Fair Health Releases 6th Annual Report Detailing Where Patients are Utilizing Health Services

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

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.

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.

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.
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.

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.