医疗膨胀:对第一方汽车伤亡索赔的影响

在过去的60年里，医疗费用一直在上升. 1960年，医疗保健只占美国GDP的5%， 相比 20% in 2020. 最重要的是，总体通胀经历了 最戏剧性的增长 与2021年同期相比，2022年2月是40年来最低的. To better understand how these inflation trends are affecting first party auto casualty claims, Enlyte analyzed its medical bill review data from losses Q1 2017 through the end of Q4 2021. 下面, we’ve outlined the key trends and patterns in first party auto casualty claims for this time period.

国家层面的医疗通胀

上面的图表显示了第一方汽车伤亡费用和每单位允许的费用, 分别, 在国家一级提供专业服务.

自2017年初以来, 每单位医师收费增加了4%的汽车伤亡第一方索赔, 虽然允许每单位增加5%. The 5% increase is primarily due to fee schedule increases in states with large volumes of claims such as New York. 相比, the Bureau of Labor Statistics Physician Services Consumer Price Index increased 6% in the same time period.

主要第一缔约方国家的医疗通货膨胀

上面的图表显示了按单位收费和允许的第一方汽车伤亡, 分别, 在佛罗里达, 新泽西和纽约.

To help understand how medical inflation has affected first party auto casualty claims at a more detailed level, we’ve highlighted a few key states to show how inflation has affected high-volume jurisdictions.

• 自2017年初以来, 佛罗里达州和新泽西州的单位电价分别上涨了4%和6%, 分别, 而纽约的每单位收费增长了15%, 从2020年第四季度开始大幅上涨. This change can be explained by provider behavior in relation to a new fee schedule implementation.
• Allowed per unit results 在佛罗里达 and New Jersey were well managed by their respective fee schedules, while New York experienced a 27% increase due to new fee schedule increase payment amounts.

按服务组分类的医疗通货膨胀

以上图表显示了按单位收费和允许的第一方汽车伤亡, 分别, 按急诊科服务组别划分, 评估，管理和疼痛管理.

急诊室一直是医疗通胀的主要推手, 自2017年以来，每单位的收费和允许大幅增加. 这些变化很大程度上是由费用从住院服务转移到门诊服务造成的. 以下是服务级别组的一些主要发现:

• The charge per unit for general evaluation and management services (provider office visits) increased 12%, while emergency department evaluation and management services (provider professional charges) experienced a 20% increase.
• 单位评价和管理服务许可增加14%, while emergency department evaluation and management services experienced a 16% increase.
• 2017年1月至2021年6月, charge per unit for pain management services increased 12% while allowed per unit increased only 2%. While empirical data is not available in our bill review data yet to support the reasons for this change, it is our hypothesis that the focus on control of opioid prescriptions may have an effect the increase of pain management services.

按服务组划分的医疗严重程度

The charts above demonstrate charged and allowed per claimant for some of the most frequent service groups seen in auto first party medical billing data.

A closer look at a few more service groups identified additional trends of medical severity increases for auto first party claims:

• While the surgery service group demonstrated two clear decreases in charge and allowed per claimant corresponding with the start of the pandemic and the emergence of the Delta variant, 每个索赔人的总手术费用和许可分别增加了18%和33%, 分别, 自2019年1月起.
• 自2019年1月起, physical medicine and rehabilitation services have experienced a 17% increase in average charge per claimant and 22% increase in average allowed per claimant.
• Some of these increases can be attributed to the changes and expenses providers incurred and billed as a result of PPE use, 大流行期间和大流行后就诊病人减少，消毒要求也降低.

按伤害分类的医疗严重程度

The charts above demonstrate claimant injury distribution as well as charge and allowed per claimant for specific injury classifications.

While the distribution of injury types for first party auto casualty claims has remained relatively steady 自2019年1月起, 一些特定的伤害抬高了这些索赔的成本.

• 在大流行开始时，每个索赔人的收费和允许数量激增, 分别为40%和51%, 与创伤性脑损伤有关. 这可能是由于道路上车辆类型的新组合(如.e., more trucks leading to more severe injuries) during the pandemic and involved in crashes.
• 自2019年1月起, ICD10 ' M '索赔人诊断, 或者肌肉骨骼系统的疾病, 收费和允许的严重性分别增加了20%和31%, 分别. M代码通常不是伤害代码，但可以作为与损失相关的症状. Working with carriers who experience a high volume of M code diagnoses will involve a focus on utilization review processes to insure relatedness to the claims.

索赔频率

上图显示了与美国相比的第一方索赔频率.S. 交通部里程驱动报告.

把这些趋势放在更大的背景下, it is important to also understand how first party auto casualty claim frequency has been trending. 这是大流行的结果, 我们已经看到了驾驶习惯的重大转变, with two clear downturns in miles driven (March 2020 and January 2021 分别) corresponding with the start of the pandemic and the emergence of the Delta variant. This dip in miles driven has resulted in lower claim frequency while miles driven has returned to pre-pandemic levels. 截至2022年1月，索赔频率仍比预期低26%. 

关于我们的数据

This report is generated based on Enlyte’s first party auto casualty Medical Price Index, 其中包括医疗账单审查数据. The data in this report is compiled  from losses during Q1 2017 through the end of Q4 2021. Our data represents the most comprehensive and largest data set available for this market segment in medical bill review.