Draft- Not for Distribution

Background

The Utah All Payer Claims Database (APCD) contains data from commercial and non-commercial health insurance carriers across the state of Utah including costs of common medical procedures.

Based on data from the APCD, this databyte provides descriptive statistics on Utah’s commercially insured population and the utilization and cost comparisons of primary care office-based visits in 2021. The purpose of this databyte is to inform the consumer about average costs among five selected primary care provider (PCP) specialties to assist in the decision-making while seeking care.

Methods: Office visits are coded based on the total length of time of the visit. For new patients, they generally take 20,30, and 45 minutes for short, medium, and long visits respectively. For established patients, they take about 10,15, and 25 minutes respectively. The CPT codes used for this analysis are as follows: 99202, 99203, 99204, 99212, 99213, 99214.

Results:

The counts of new patient office visits are on a lower scale than those of established patients. In the year 2021, physician assistant office visits had the most volume out of all of the PCP specialties and were performed 6,015; 34,964; and 22,967 times for short, medium, and long visits respectively. Conversely, pediatric office visits had the least volume and were performed 580; 3,627; and 3,710 times for short, medium, and long visits respectively.

Family medicine physicians have the highest utilization among the five PCP specialties for established patients. Short office visit counts ranged from 2,359–10,672 with family medicine having the highest, and internal medicine having the lowest. Medium-length office visits ranged from 51,366–257,578. Long office visits ranged from 57,240–254,221.

For new patients, the average cost for short office visits led by a nurse practitioner was about $75. Since pediatric providers only work with children, it is helpful to look at the other 3 PCP specialties as a separate group. Except for pediatrics, which on average cost about $89, the range of cost for the remaining PCPs for new patients was $79–$87. There were no standard errors that overlapped across specialties.

Established visits cost significantly less than new patient office visits. Nurse practitioner office visits cost, on average about $46. The range in cost for established patient office visits among the other PCPs was between $48–$54, not including pediatric providers. Short pediatric office visits on average cost about $55. There were no standard errors that overlapped across specialties.

Nurse practitioners continue to have the lowest average cost for medium-length office visits as well. New patient office visits on average cost about $116 for nurse practitioners and range from about $118–$131 for PCPs not including pediatrics. Pediatric visits have the highest average cost at about $153. There were no standard errors that overlapped across specialties.

Established patient office visits cost significantly lower than new patient office visits. Nurse practitioners have the lowest average cost at about $78. The range in cost for other PCPs not including pediatrics is between $80–$90. Pediatric visits were similar in cost at about $91. Except for family and internal medicine, standard errors did not overlap across specialties.

Nurse practitioners continue to show as the least expensive option for long office visits as well. For new patients, the average cost is about $177 for nurse practitioners. The range in cost for the other PCPs not including pediatrics is $180–$205. Long pediatric office visits cost on average about $308. None of the standard errors overlapped across specialties.

Established patient visits continue to cost significantly lower than new patient office visits. Nurse practitioners are the least expensive option, costing about $114 while the other PCPs, not including pediatrics, cost between $117–$134. Pediatric office visits for established patients were not much higher, costing on average about $138. There were no standard errors that overlapped across specialties.

Conclusion

Out of the 5 selected PCPs presented in this databyte, the average cost for short, medium, and long office visits for both new and established patients is the least expensive when working with a nurse practitioner. Although these data do not represent what to expect in cost at the individual level since it varies depending on insurance plans and providers, consumers may want to consider working with nurse practitioners to save money on office-based visits.