It May Be Time to See Doctor - After Recent Slowdown, Health-Care Firms Detect Uptick in Outpatient Visits

Years of economic drag have had some profound effects on Americans. One big one: They stopped going to the doctor as much as they used to.

Now people may be starting to head back for checkups and other medical procedures. Any shift has important implications for the health-care sector and the broader economy, since the drought has helped restrain spending growth.

The trend has been surfacing in the quarterly results of some of the biggest health-care companies, including major health insurers and hospital operators such as Tenet Healthcare Corp., which said outpatient visits were up 5.3% over last year.  UnitedHealth Group Inc., WellPoint Inc. and Aetna Inc. all flagged upticks in outpatient use on recent earnings calls, with WellPoint and Aetna pointing to doctor services as well.

Tenet is "seeing an increased willingness of consumers to get that checkup, get that imaging done, get that minor surgery taken care of," said Trevor Fetter, the company's chief executive, in an interview.

The nature of the rebound may reflect a change in where people go for care, because it doesn't appear to extend to the priciest category: Hospital stays generally aren't increasing, according to the insurers. There has been a long-term migration of some types of surgeries into outpatient centers.

Tenet, for its part, said its admissions on a same-hospital basis were down 0.4% compared with last year, and some other hospital companies reported larger dips. Medical-device makers' sales also remain under pressure from slow traffic in U.S. hospitals, despite some glimmers of improvement in areas like orthopedic surgery.

But even a small increase in use is notable after the slowdown that has stretched for more than two years, and some insurers spotted an outpatient blip even before the most recent quarter. Generally, the muted use of medical services has helped buoy the results of health insurers, and posed a tough challenge to hospitals and other health-care providers already struggling with cutbacks in government payments.

Economists have attributed the medical-use drag largely to the challenging economy, which has left even some insured consumers leery of extra costs and nervous about time away from work. They have also pointed to structural changes, such as the rise of health plans that force people to pay more out of their pockets for medical services.

Those same trends may be helping to drive the current move toward more outpatient services, as people continue to avoid the most expensive care. Health plans have been encouraging this by providing more pricing information. Insurers and the health-overhaul law have also created new efforts to reduce hospital stays and boost primary care, partly as a way of heading off worse health problems later.

A survey of around 2,500 consumers by Wedbush Securities earlier this year found that nearly a third had postponed or canceled medical services such as knee surgeries during the economic downturn, and most cited out-of-pocket charges as the main reason. Of those who had put off care, 29% said they planned to get a delayed low-cost procedure by the end of the year, while just 6% said they would get an expensive one; 11% said both.

Debbie Hall, administrator of the Cheyenne Surgical Center, an outpatient facility in Wyoming, said she has seen growth this year in spinal fusion surgeries, disc removals and laparoscopic gallbladder surgeries, all procedures that could have been done in a hospital. "Insurance carriers are trying to shift business toward us," she said, and patients are also increasingly opting to keep costs down if possible.

Indeed, UnitedHealth Group and Aetna both said that part of the recent outpatient boost stems from their initiatives to get certain services moved out of inpatient settings. UnitedHealth, for instance, has a program, pegged to a heart association's guidelines, that aims to test for heart attacks in a hospital's outpatient suite rather than sending chest-pain patients straight to an intensive-care unit. "Some of that outpatient growth is purposeful on our part," said Joe Zubretsky, Aetna's chief financial officer, in an interview.

Visits to primary-care physicians may also be on the rise. Humana Inc. said it saw a rise in checkups fueled by a new Medicare benefit under the health law. Truven Health Analytics Inc., which tracks a cohort of around 3,600 primary-care physicians, said that their average daily visits went up in the first and second quarter of this year, compared with 2011. That came after nine straight quarters of decreases, according to Truven, which was spun off from Thomson Reuters Corp.


Health plans that encourage primary care are one reason visits have increased at Village Health Partners, a 20-physician family practice in Plano, Texas, said Christopher Crow, its president, who said he sees employers using "benefit designs that include both carrots and sticks" to get folks to seek preventive services and tests. Dr. Crow also pointed to improvements in the local economy.

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