Urgent Care Insurance Claims Rise Sharply, Faster than ED

Gregory A. Freeman, March 26, 2018

The average median billed charge for professional evaluation and management services (E&Ms) provided in a hospital setting increased 28% in five years, from an index value of 1.00 in May 2012 to 1.28 in May 2016, according to the FH Medical Price Index, the report says. “The index also shows that five-year growth for allowed amounts for professional E&Ms in a hospital setting—reflecting the maximum amount an insurer will pay for a service—was slightly lower: 26%, from 1.00 in May 2012 to 1.26 in May 2017.

Surgery Charges Almost Steady

By contrast, the index for professional billed charges for surgery shows growth of only three percent in the five-year period, and the surgery allowed amount index shows growth of two percent, FAIR Health President Robin Gelburd said in a statement accompanying the report. The relative flatness of the surgery indices compared to those for professional E&Ms in a hospital setting may be due to a number of factors, including hospitals buying physician practices, new technologies that lower prices and hospital surgeons needing to keep their prices competitive with ASCs.

"In a time when healthcare spending accounts for almost 18% of the nation’s gross domestic product, and the healthcare ecosystem is undergoing rapid evolution, we hope that these new tools will inform decision making by all healthcare stakeholders, including payors, providers, government officials, policy makers and others," Gelburd said.

Gregory A. Freeman

Gregory A. Freeman is a contributing writer.

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