FAIR Health Identifies Key Indicators for Changing Venues of Care

September 20, 2018

Patients increasingly are seeking treatment from alternative venues of care, such as urgent care centers, retail clinics, ambulatory surgery centers (ASCs) and telehealth. FAIR Health is opening a window into trending key indicators associated with these venues.

Drawing on our database of billions of private healthcare claims, FAIR Health is able to track changes in utilization for a venue of care over time, both nationally and by geographic area. For example, urgent care center usage increased 1,974 percent nationally from 2007 to 2017. The increase was greater in rural areas (2,312 percent) than urban areas (1,948 percent).

FAIR Health can identify the most common diagnoses for a venue of care. In 2017, the number one diagnosis at retail clinics was acute respiratory infections, representing 34 percent of all claim lines for that venue. By contrast, the number one diagnosis associated with telehealth was mental, behavioral and neurodevelopmental disorders, at 16 percent of all telehealth claim lines.

The most common procedures for a venue of care can be identified, along with the typical costs, which may differ from one venue to another. In 2016, the median charge for a 30-minute new patient office visit (CPT^®1 code 99203) ranged from $294 in an office to $242 in an urgent care center to $109 in a retail clinic.

Utilization by age and gender is another area that can be illuminated by claims data. In 2016, ASC utilization was higher for males than females in the pediatric population (ages 0 to 18). But, among patients aged 19 and older, females were five to ten percent more likely than males to use an ASC.

FAIR Health can analyze patient migration from one venue to another. In the period 2014-2016, 76 percent of patients who were first diagnosed with an upper respiratory infection in an office setting and who required a second visit returned to an office for that visit. Nine percent went to an inpatient setting, eight percent to an outpatient setting, four percent to the emergency room and three percent to urgent care.

FAIR Health can provide similar, market-specific information about venues of care and patient migration in a designated location. Such analyses can inform strategic decisions about issues such as affiliation, expansion and referral streams.

For more information on FAIR Health data and analytics related to venues of care or patient migration, email us at info@fairhealth.org or call us at 855-301-3247, Monday through Friday, 9 am to 6 pm ET.

^{1. CPT © 2017 American Medical Association (AMA). All rights reserved.}