Robin Gelburd, JD

Robin Gelburd, JD, is the President of FAIR Health, a national, independent nonprofit organization with the mission of bringing transparency to healthcare costs and health insurance information. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 31 billion claim records contributed by payers and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. Certified by CMS as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health houses data on Medicare Advantage enrollees in its private claims data repository. Gelburd is a nationally recognized expert on healthcare policy, data and transparency.

 increased 5680% nationally from 0.15% of medical claim lines in May 2019 to 8.69% in May 2020, according to new data from FAIR Health’s 

 (Exhibit 1). Although substantial, that increase was less than the year-to-year increase the previous month, when telehealth claim lines increased 8336% nationally from 0.15% of medical claim lines in April 2019 to 13.00% in April 2020. The data represent the privately insured population, excluding Medicare and Medicaid.

Exhibit 1. Monthly Telehealth Regional Tracker, May 2020, United States

Against the backdrop of the year-to-year increase, telehealth claim lines fell 33% nationally from 13.00% of medical claim lines in April 2020 to 8.69% in May 2020.

The 4 US census regions (Midwest, Northeast, South and West) all showed trends similar to the nation as a whole. In each region, there were large percent increases in volume of claim lines from May 2019 to May 2020 (Exhibit 2), but these increases were smaller than the increases from April 2019 to April 2020.

Exhibit 2. Monthly Telehealth Regional Tracker, April 2020, South

In addition, in each region, there was a drop in volume of claim lines from April to May 2020. The biggest drop was in the South, where the decrease from April to May was 40%, from 9.81% of medical claim lines to 5.87%.

Higher telehealth utilization from March to May 2020 by comparison with the same months in 2019 suggests the impact of the COVID-19 pandemic. In March and April, many states prohibited elective procedures and non-emergency medical care when rendered in person, making telehealth an attractive alternative. Many of these prohibitions expired in May as states began to open up, perhaps accounting for the drop in the telehealth share of total medical claim lines that month relative to April. Nevertheless, the pandemic continued and telehealth usage remained high by comparison with 2019.

Other notable findings of the Monthly Telehealth Regional Tracker concern the top 5 telehealth diagnoses:

Mental health conditions, already the number 1 telehealth diagnosis nationally and in every region in April 2020, accounted for an even larger share of telehealth claim lines in May 2020. Nationally, this diagnosis increased from 34% to 40% of telehealth claim lines from April to May 2020. In May 2020, it constituted 40% or more of telehealth claim lines in every region but the South, whereas in April 2020 it did so only in the Midwest.

In May 2020, developmental disorders ranked among the top 5 telehealth diagnoses in all regions and nationally, whereas in April 2020 this diagnosis was in the top 5 in only one region (the West). In May 2019, it was not in the top 5 in any region. The COVID-19 pandemic appears to be driving the movement toward more use of telehealth in this area.

Launched in May as a free service, the Monthly Telehealth Regional Tracker uses FAIR Health data to track how telehealth is evolving. An interactive map of the 4 US census regions allows the user to view an infographic on telehealth in a specific month in each region, or in the nation as a whole. In addition to data on the volume of claim lines and on diagnoses, each infographic includes findings on urban versus rural usage and the top five telehealth procedure codes.

FAIR Health is a national, independent nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information.

COVID-19 is having a pronounced impact on telehealth, but the specifics of that impact vary from month to month. FAIR Health’s Monthly Telehealth Regional Tracker is showing in detail how this venue of care is evolving.

About Robin Gelburd, JD, president of FAIR Health

Robin Gelburd, JD, is the president of FAIR Health, a national, independent nonprofit organization with the mission of bringing transparency to healthcare costs and health insurance information. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 31 billion claim records contributed by payors and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. Certified by CMS as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health includes among the private claims data in its database, data on Medicare Advantage enrollees. Ms. Gelburd is a nationally recognized expert on healthcare policy, data and transparency.

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Robin Gelburd, JD, president of FAIR Health, discusses telehealth growth in May medical claims.

