Retail Clinic and Urgent Care Center Utilization Each Decreased 12 Percent Nationally from 2022 to 2023, According to Eighth Annual FAIR Health Report

Emergency Room Utilization Increased Four Percent Nationally from 2022 to 2023

NEW YORK, March 31, 2025 /PRNewswire/ -- Retail clinic and urgent care center utilization each decreased 12 percent nationally from 2022 to 2023.¹ Ambulatory surgery center (ASC) and telehealth utilization decreased less—ASCs seven percent and telehealth three percent. By contrast, emergency room (ER) utilization increased four percent. These are among the results reported in a new FAIR Health white paper containing the eighth annual edition of FH^® Healthcare Indicators and FH^® Medical Price Index. Like the previous editions, this year's edition of FH Healthcare Indicators and FH Medical Price Index is intended to provide perspective for all healthcare stakeholders in a rapidly changing healthcare environment.

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FH Healthcare Indicators
FH Healthcare Indicators reveal trends in the places where patients receive healthcare. Focusing on alternative places of service and ERs, FH Healthcare Indicators evaluate changes over time in utilization, diagnoses, procedures, costs and geographic and demographic factors.

Among the other key findings:

• ERs held the highest percentage of medical claim lines in 2023 among the places of service studied, with 4.3 percent of all medical claim lines nationally. The comparable percentages for the other places of service were 3.8 percent for telehealth, 1.9 percent for urgent care centers, 1.0 percent for ASCs and 0.2 percent for retail clinics. The remainder of the services were primarily rendered in traditional places of service, such as physician offices.
• In 2023, as in previous years, more claim lines were submitted for females than males in most age groups in these alternative places of service and ERs.
• In 2023, Georgia was one of the top five states for retail clinics and urgent care centers, as measured by the percentage of medical claim lines accounted for by those places of service, but it was not among the top five states for telehealth.
• In 2023, COVID-19 remained on the list of most common diagnostic categories in retail clinics, urgent care centers and telehealth, but fell in the rankings. COVID-19 fell off the list of most common diagnostic categories in ERs (for individuals over the age of 22).
• Across offices, urgent care centers and retail clinics in 2023, the highest median allowed amount for CPT^®2 99204 (new patient office or other outpatient visit, 45-59 minutes) was in offices, at $183, while the median allowed amount for urgent care centers was $179 and for retail clinics $138.

FH Medical Price Index
FH Medical Price Index reports shifts in costs and facilitates comparisons among medical prices in six categories of procedures from May 2012 to November 2024:

• Professional evaluation and management (E&M; excluding E&Ms performed in a hospital setting);
• Hospital E&M (excluding E&Ms performed in a professional setting, such as typical office visits);
• Medicine (excluding E&Ms);
• Surgery (procedures for which the physician would bill);
• Pathology and laboratory (including both technical and professional components, e.g., both equipment and professional services); and
• Radiology (including both technical and professional components).

The report reflects professional fees and related costs; it does not include facility fees.

For the period November 2023 to November 2024:

• Of the six procedure categories, pathology and laboratory had the greatest percent increase in charge amount index, six percent. The surgery charge amount index increased five percent, the professional E&M and medicine charge amount indices each increased four percent and the radiology charge amount index increased two percent.
• Hospital E&M was the only category to remain flat in charge amount index.
• Hospital E&M, medicine and surgery each had the greatest percent increase in allowed amount index, four percent. The professional E&M and pathology and laboratory allowed amount indices each increased three percent.
• Radiology had the smallest percent increase in allowed amount index, one percent.

For the new white paper, FH^® Healthcare Indicators and FH^® Medical Price Index 2025: An Annual View of Place of Service Trends and Medical Pricing, click here.

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About FAIR Health
FAIR Health is a national, independent nonprofit organization that qualifies as a public charity under section 501(c)(3) of the federal tax code. It is dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health possesses the nation's largest collection of commercial healthcare claims data, which includes over 50 billion claim records and is growing at a rate of over 3 billion claim records a year. FAIR Health licenses its commercial data and data products—including benchmark modules, data visualizations, custom analytics and market indices—to commercial insurers and self-insurers, employers, providers, hospitals and healthcare systems, government agencies, researchers and others. 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, which accounts for a separate collection of over 50 billion claim records; FAIR Health includes among the commercial claims data in its database, data on Medicare Advantage enrollees. FAIR Health can produce insightful analytic reports and data products based on combined Medicare and commercial claims data for government, providers, payors and other authorized users. FAIR Health's systems for processing and storing protected health information have earned HITRUST CSF certification and achieved AICPA SOC 2 Type 2 compliance by meeting the rigorous data security requirements of these standards. As a testament to the reliability and objectivity of FAIR Health data, the data have been incorporated in statutes and regulations around the country and designated as the official, neutral data source for a variety of state health programs, including workers' compensation and personal injury protection (PIP) programs. FAIR Health data serve as an official reference point in support of certain state balance billing laws that protect consumers against bills for surprise out-of-network and emergency services. FAIR Health also uses its database to power a free consumer website available in English and Spanish, which enables consumers to estimate and plan for their healthcare expenditures and offers a rich educational platform on health insurance. An English/Spanish mobile app offers the same educational platform in a concise format and links to the cost estimation tools. The website has been honored by the White House Summit on Smart Disclosure, the Agency for Healthcare Research and Quality (AHRQ), URAC, the eHealthcare Leadership Awards, appPicker, Employee Benefit News and Kiplinger's Personal Finance. For more information on FAIR Health, visit fairhealth.org.

Contact:
Rachel Kent
Executive Director of Communications and Marketing
FAIR Health
646-396-0795
[email protected]

¹ Utilization in this study is a relative, normalized measure, not an absolute one. See Methodology section of the white paper.
² CPT © 2024 American Medical Association (AMA). All rights reserved.

SOURCE FAIR Health