The IMS Institute of Healthcare Informatics released a report in 2013 entitled ‘Medicine Use and Shifting Costs of Healthcare: A Review of the Use of Medicines in the United States in 2013’ that found an increase in the overall use of healthcare services by patients in 2013, for the first time after three years. The study showed that total spending on U.S medicine rose to 1.0 percent on a real capita basis in 2013 and the primary drivers for increased spending include the price increases on some branded drugs, cost of new medicines, a $10 billion reduced impact of patent expirations compared to 2012.
According to the report, overall utilization of healthcare services grew in the U.S. as consumers get back to the healthcare system mainly through more office visits to specialist physicians and outpatient treatments after several years of self-rationing. The major findings of the health study regarding this are:
- If the number of office visits to primary care physicians by patients fell by 0.7 percent in 2013, visits to specialists increased by 4.9 percent overall and by 9.5 percent for seniors.
- The number of hospital visits increased in 2013 especially by patients who have commercial health coverage and received outpatient treatments.
- Patients filled more than 12 retail prescriptions (on average) in 2013, which is about 2 percent up year over year. However, those aged 65 and more filled 28 prescriptions (on average) annually which is slightly down from 2012.
Increase in healthcare usage is really advantageous to healthcare providers though it would involve more heavy medical billing tasks. It seems that this trend is likely to continue in 2014 due to the following reasons.
- The newly insured people under the Affordable Care Act and Medicaid expansion are not included in the increased usage. It is estimated that the 7.1 million American selected insurance plans (on both state and federal exchanges) during this enrollment period will result in a huge influx of patients to physicians’ offices. Which in turn will increase the amount of insurance billing.
- The study found patients with insurance paid higher out-of-pocket costs in the form of deductibles and co-insurance in 2013 even though prescription co-payments declined. The use of healthcare services increased in such a scenario. In the case of Obamacare health plans, the maximum out-of-pocket cost is limited to $6,350 for an individual plan and $12,700 for a family plan. Despite premium subsidies, extra subsidies are given for those who make less than 250% of the poverty line, or $28,725 for a single person and $58,875 for a family of four to defray out-of-pocket costs including deductibles and co-payments under Obamacare. Without a doubt, we can say that the use of health care services will increase further.
- As per the Affordable Care Act, the health plans offered through insurance exchanges must cover ten essential health benefits which include mental health and substance use disorder services. With this, health insurance can no longer be denied on the basis of pre-existing mental illness. This will surely increase access to preventive care services.
Physicians who start feeling the influx of these patients and increased workload can may move towards outsourcing their increased workload to a medical billing and coding company. This may allow them to streamline their billing processes to receive reimbursement without losing the time that is to be devoted to patient care.
Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.