Telehealth Growth in May Rises Year to Year, but Drops Month to Month

Nationally and in every US census region, chronic kidney disease (CKD) and kidney failure were the most common comorbidity in hospitalized COVID-19 patients, accounting for 13% of all such patients in the period January-May 2020 (

). All regions except one resembled the nation in having type 2 diabetes as the second most common comorbidity; the exception, the South, had hypertension in that rank. These are among the findings of FAIR Health’s fourth COVID-19 study, 

Key Characteristics of COVID-19 Patients: Profiles Based on Analysis of Private Healthcare Claims

Most Common Comorbidities of Patients Hospitalized for COVID-19, Nationally, January-May 2020

This study uses the nation’s largest repository of private healthcare claims to illuminate some of the key characteristics of patients diagnosed with COVID-19. These characteristics include age, gender, rural vs urban area by age, venue of care where first diagnosed, venue of care by age, comorbidities of hospitalized patients and median costs of hospitalization. The patient characteristics are analyzed nationally and also by US census region. The data studied are from the period January-May 2020.

Nationally, the median charge amount for hospitalization of a COVID-19 patient ranged from $34,662 for the 23-30 age group to $45,683 for the 51-60 age group (

). The median estimated in-network amounts ranged from $17,094 for people over 70 years of age to $24,012 for people aged 51-60 years.

Median COVID-19 Hospitalization Charge Amounts and Estimated Allowed Amounts by Age, Nationally, January-May 2020

The West was the region with the widest range of costs for COVID-19 hospitalizations. There, median charge amounts ranged from $21,407 for the 19-22 age group to $93,459 for the over 70 age group. Median estimated in-network amounts ranged from $15,289 for the 19-22 age group to $60,205 for the over 70 age group.

Nationally, an office was the most common setting for initial presentation of patients with COVID-19: 33.3% of COVID-19 patients presented to an office and 23.0% presented to an inpatient facility (

). However, older people (age 61 and above) most commonly presented first to an inpatient setting.

Distribution of Patients with COVID-19 Diagnoses by Venue of Care Where First Diagnosed, Nationally, January-May 2020

In the Northeast, telehealth was more common for initial diagnosis of COVID-19 than emergency rooms (6.7% vs 6.2% of COVID-19 patients). The Northeast was the region with the highest percentage of COVID-19 patients who received their initial diagnosis via telehealth.

Nationally, males were associated with a larger share (54%) of the distribution of COVID-19 claim lines than females (46%).

Nationally, during the January-May time frame, COVID-19 was most commonly associated with the age group 51-60, which accounted for 29.9% of the distribution of claim lines with this diagnosis. Children (0-18 years) accounted for the smallest share, 1.5%. (It should be noted, however, that the age distribution may be in flux, with the average age of new COVID-19 patients in the United States having dropped by about 15 years compared with a few months ago, according to recent reports.)

In the South, Midwest and West, the age groups 19-30 and 31-40 accounted for larger shares of the distribution of claim lines than in the Northeast and the nation as a whole.

Across age groups on the national level, rural and urban areas were similar in their association with COVID-19 claim lines. In the largest age group, 51-60, rural and urban areas had almost identical shares of the COVID-19 claim line distribution, respectively 30.2% and 30.3%.

Profiles of COVID-19 patients have many potential applications, including determining risk factors, influencing treatment protocols, setting priorities for eventual vaccination distribution, inspiring further research, and planning and budgeting for use of healthcare resources. FAIR Health presents this report to help support that broad range of applications by stakeholders throughout the healthcare sector.

This is the fourth in a series of briefs released by FAIR Health on the COVID-19 pandemic. The first brief examined 

projected US costs for COVID-19 patients requiring inpatient stays

the impact of the pandemic on hospitals and health systems

, a national, independent nonprofit organization with the mission of bringing transparency to healthcare costs and health insurance information. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 31 billion claim records contributed by payors and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. Certified by the Centers for Medicare & Medicaid Services (CMS) as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health includes among the private claims data in its database, data on Medicare Advantage enrollees. Ms. Gelburd is a nationally recognized expert on healthcare policy, data and transparency.

