Filed Under:Health Insurance, Individual Health

Insurer think tank: radiologists not the villains

The market may have reined in out-of-network billing in 2011.
The market may have reined in out-of-network billing in 2011.

New federal laws may have increased employer health plan spending on mental health care and preventive services between 2010 and 2011, but the overall rate of increase was modest.

The Health Care Cost Institute (HCCI)—a nonprofit think tank that uses data from Aetna Inc. (NYSE:AET); Humana Inc. (NYSE:HUM); Kaiser Permanente; and UnitedHealth Group Inc. (NYSE:UNH)—has published service-by-service data in a new group health plan cost report.

HCCI analysts found that health plans spent an average of $4,547 on health care per enrollee younger than 65 in 2011, up 4.6 percent from the 2010 average.

Use of most types of care decreased or increased only slightly.

Use of inpatient hospital care per 1,000 enrollees, for example, fell 3.5 percent in 2010, to 61.7, then fell another 0.5 percent in 2011, to 61.4.

Emergency room use rose 3.7 percent, but overall use of hospital outpatient services increased just 2.1 percent.

Use of outpatient services increased 1.6 percent, and use of professional procedures increased 1.2 percent.

In January 2011, employer health plans with more than 50 insured employees that provide mental health benefits had to start complying with the federal Mental Health Parity and Addiction Equity Act (MHPAEA). MHPAEA limits large plans' ability to put tighter limits on mental health care than on other types of care.

In 2011, group plans and writers of individual health insurance had to start complying with the preventive services provisions in the Patient Protection and Affordable Care Act of 2010 (PPACA). The PPACA provisions require plans to cover some preventive health services, such as checkups, without imposing co-payments, deductibles or other cost-sharing provisions on the patients.

Perhaps as a result, use of mental health and substance abuse inpatient services jumped 10 percent, to 4.1 per 1,000 insureds. Per-capita spending on those services climbed 17 percent, to $31.

Use of primary care provider preventive visits increased 4.7 percent, to 336 per 1,000 insureds. Per-capita spending on primary care preventive services rose 8.3 percent, to $40. Per-capita spending on preventive care visits with specialists increased 4.7 percent, to $17.

Spending on specialist office visits other than preventive visits grew at a 7.8 percent clip in 2011 after purring along at 9.8 percent in 2010.

In the past, patients and patient advocates have complained bitterly about anesthesiologists, pathologists, radiologists and other hospital-based specialists who surprise patients who are using in-network hospitals with out-of-network specialty care bills.

HCCI found that per-capita spending on anesthesia increased 5.6 percent in 2011, which was a little higher than the overall 2011 professional procedures increase average of 4.5 percent. Per-capita spending on pathology increased 6.6 percent.

Per-capita spending on radiology actually fell 2.4 percent, to $140.

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Nichole Morford

Nichole Morford
Managing Editor

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