Trends in Place of Service and Prices

It is good to have multiple sources of data and analysis on health care issues.  Earlier this week we discussed a report from the Health Care Cost Institute on a limited set of services performed in a doctor’s office or hospital outpatient department.  Today we look at a report from Fair Health, a non-profit which collects data on health care services and pricing.    (Fair Report)    From 2016 to 2017, telehealth use grew 53%, urgent care visits rose 14%, retail clinic utilization increased 7%, ambulatory service center rose 6%, while ER use declined by 2%.  All of these sites of care, however, a relatively very small compared to the total.  And for some of these sites, like retail and telehealth, a few types of services account for most of the visits.  Respiratory infection issues account for over a third of visits to retail clinics.  Utilization also can vary by geography, for example in urban areas retail clinic use declined by 28% while it grew 3% in rural areas.  As might be expected, retail clinics have lower prices; the median cost for a 30 minute new patient evaluation was $213 in an urgent care center, $207 in an office setting and $129 in a retail clinic.  Looking at increases from November 2017 to November 2018, in both charged (or billed) amounts and allowed (or paid) amounts, for evaluation and management services across various service types, there has been a steady rise. For hospital E & M, it was 7% on both charged and allowed.  For radiology, the charged figure rose 6% and the allowed amount 7%.  For professional (physician, nurse practitioner, etc.) charged grew 4% and allowed by 3%.  For medicine, it was 4% and 3%, for surgery, 6% and 6% and for pathology and lab, 3% and 3%.  It is apparent from this that prices for this common set of services are rising faster than inflation and must be putting pressure on total health spending.  The report contains an extensive amount of detail, which is useful to understand certain trends.  One thing that comes through is that consumers continue to be driven by convenience, most of the alternative sites of care don’t usually require appointments and allow people with more minor issues to drive to a nearby clinic or urgent care center or use telecommunications to get quick attention.