Profiles of COVID-19 Patients: A Study of Private Health Care Claims

 ncreased 8,336% nationally, from 0.15% of medical claim lines in April 2019 to 13.00% in April 2020, according to new data from FAIR Health’s 

). The data represent the privately insured population, excluding Medicare and Medicaid.

Monthly Telehealth Regional Tracker, April 2020, United States

In a sign that the increase is related to the COVID-19 pandemic, the change continued and intensified a trend that began the month before, in March 2020, when the pandemic started its rapid escalation in the United States. The April 2019 to April 2020 increase of 8,336% almost doubled the 4,347% growth that occurred from March 2019 to March 2020.

In the Northeast, the region of the country where the pandemic hit hardest in March and April, telehealth growth was even more pronounced. Telehealth claim lines in the Northeast increased 26,209% from 0.07% of medical claim lines in April 2019 to 19.69% in April 2020 (

). This increase was even larger than the already sizable 15,503% growth in the Northeast from March 2019 to March 2020.

 Monthly Telehealth Regional Tracker, April 2020, Northeast

The swift growth of telehealth in March and April of this year fulfills expert predictions related to COVID-19. Telehealth permits healthcare services to be delivered without in-person contact, reducing the risk of disease transmission, and frees up in-person healthcare resources for COVID-19 patients. For those reasons, federal and state regulations related to telehealth have been relaxed, and private payers have expanded access to telehealth. In addition, with fewer elective procedures occurring around the country due to widespread restrictions, the telehealth share of total medical claim lines was expected to increase.

Telehealth grew markedly from April 2019 to April 2020 in other US census regions, but not as much as in the Northeast. In the West, the increase as a percentage of medical claim lines was 3,967%; in the Midwest, 6,754%; and in the South, 6,039%. In each region, the increase from April 2019 to April 2020 was greater than from March 2019 to March 2020.

Nationally and in all regions except the Midwest, telehealth had a greater share of medical claim lines in urban than rural areas in April 2019 and April 2020. In the Midwest, telehealth had a greater share in rural areas in April 2019, but the greater percentage shifted to urban areas in April 2020.

In the Midwest, diabetes mellitus appeared as one of the top 5 diagnoses in April 2020, a position it had not occupied in April 2019. This suggests that because in-person care was less accessible during the pandemic, telehealth was being used increasingly to treat chronic conditions like diabetes as well as acute ones.

Joint/soft tissue disorders and issues were not in the top 5 diagnoses in April 2019 nationally or in any region except the West, but in April 2020 they were in the top 5 nationally and in every region. This suggests that telehealth was being used during the pandemic for conditions for which it was previously less commonly used.

Hypertension climbed from number 4 in the top 5 diagnoses nationally in March 2020 to number 3 in April 2020. This may be related to increased stress during the pandemic and to increased telemonitoring of patients with hypertension.

Launched in May as a free service, the Monthly Telehealth Regional Tracker uses FAIR Health data to track how telehealth is evolving on a monthly basis. An interactive map of the 4 US census regions allows the user to view an infographic on telehealth in a specific month in each region, or in the nation as a whole. In addition to data on the volume of claim lines, urban versus rural usage, and diagnoses, each infographic includes findings on the top five telehealth procedure codes.

FAIR Health is a national, independent nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. Month by month, FAIR Health’s Monthly Telehealth Regional Tracker is showing the impact of COVID-19 on telehealth. Our data indicate that this venue of care is being transformed at a rapid pace.

1. A claim line is an individual service or procedure listed on an insurance claim.

The explosive growth of telehealth seen in March 2020 continued unabated in April, claims data show.

