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The changing location of medical care

Emergency departments saw a 30% decrease in overall use between 2019 and 2020, but they weren’t alone. Declines were seen in retail clinics, urgent care centers and doctors’ offices. Where have all these patients gone?

I have a word for you, telehealth. Remote care, driven by infectious disease, made big inroads in the past year – increasing 7000% between 2019 and 2020.

“…telehealth has grown in 2020 on a scale not seen in previous years.”

This is a sea change fueled by two important trends – first, the self-imposed limits of face-to-face encounters in doctors’ offices. But more interestingly, unlike other places of care, most patients were not seeking treatment for an infectious disease, i.e. COVID. The majority of these visits, 44%, were for mental health issues. This may help explain the several thousand mental health apps now available on our phones. If we are looking for lasting change, mental health is moving from the office to remote care on our desktops and phones. Without the need to touch, feel or probe, at least with the doctor’s hands, this care can be easily distanced and a win-win for everyone. It allows for more convenient and private access for patients and the ability for practitioners to provide care in an area larger than their neighborhood.

Retail clinics and urgent care

Here we’re talking about those offices within a CVS, Walgreens, or Walmart, and those that I pejoratively describe as “doc in the box,” corporate health care that looks a lot like the Chipotles of the healthcare industry. health. Although their growth in recent years has been touted at 30 or 40% or more, this figure is misleading. Retail clinics represent 0.05% of total claims and emergency care 1.3%. They are practical, especially for 31-40 year olds, their most frequent consumer. It’s much easier to show up for a minor ailment than to make an appointment and wait to be seen in a doctor’s office. That said, their commercial placement limits usage. The map shows no discernible trend and usage is even less in rural areas than in urban and suburban areas.

In the COVID era, both acted as de facto diagnostic hubs – 50% of visits to retail clinics were related to COVID exposure, symptoms, or the need for vaccinations. For emergency care, the percentages were higher, 13% of their requests for “antigen detection” and an additional 60% for the office visits that accompanied this test. We might consider the extra amount we pay for long-term convenience. Consider payments.

While the difference between the “list price” of drugs and their actual cost grabs the headlines, a similar phenomenon occurs for all medical expenses: the “fee” has only a loose relationship to the amount “paid “. The cost of COVID care includes payment for vaccinations and “assessment and management” of the patient. Payment for vaccination comes from the federal government and is consistent across all “care platforms.” This is not the case with these payments for evaluation and management.

Location, location, location

Some facilities are more expensive to operate; they have expensive imaging equipment and provide round-the-clock care. to an emergency department. More importantly, their overhead costs are comparable to those of a doctor’s office. This is not reflected in payments for care.

Care for the “well-worried” and those with simple diagnostic issues, a sore throat, earache or sprain, tends to revolve around quick in and out retail and patient care. emergency, paid more than a doctor in their office for identical services. As care becomes more complex (roughly consistent in illustration by time spent with patient), in-office care receives slightly higher rates than emergency care – malls n don’t even intervene.

Moving high-margin, low-complexity care to more convenient places has gained traction with the pandemic, but it comes at a cost. This convenience of care, and I don’t deny its value, costs you more in doctor’s fees, $19 to $35 more (depending on CPT codes 99202 and 99203). More importantly, for physicians, it changes their patient mix – removing high-margin, low-complexity care leaves only low-margin, high-complexity patients. The $239 I get for the hour of care at the resort (99205) is a lot less, $93, than the four 15-minute patients (99202) I could have seen.

This disparity in payment and the desire to balance work and personal life are important factors in ending consistent face-to-face primary care. We are wise in terms of money and money. We have to be careful what we wish for.

[1] The dataset includes private insureds and those participating in Medicare Advantage programs, but not traditional health insurance. Data does not include government-insured or uninsured persons.

Source: FH® Healthcare Indicators and FH® Medical Price Index 2022 – A Equitable Health White Paper

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