Feb 28, 2023 - Health

Medical claims are increasing in complexity, report finds

Share of U.S. emergency department insurance claims for urinary tract infections, by level
Data: Kaiser Family Foundation analysis of Merative MarketScan data; Note: Includes enrollees with private insurance coverage from large employers; Chart: Simran Parwani/Axios

Visits to emergency departments and physicians' offices have grown more complex and costly over time — at least based on the way providers are billing, per a Peterson-KFF Health System Tracker report released Monday.

What they're saying: "There is a trend towards visits being billed at higher levels over time," the authors wrote. "For consumers who bear the marginal costs of more expensive services — those with co-insurance or deductibles — this trend impacts out-of-pocket costs in addition to overall health system costs."

By the numbers: The overall number of claims at the highest two levels of complexity in outpatient settings such as office, urgent care, and emergency departments grew from 22% in 2004 to 43% in 2021.

  • For the emergency department it grew from 33% in 2004 to 60% in 2021.

Between the lines: The report also looked at specific conditions, such as urinary tract infections, which were unlikely to be worsening over time and where their presence with another disease have a smaller impact.

  • Moderately complex claims accounted for 54% of emergency department claims and 67% of all outpatient office claims for UTIs in 2004. Higher complexity claims made up 26% and 14% in those settings, respectively.
  • Moderate complexity UTI claims accounted for only 31% of emergency department claims and 57% of outpatient office claims in 2004. The number of higher complexity claims in those settings jumped to 66% and 37%, respectively, by 2021.
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