesota fell off the list after having ranked first in 2018, third in 2019 and fifth in 2020.
  • In 2021, COVID-19 joined the list of most common diagnostic categories in retail clinics, urgent care centers, telehealth and ERs (for individuals over the age of 22).
  • Across offices, urgent care centers and retail clinics in 2021, the highest median charge amount for CPT®2 99203 (new patient outpatient visit, total time 30-44 minutes) was in urgent care centers at $240, while the median charge for offices was $226; in 2020, offices had had the highest median charge for that code.

FH Medical Price Index reports shifts in costs and facilitates useful comparisons among medical prices in six procedure categories from May 2012 to November 2022:

  • Professional evaluation and management (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 (including both technical and professional components, e.g., both equipment and professional services); and
  • Radiology (including both technical and professional components).
  • The reports reflect professional fees and related costs; they do not include facility fees.

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For the period November 2021 to November 2022:

  • Of the six procedure categories, hospital E&Ms had the greatest percent increase in the charge amount index, six percent. The allowed amount index for hospital E&Ms increased three percent.
  • Surgery and pathology and laboratory each had the greatest percent increase in the allowed amount index, four percent. The charge amount index for surgery increased five percent, while the charge amount index for pathology and laboratory increased four percent.
  • Radiology was the only category to stay completely flat in the charge amount index, at zero percent change. The allowed amount index for radiology grew two percent.
  • Professional E&Ms had the smallest percent increase in the allowed amount index, one percent. The charge amount index for professional E&Ms grew three percent.
  • The medicine charge amount index increased two percent, while the medicine allowed amount index grew three percent.

FAIR Health President Robin Gelburd stated: “We hope that this new edition of FH Healthcare Indicators and FH Medical Price Index, like those in previous years, continues to inform decision making throughout the healthcare sector by payors, providers, government officials, policy makers, academic researchers and others.”

For more information, see a free, 45-minute webinar on the findings. Entitled “FH® Healthcare Indicators and FH® Medical Price Index 2023: Providing Clarity in a Rapidly Changing Healthcare Environment,” it will be hosted by Ms. Gelburd on Wednesday, April 19, from 1 to 1:45 pm ET. To register, click here.

For the new white paper, FH® Healthcare Indicators and FH® Medical Price Index 2023: An Annual View of Place of Service Trends and Medical Pricing, click here.

1 Utilization in this study is a relative, normalized measure, not an absolute one. See Methodology section of the white paper.

2 CPT © 2022 American Medical Association (AMA). All rights reserved.

About FAIR Health

FAIR Health is a national, independent nonprofit organization that qualifies as a public charity under section 501(c)(3) of the federal tax code. It is 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 40 billion claim records and is growing at a rate of over 2 billion claim records a year. FAIR Health licenses its privately billed data and data products—including benchmark modules, data visualizations, custom 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 includes among the private claims data in its database, data on Medicare Advantage enrollees. 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’s systems for processing and storing protected health information have earned HITRUST CSF certification and achieved AICPA SOC 2 Type 2 compliance 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, which enables consumers to estimate and plan for their healthcare expenditures and offers a rich educational platform on health insurance. An English/Spanish mobile app offers the same educational platform in a concise format and links to the cost estimation tools. 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 Dr. Marty Makary’s book The Price We Pay: What Broke American Health Care—and How to Fix It and Dr. 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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SOURCE: Press Release; https://www.fairhealth.org/press-release/telehealth-utilization-declined-76-percent-nationally-from-2020-to-2021

 

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