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Comparison of definitions for identifying urgent care centers in health insurance claims

Abstract

Studies show increasing use of urgent care centers (UCCs) and there is interest in evaluating their potential for cost savings. Previous research provides limited information on generalizable methods of identifying urgent care centers and does not validate these methods. The objective of this study is to describe and validate two claims-based UCC definitions. We used FAIR Health insurance claims from 444,263 organization National Provider Identifiers (NPIs) with at least 10 claims, January 2016–March 2019 and merged this data with National Plan and Provider Enumeration System data. The first definition required (1) a UCC place of service code (POS), (2) ≥ 10% Current Procedure Terminology (CPT) codes specific to UCCs, or (3) a UCC taxonomy code in the primary field. The second definition relaxed these criteria. A random sample of 5% of NPIs identified as UCCs were validated through internet searches. Prevalence and positive predictive value (PPV) were calculated for both definitions. The first definition identified 6669 (1.5%) of NPIs as UCCs resulting in a PPV of 92%. The second definition identified 8261 (1.9%) of NPIs as UCCs and had a PPV of 87%. Out of NPIs identified under the first definition, 96% were identified using POS codes, 50% were identified using taxonomy codes, and 46% using CPT codes, with 62% of NPIs meeting multiple criteria. Findings suggest that these methods may be used by researchers to identify UCCs in studies of cost or utilization in different healthcare settings.

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Data availability

The specific claims dataset used in this study may be purchased from FAIR Health. National Plan and Provider Enumeration System (NPPES) data is publicly available at https://nppes.cms.hhs.gov/#/.

Code availability

Upon request.

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Acknowledgements

The authors would like to thank Ateev Mehrotra, MD, MPH (Harvard Medical School), Carl Berdahl, MD, MS (RAND and UCLA), and Tom Schroeder (US Consumer Product Safety Commission) for their comments on previous iterations of this draft.

Funding

The US Consumer Product Safety Commission Funded this study (Grant no: AWD-00000219).

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Contributions

CB obtained the data. CB and SH designed the study and drafted the manuscript. All authors analyzed the data and provided critical revisions.

Corresponding author

Correspondence to Christine Buttorff.

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None declared.

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Buttorff, C., Heins, S.E. & Al-Ibrahim, H. Comparison of definitions for identifying urgent care centers in health insurance claims. Health Serv Outcomes Res Method 21, 229–237 (2021). https://doi.org/10.1007/s10742-020-00224-6

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Keywords

  • Classification
  • Urgent care
  • Emergency medicine
  • Injuries
  • Insurance claims data