FAIR Health Delivers Keynote at Arizona State of Reform Conference
On May 23, FAIR Health President Robin Gelburd delivered the morning keynote address at the first annual Arizona State of Reform Health Policy Conference in Phoenix, Arizona. Ms. Gelburd shared data revealing the distinctive aspects of Arizona’s healthcare environment. This address followed on other recent keynotes delivered by Ms. Gelburd at the Alaska State of Reform, Washington State of Reform and Texas State of Reform conferences held in October 2018, January 2019 and February 2019, respectively.
Speaking to an audience of healthcare stakeholders, including payors, providers, researchers and government agencies, among others, Ms. Gelburd noted that FAIR Health’s data enable geographical specificity in cost and utilization analyses, providing insight into 493 distinct geozips nationwide. (A geozip is a geographical region that tends to track with the first three digits of a zip code.)
Alternative Venues of Care
Ms. Gelburd presented data on alternative venues of care (such as retail clinics, urgent care centers and ambulatory surgery centers) showing that their utilization has risen nationwide. There are, however, notable regional differences in use patterns. For example, in Arizona in 2017, retail clinics were used mainly by those over age 60 (54 percent of claim lines), while nationally that age group represented only 16 percent of claim lines. Ms. Gelburd pointed out that Arizona is experiencing challenges in access to primary care, and it may be that the over-60 population in Arizona is using retail clinics as a vital part of their “primary care landscape.” This is unusual when compared to national trends.
For emergency room (ER) use, Arizona experienced a 65 percent increase in claim lines from 2009 to 2017, compared to a 128 percent increase nationally. The distribution of ER diagnoses differed notably in Arizona as compared to the nation, Ms. Gelburd said. Nationally, the number one ER diagnosis in 2017 was cardiac events. That diagnosis did not appear among the top five ER diagnoses in Arizona, where the top diagnosis was acute respiratory infection. Since cardiac events generally lead to inpatient admissions, Ms. Gelburd said, and freestanding ERs do not perform inpatient admissions, the high number of freestanding ERs in Arizona may have caused the percentage of cardiac events in ERs in that state to be less than in the nation as a whole.
Ms. Gelburd also discussed use of behavioral health services in Arizona. Major depressive disorder (21 percent of behavioral health claim lines) was the top behavioral health diagnosis in Arizona in 2017. The top diagnosis nationally was mental and behavioral disorders due to psychoactive substance abuse (28 percent of behavioral health claim lines).
Varying Reimbursement Models
Surprise billing for emergency services is currently a highly contentious issue. Ms. Gelburd noted that reimbursement models for specific procedure codes for emergency services can vary greatly from city to city. For instance, in Phoenix the 80th and 50th percentile charges ($1,800 and $1,723, respectively) for a high-severity ER visit (CPT®1 99285) were higher in contrast to those in the Prescott/Kingman/Globe area ($1,219 and $1,023, respectively). Ms. Gelburd noted that FAIR Health, as a neutral, independent authority, is frequently consulted as a resource on surprise billing.
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1. CPT © 2018 American Medical Association (AMA). All rights reserved.