Telehealth, Urgent Care, Retail Clinics Getting More Popular

Ken Terry

April 02, 2019

The use of alternative places of health service, such as telehealth, retail clinics, urgent care clinics, and emergency rooms, has grown rapidly over the past decade, a new report from the independent, nonprofit research firm FAIR Health shows.

But a very low percentage of the care delivered in the US healthcare system is provided in these venues, according to FAIR Health's analysis of the largest private claims database in the country.

From 2016 to 2017, for example, the number of telehealth claim lines grew by a dramatic 53%, but represented only 0.11% of all medical claim lines. (Claim lines are individual services within a claim.)

The utilization of urgent care centers (UCCs) jumped 14% in 2017, but only 1.2% of all claim lines came from UCCs. Similarly, retail clinic claim lines increased 7%, but utilization of that care setting was just 0.03% of the claims universe.

By comparison, the utilization of emergency rooms (ERs) dropped 2% in 2017, but totaled 2.6% of total claim lines — the highest percentage among the care venues studied. Utilization of ambulatory surgery centers (ASCs) increased 6% to nearly 1% of all claim lines.

Retail clinics, while increasing their overall number of claim lines, hit a wall in urban areas, where their utilization fell 28% in 2017. Retail clinic use held steady in rural areas, however, with 3% growth. In the same period, UCC utilization increased 15% in urban areas while remaining flat in rural regions.

Small Base, Big Growth

Over longer periods of time, the report shows, the use of alternative care settings has grown very rapidly from a small base. From 2008 to 2017, for example, UCC usage climbed by 1434%, more than seven times faster than the 194% growth of ER utilization. Claim lines for ASCs grew 97% during the same period.

Similarly, claim lines for retail clinics jumped 674% from 2012 to 2017, although retail clinic growth slowed compared with that shown in last year's report.

Telehealth utilization soared by 1202% from 2012 to 2017, and the number of telehealth claim lines accelerated more quickly in urban areas than in rural areas. The rural increase in telehealth claim lines during this time period was 482%, while urban usage jumped 1289%.

Diagnostic Categories

In 2017, more women than men used alternative care settings. The most common diagnostic category in 2017 in retail clinics and UCCs, and among people over 22 years old in the ER, was respiratory infections.

For individuals aged 22 and younger in the ER, digestive system issues were the top diagnostic category. Of course, the range of issues seen in the ER was more extensive and wide-ranging than in any of the other alternative care settings.

Mental health issues were the top diagnostic category among claims submitted for telehealth services in 2016. But in 2017, behavioral health dropped to the fifth most common problem. The leading categories in telehealth claims were injuries (eg, contusions, open wounds), acute respiratory infections, and digestive system issues.

The report reveals differences in the ages of people who used various alternative care settings. In UCCs, the highest number of claims was submitted for individuals aged 31-40 in 2017. In comparison, the peak age group for retail clinics was 51-60 years of age. Forty-four percent of the telehealth claims were associated with people aged 31-60 — a decrease from 56% the previous year. At the same time, children and young adults increased their use of telehealth.

Comparative Prices

Based on its analysis of roughly 28 billion claims, FAIR Health also provided price comparisons for specific diagnostic categories across the alternative care settings.

For evaluation and management (E&M) codes, retail clinics in 2017 had national average charges ranging from $147 for CPT 99203 (a 30-minute new-patient visit) to $105 for CPT 99213 (a 15-minute established-patient visit). The average allowed amounts for those codes were $99 and $78, respectively.

Urgent care centers had national average E&M charges ranging from $308 for CPT 99204 (a 45-minute new-patient visit) to $166 for CPT 99213 (a 15-minute visit). Average allowed amounts for those codes were $168 and $98, respectively. So not only charges but also allowed amounts were higher in UCCs than in retail clinics.

The report also compares median charges and allowed amounts for office, UCC, and retail clinic E&M codes. For a CPT 99203 visit, for instance, the median charges were $207 for offices, $213 for UCCs, and $129 for retail clinics in 2017. The median allowed charges were $92, $114, and $85, respectively.

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