Report: More patients are seeking care outside the ED, but median charges continue to rise

A bar chart showing positive business growth
A new analysis rolled out by FAIR uses claim data to chart trends in the cost of medical care and where patients receive their care. (Getty/NicoElNino)

Costs associated with evaluation and management (E&M) claims have greatly outstripped other types of healthcare services over the last five years, according to an analysis or privately billed healthcare claims. 

Hospital E&M claims saw the largest increase in charges (28%) and allowed amounts (26%) between 2012 and 2017, according to the report published (PDF) by FAIR Health, which charts industry trends based upon information from the group’s database of more than 25 billion claim records. Comparatively, surgery charges and allowed amounts grew just 3% and 2% respectively.

At the same time, use of nontraditional care providers, such as retail clinics and telehealth, have seen significant growth, particularly among patients seeking treatment for respiratory infections associated with the common cold and behavioral health. Claim lines for retail clinics increased 847% between 2011 and 2016, according to the report.

Urgent care centers saw a steady increase in claims, particularly in rural areas, with claim lines increasing 1,725% between 2007 and 2016. ED claims, meanwhile, grew at a much slower rate of 229% over the same time frame. 

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While the report found the median charge for a 30-minute new patient office visit at a retail clinic to be only a third of that charged at a physicians office, the proliferation of alternative venues of care does not appear to have put a dent in rising charges generally. Across six categories of procedures, median charges increased between 2012 and 2016. 

Behavioral health claims topped the list for telehealth services, a use for the technology that has also been heavily promoted by behavioral health advocates. Researchers at FAIR suggest the growth in alternative care venues reflects a combination of increased availability of such providers and consumer acceptance of them.

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Robin Gelburd, J.D., president of FAIR Health, believes the new analyses will be useful in identifying and clarifying medical cost trends. “We hope that these new tools will inform decision-making by all healthcare stakeholders, including payers, providers, government officials, policymakers and others,” she said in a statement.

FAIR also calculates an estimate for the amount payers actually receive, which has generally followed trends similar to charges. Researchers did highlight some exceptions, such as a period between May 2013 and May 2014, when, despite flat charges for pathology and laboratory services, allowed amounts declined by half.