Health spending data reflect more patients seeing their doctors

Patients appear to be going to physicians more, thanks to greater access to preventive care services and a better economy, resulting in a rise in spending on doctors. Protocols of patient-centered medical homes that keep physicians updated on patients’ health coupled with electronic health records also may account for the increase.

In a Milliman Medical Index survey released in May, physician and other professional services for an average family of four that receives health care benefits through an employer-sponsored preferred provider organization plan cost about $7,000 in 2013, a 5.2% increase over 2012. That’s 32% of the total health cost of $22,030 — $12,886 through employer subsidies, and $9,144 from employee payroll deductions and out-of-pocket costs.

Overall, health spending went up 6.2%, the third consecutive year the growth rate decreased after reaching a peak of 7.8% in 2010. Outpatient procedure spending in 2013 has grown the fastest, at 9.2%, followed by pharmacy-related costs at 7.9%, and inpatient care, at 5%. Milliman said a shift in many procedures from inpatient to outpatient care was reflected in their growth rates. Spending on physicians was counted as professional services no matter whether the care was outpatient or inpatient.

In 2013, about half of the 5.2% cost increase to PPO plans was due to more patients going to physicians for more services, said Lorraine Mayne, principal and consulting actuary for Milliman, a health consulting company. She said part of the annual increase had been flat for the previous two years.

Mayne said it’s likely that some families had postponed health care to avoid paying for their out-of-pocket share. But an improved economy and more people being employed and insured probably have contributed to the rise in physician utilization.

Economy affects patient decisions

Patients tend to skip health care when the economy is doing poorly, according to a Kaiser Family Foundation report in 2012. It found that health care costs worry even patients with insurance and relatively high incomes. The financial worries of patients with even comfortable circumstances point to the reasons many researchers had seen a drop in patient volume at physician offices.

Low-income and uninsured patients are most likely to report delaying or skipping a trip to the doctor, with 81% of the uninsured reported having done so in the previous 12 months before they were surveyed. More than half of the insured polled — 55% — said they had delayed or skipped care in the past year. More than one in five insured adults had trouble paying medical bills.

“I think employees do show a sensitivity to cost, and it reduces utilization,” Mayne said.

The numbers also may reflect changes wrought by the Affordable Care Act. Although the law won’t be fully implemented until 2014, some provisions already have taken effect, such as allowing those 26 and younger to stay on their parents’ insurance, banning insurers from using preexisting conditions to reject patients, removing insurer caps on lifetime health coverage and mandating that certain preventive care be covered with no out-of-pocket cost to patients.

Greater awareness by patients of preventive care probably contributed to greater physician utilization, said Daniel R. Spogen, MD, a family physician in Reno, Nev., and a member of the board of directors for the American Academy of Family Physicians. Insurance plans are actively promoting preventive care, which gives patients incentives to engage in it, he said.

The ACA covers 15 services for adults, 22 for women only and 26 for children. The services include screenings for hypertension, high cholesterol, colorectal cancer and type 2 diabetes.

Patient-centered medical homes that use registries and EHRs may be a contributing factor, Dr. Spogen said. When physicians are better able to track when patients have tests and when they need follow-up care, patients are more inclined to comply, he said.

“A decade ago, all primary care physicians were using paper, and that’s not a good way to do it,” Dr. Spogen said.