Urgent care claims skyrocket; ER claims pale in contrast
Private insurance claim lines for services rendered in urgent care centers grew 1,725% between 2007 and 2016. That was well above the growth rate of 229% for emergency room (ER) claims during the same period.
In FAIR Health’s Healthcare Indicators and Medical Price Index, the data collection firm found large differences in charges depending on location: $294 for a 30-minute new patient office visit, $242 in an urgent care center and $109 in a retail clinic.
The average median billed charge for professional evaluation and management services (E&Ms) provided in a hospital setting increased 28% between 2012 and 2016.
FAIR Health pointed to a huge increase in alternative places of service, including retail clinics, urgent care centers, telehealth and ambulatory surgery centers (ASCs). However, the growth in urgent care centers, retail clinics and telehealth skyrocketed the most.
The data underscores a greater trend by payers, such as Anthem, to push more care to less pricey while still medically appropriate settings rather than a more expensive ER.
Payers are pulling many levers in an attempt to contain healthcare costs, which continue to grow. A recent JAMA report found the U.S. is spending about twice as much as other high-income countries on medical care despite having similar utilization rates. The difference is the U.S. spends much more on labor and goods, including pharmaceuticals and administrative costs.
Though FAIR Health found increased costs for every procedure category reviewed, the growth varied from 28% in median procedure charges for hospital E&Ms to 3% for surgery over a five-year period.
The difference between the surgery growth and professional E&Ms in a hospital setting could be connected to hospitals buying physician practices, new technologies that lower prices and hospital surgeons needing to remain competitive against ASCs, the report said.
The findings show that acute respiratory infections, including the common cold, were the number one diagnostic category in retail clinics in urgent care centers. In telehealth, mental health-related diagnoses topped the list. People between 31 and 40 years old were most likely to visit urgent care centers, while people between 41 and 60 years old were most likely to use telehealth services.
Also, claims for ASCs increased more in rural areas (127%) than urban areas (95%) or nationally (97%) between 2007 and 2016.