A review of privately insured claims data shows that the median charge for a 30-minute new patient office visit ranged from $294 in an office to $242 in an urgent care center to $109 in a retail clinic.
Urgent care centers saw volumes grow at a rate of 1,725% for privately insured patients between 2007 and 2016, which is more than seven times the volume growth of emergency rooms for the period, according to data compiled in two reports by nonprofit FAIR Health.
The FAIR Health reports examine healthcare pricing, care venue utilization and services and are based on more than 25 billion privately billed healthcare claims.
Among the findings:
- From 2007 to 2016, urgent care centers showed an increase in claims of 1,725%—a growth rate more than seven times that of ER claims (229%) in the same period.
- In retail clinics and urgent care centers in 2016, acute respiratory infections, such as the common cold, were the number one diagnostic category.
- In telehealth, mental health-related diagnoses were the number one diagnostic category.
- Across all care venues in 2016, more claims were submitted for women than men in every adult age group.
- In 2016, the median charge for a 30-minute new patient office visit ranged from $294 in an office to $242 in an urgent care center to $109 in a retail clinic.
- From 2007 to 2016, claims for ambulatory surgery centers increased 127% in rural areas and 95% in urban areas.
- The 31- to 40-year-old demographic accounted for 18% of claims among patients using urgent care centers. For telehealth, the peak age groups were 41 to 50 and 51 to 60 years, at 19% each.
- The median billed charge for evaluation and management services in a hospital increased 28% in from 2012 to 2016. For the same period, the growth for allowed amounts for E&Ms in a hospital—reflecting the maximum amount an insurer will pay for a service—was 26%.
- The index for billed charges for surgery shows growth of 3% from 2012 to 2016, and the surgery allowed amount index shows growth of 2%.
FAIR Health said the relative flatness of the surgery indices when compared to those for professional E&Ms in a hospital are due to factors that include hospitals buying physician practices, new technologies that lower prices, and hospital surgeons staying competitive with ambulatory surgery centers.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.