Fourth Annual FAIR Health Report Captures Pre-Pandemic State of the Healthcare System

From 2018 to 2019, telehealth increased in utilization by 73 percent, urgent care centers by 47 percent, retail clinics by 39 percent, emergency rooms (ERs) by 33 percent and ambulatory surgery centers (ASCs) by 30 percent. These are among the findings in a new FAIR Health white paper containing the fourth annual edition of FH® Healthcare Indicators and FH® Medical Price Index.

Like the previous editions, this year’s edition of FH Healthcare Indicators and FH Medical Price Index is intended to provide clarity to all healthcare stakeholders in a rapidly changing healthcare environment. FAIR Health bases the reports on its database of over 33 billion privately billed healthcare claim records—the largest such repository in the country.

FH Healthcare Indicators reveal trends and patterns in the places where patients receive healthcare. Focusing on alternative places of service—retail clinics, urgent care centers, telehealth and ASCs—as well as ERs, FH Healthcare Indicators evaluate changes in utilization, geographic and demographic factors, diagnoses, procedures and costs. For example, FH Healthcare Indicators show that in 2019, the median charge amount for a 30-minute new patient office visit (CPT®1 99203) ranged from $150 in a retail clinic to $217 in an office to $239 in an urgent care center.

FH Medical Price Index
FH Medical Price Index reports shifts in costs and facilitates useful comparisons among medical prices in six procedure categories from May 2012 to November 2020:

  • Professional evaluation and management (E&M; excluding E&Ms performed in a hospital setting);
  • Hospital E&M (excluding E&Ms performed in a professional setting, such as typical office visits);
  • Medicine (excluding E&Ms);
  • Surgery (procedures for which the physician would bill);
  • Pathology and laboratory (technical and professional components, i.e., both equipment and professional services); and
  • Radiology (technical and professional components).

The reports reflect professional fees and related costs; they do not reflect facility fees.

For the period November 2019 to November 2020:

  • Of the six procedure categories, hospital E&Ms had the greatest percent increase in charge amount index, 6 percent, and in allowed amount index, 10 percent.
  • The radiology charge amount index decreased one percent, the only decrease in either charge amount or allowed amount indices.
  • Radiology had the lowest percent increase in allowed amount index, three percent.

In this edition, as in previous editions, FH Healthcare Indicators and FH Medical Price Index each advance one year in the data they report: FH Healthcare Indicators to 2019 and FH Medical Price Index to 2020. For this reason, FH Healthcare Indicators do not include data from the COVID-19 pandemic year (next year’s edition will extend to 2020), whereas FH Medical Price Index does. Indeed, this year’s FH Healthcare Indicators present a valuable picture of the nation’s healthcare environment just before COVID-19 arrived in the United States, while FH Medical Price Index offers an account of healthcare pricing trends in the midst of the pandemic.

FAIR Health President Robin Gelburd stated: “As in previous years, FH Healthcare Indicators and FH Medical Price Index are highly relevant to understanding the nation’s healthcare system. We hope that this new edition continues to inform decision making throughout the healthcare sector by payors, providers, government officials, policy makers, academic researchers and others.”

For the new white paper FH® Healthcare Indicators and FH® Medical Price Index 2021: An Annual View of Place of Service Trends and Medical Pricing, click here.

1 CPT © 2020 American Medical Association (AMA). All rights reserved.