Telehealth Growth in April Suggests Continuing Impact of COVID-19

In April 2020, in the midst of the COVID-19 pandemic, healthcare professional services declined 68% in utilization 

) and 48% in revenue based on total estimated in-network amounts compared to April 2019 nationally (

). In the Northeast, the region hit hardest at that time by the pandemic, professionals experienced particularly sharp drops in utilization (80%) and revenue (79%) in April 2020 (

). These are among the findings of FAIR Health’s third COVID-19 study, 

Healthcare Professionals and the Impact of COVID-19: A Comparative Study of Revenue and Utilization

Monthly Percent Change in Utilization of Professional Services from 2019 to 2020, Nationally

Monthly Percent Change in Professional Revenue Based On Total Estimated Allowed Amounts from CPI-Adjusted 2019 to 2020, Nationally

Monthly Percent Change in Professional Services’ Utilization and Revenue Based on Total Estimated Allowed Amounts from CPI-Adjusted 2019 to 2020, Northeast

During March and April 2020, deferral of elective procedures and many routine in-person medical visits imposed a financial burden on healthcare providers and caused changes to their practices, such as a new emphasis on telehealth. To study these issues, FAIR Health drew on its repository of private claims data to analyze, on a monthly basis, changes in utilization and estimated in-network reimbursement amounts for professionals in the first 4 months of 2020 as compared to the same months in 2019 (adjusted by the Consumer Price Index). The second part of the study focused on 7 specialties: cardiology, dermatology, oral surgery, gastroenterology, orthopedics, pediatric primary care and adult primary care. For each specialty, FAIR Health analyzed changes in utilization and estimated in-network reimbursement amounts in the first 4 months of 2020 as compared to the same months in 2019, as well as changes in the 5 most common procedures in the first 4 months of 2020. Among the findings:

Of specialties studied, oral surgery had the largest decreases in utilization and revenue in both March and April 2020. In March 2020, oral surgery utilization declined by 80%, and revenue based on total estimated in-network amounts dropped 84%; in April 2020, oral surgery utilization declined 81% and revenue 92%. Gastroenterology had the second largest decreases in all 4 categories.

Of specialties studied, pediatric primary care had the smallest decreases in March 2020 utilization (52%), March 2020 revenue based on total estimated in-network amounts (32%), April 2020 utilization (58%) and April 2020 revenue (35%).

Comparing March 2019 to March 2020, utilization of professional services decreased 65% and professional revenue based on total estimated in-network amounts decreased 45%. In the Northeast, comparing March 2019 to March 2020, utilization of professional services fell 60% and revenue based on total estimated in-network amounts declined 55%.

Across many specialties from January to April 2020, office or other outpatient evaluation and management (E&M) visits became more common relative to other procedures, both by utilization and total estimated in-network amounts. This may have been due in part to the fact that many of these E&M services could be rendered via telehealth, whereas certain other procedures that became less common required in-person visits.

In oral surgery, a procedure specifically for telehealth—telephone E&M by a physician or other qualified healthcare professional, 11-20 minutes (CPT

—climbed from number 131 in utilization in January 2020 to number 1 in April 2020.

Total knee replacement (CPT 27447) and total hip replacement (CPT 27130) ranked high in the orthopedic top 5 procedures by total estimated in-network amounts in January 2020. They fell out of the top 5 by April 2020.

For pediatric patients 0-4 years of age, there was little change in preventive care visits from March-April 2019 to March-April 2020, whether from the standpoint of utilization or of revenue based on total estimated in-network amounts. Decreases in these months were much greater for preventive care visits for older pediatric patients (5-17 years of age) and adults (18 and older).

As with past studies in our COVID-19 series, we again use FAIR Health’s vast data repository to illuminate the impact of the pandemic. We hope this report will be useful to stakeholders throughout the healthcare sector, including providers, payors, policy makers and researchers.”

This is the third in a series of briefs released by FAIR Health on the COVID-19 pandemic. The first brief examined 

Author | Robin Gelburd, JD

Articles

Telehealth Growth in May Rises Year to Year, but Drops Month to Month

Profiles of COVID-19 Patients: A Study of Private Health Care Claims

Telehealth Growth in April Suggests Continuing Impact of COVID-19

Health Care Professionals and the Impact of COVID-19: A Comparative Study of Revenue and Utilization