The Price of Services at Different Sites of Care

By April 3, 2018Commentary

Fair Health is a non-profit entity which has created a massive, multi-payer database of claims paid and analyzes the data for price and other trends.  It releases a report of place of service trends and on prices.   (Fair Health Brief)   Some highlights from the report.  Urgent care center usage is growing very rapidly, suggesting it is becoming a common place for primary care.  From 2007 to 2016 claims for urgent care services rose 1725%, while ER use, which draws a lot more attention, increased 229% in the same time frame.  The most common complaint treated in retail clinics and urgent care centers in 2017 was acute respiratory infection, while mental health issues were the most cause of telehealth use, at 31% of all claims.  While urgent care use rose faster in rural than urban areas early in the study period, they were roughly equivalent by 2016.  Ambulatory surgery center use increased more in rural areas than urban ones.  Telemedicine use rose about 643% from 2011 to 2016, with more growth in rural areas.  People aged 31 to 40 are the largest set of users of urgent care centers, while those aged 41-60 were the highest users of telehealth sites.  Younger people and females are higher users of retail clinics.  Urgent care centers tend to be used more for children and women are also higher users of this setting than are men.

In terms of prices, with May 2012 being the base month, Fair Health tracked both submitted charges and allowed (reimbursed) amounts.  In 2016 the median charge (a weighted average would be more meaningful) for a 30 minute new patient visit cost $294 in a physician’s office, $242 in an urgent care center and $109 in a retail clinic.  Not much benefit from a cost perspective to urgent care use, and maybe there is something to that CVS/Aetna merger after all, if you can convince patients to get all their care at a retail clinic.  Hospital evaluation and management services had the highest increase in submitted charges, 28%, and paid amounts, 26%, over a five-year period.  Not surprising given consolidation horizontally and vertically within hospital systems.  Doctor office charges and paid amounts, by comparison, rose 22% and 21% respectively.  By comparison, surgery and radiology charges and paid amounts rose by a much slower percent, with surgery prices being almost flat.   The report provides an interesting new look at site of care usage and price trends.

Kevin Roche

Author Kevin Roche

The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry through Roche Consulting, LLC. Mr. Roche is available to assist health care companies through consulting arrangements and may be reached at khroche@healthy-skeptic.com.

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