FAIR Health Delivers Keynote at Washington State of Reform Conference

January 17, 2019

On January 10, FAIR Health President Robin Gelburd delivered the afternoon keynote address at the 2019 Washington State of Reform Health Policy Conference in Seattle, WA. Speaking to hundreds of attendees, Ms. Gelburd presented FAIR Health data that shed light on Washington State’s healthcare sector and how it differs from that of other states and the nation.

Underlying Ms. Gelburd’s presentation was the geographical specificity of FAIR Health cost and utilization data, which provide 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.) Ms. Gelburd noted that FAIR Health has data for eight geozips in Washington State, as compared to the two regions that Medicare uses for the state.

Venues of Care

Ms. Gelburd presented data on utilization, diagnoses and patient age distribution for different venues of care in Washington State versus the nation. For example, she showed that, from 2009 to 2017, there was a dramatically higher increase in usage of retail clinics in Washington (3,400 percent) than nationally (625 percent). In contrast, increase in usage of urgent care centers was about the same in Washington as nationally (both 533 percent).

The distribution of diagnoses differed somewhat in Washington as compared to the nation. In retail clinics and urgent care centers in Washington and the nation in 2017, acute respiratory infection was the top diagnosis. But in Washington, urinary tract infection was the second most common diagnosis in both venues. In contrast, nationally the second most common diagnosis in both venues was general symptoms (fever, malaise, headache).

Emergency room (ER) utilization differed sharply in Washington and the nation. ER usage fell 31 percent in Washington from 2014 to 2017, while growing 111 percent nationally. Patient age distribution also differed in Washington and the nation. Utilization was highest for patients over age 70 in Washington, compared to patients aged 51-60 nationally.

Behavioral Health

Another area of focus for Ms. Gelburd’s address was behavioral health. She revealed that in the 10 years from 2007 to 2017, just before and since the Mental Health Parity Act of 2008, utilization of behavioral health in Washington increased more slowly than in the nation and two other western states. In Washington, usage increased 55 percent compared to 93 percent nationally and 180 percent and 184 percent, respectively, in California and Colorado.

Varying Reimbursement Models

Ms. Gelburd compared different reimbursement models for specific procedure codes in Seattle and Washington, including 80th and 50th percentile charges, 125 percent of median allowed and the Centers for Medicare & Medicaid Services (CMS) rate. The results varied. For example, the 80th percentile charge for a moderate severity ER visit (CPT^®1 99283) was higher in Seattle ($421) than the state as a whole ($379), but the 50th percentile charge was lower in Seattle ($219) than statewide ($290).

For more information on FAIR Health custom analytics and services to states, contact us by email at info@fairhealth.org or call us at 855-301-3247, Monday through Friday, 9 am to 6 pm ET.

^{1. CPT © 2018 American Medical Association (AMA). All rights reserved.}