More January 2014 Visit Volume Research

Last week, I posted some data about national visit volume that I hope made clear that the perceived dip in the January 2014 visit volume was largely cyclical and weather related.  Sure, there are some practices whose variance isn’t explained so easily.  For example, one of the comments I received reflected my thoughts:

“I think there data would be more clear if your grouped your clients by zip code or region. The weather has a direct influence and sick season probably starts at different times in the east versus west coast.”

Let’s see!  Below, I’ve broken the visit data down by US Census categories and pulled out one obvious set of states to see if there are geographical highlights.  Some caveats:

  • PCC data by region is not as effective as the national data.  In some regions, like the Pacific, there are far fewer examples than, say, the Mid Atlantic region.
  • It may be that the census groupings don’t make sense from a weather or clinical relationship perspective.
  • Although the weather patterns are uneven nationally, it may be that a month-sized sample evens things out.
  • I’m comparing the month of January in each instance, not the estimated “peak” time frame from each season.  Last week, we noted that perhaps we ought to look at Oct-Dec 2013 to compare to Jan 2013 instead.

Oh, which states are in which group?

  • New England Division: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont
  • Middle Atlantic Division: New Jersey, New York and Pennsylvania
  • East North Central Division: Illinois, Indiana, Michigan, Ohio and Wisconsin
  • West North Central Division: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota
  • South Atlantic Division: Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia and West Virginia
  • East South Central Division: Alabama, Kentucky, Mississippi and Tennessee
  • West South Central Division: Arkansas, Louisiana, Oklahoma and Texas
  • Mountain Division: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah and Wyoming
  • Pacific Division: Alaska, California, Hawaii, Oregon and Washington

I’m sure I can (and should) drum up more warnings before showing the data, but here it is anyway.  Click on the picture for a zoom-in.


Conclusions, no matter how weak, we can draw from this data:

  • Most, but not all, regions saw a dip in 2012 and then a huge jump in 2013, making the dip that all groups saw in 2014 that much more dramatic.  This is particularly true for our clients in the “West North Central” bracket.
  • Subjectively, I grouped AZ, NM, CA, and WA together as places where I guess the weather had the least impact this year (I consulted a monthly weather log from NOAA).  You’ll see that their 2011 -> 2012 and 2013 -> 2014 changes are fairly dramatic.
  • The “Mid-Atlantic” (NY, NJ, PA) and New England (CT, RI, MA, ME, NH, VT) – where PCC has the most clients – got nailed this year.  We know that December 2013 looked a lot better for them, but there it is.
  • East South Central (AL, KY, TN, MS) is the most stable and flat of the group.  Maybe they don’t have the same infectious season as, say, New England.
  • My subjective grouping of some “warm” states shows that they were hit just as badly as everyone else (“All Else”), perhaps more so.  I suspect that there are variables there that are outside the scope of what we’re looking at here.

Next, I will try to tease out sick/well visit rates, perhaps!

Input welcomed.


10 replies
  1. Irwin Berkowitz
    Irwin Berkowitz says:

    You poo pooed the effect of increasing copays and the increasing number of families with high deductible insurance. I spoke to an insurance broker who was supposed to get back to me as to the proportion of insured with this type of insurance. That has not as yet happened but he does agree with the trend. As for rich people they also think twice about spending $50 for a copay. The rich don’t stay rich by squandering their money.

  2. Irwin Berkowitz
    Irwin Berkowitz says:

    You poo-pooed the effect of high deductible health insurance and higher copays on the number of office visits. I attempted to get some numbers from a large insurance broker about the trends regarding the percentage of insured with these types of policies. He has yet to get back to me with them but says the trend is higher in both. As to a comment regarding the higher copays not affecting the “well to do”, let me assure you that a $50 copay will make most people think twice about all but an essential visit. The rich stay rich by watching their money.

    • Chip Hart
      Chip Hart says:

      First, the rich don’t stay rich by avoiding physician visits and $50 copays. If they skip a visit EVERY SINGLE MONTH, that’s $600 “saved.” That’s not the difference between rich and anything else.

      Second, I poo-poo the HDHP impact for a couple of reasons:

    • I’ve got ample evidence, presented here, that January 2014 was slower in general because of weather
    • I’ve got ample evidence, presented here, that January 2014 was the backside of a peak that happened in Oct/Nov 2013 vs the peak that also happened in Jan 2013.
    • If HDHP plans are so negatively impactful in this particular month, why did the visit rate RISE in Jan 2013? HDHPs were very much in place in Jan 2013.

      I am sure that HDHPs have some effect. But not nearly as much as being closed for a few days of bad weather and seeing the viral peak happen in November and not January.

    • Reply
  3. Irwin Berkowitz
    Irwin Berkowitz says:

    My wife says I always like to get in the last word.
    To rebut your response to my figurative description of how the
    “rich” watch their money, $600 does not make or break a well
    off individual, but most people do not like to spend money on
    necessities such as medical care. The higher the copay the
    more attention is paid to the necessity of the visit.
    I do agree with you that the major influence in our decrease in
    revenue this winter in the Northeast was the weather, but the
    trend toward High Deductible Health Insurance may have to be
    addressed in regards to our future projections regarding number
    of doctor visits. This is illustrated by the following article:

    Each year, HRI issues its projection for the following year’s medical cost trend based on activity in the market that serves employer-based insurance.

    Consumer-driven health plans – insurance coverage with a high-deductible – are set to go mainstream in 2014. According to the 2013 PwC Touchstone Survey of major US companies, 44% of employers are considering offering high-deductible health plans as the only benefit option to their employees in 2014. Already, 17% of employers offer high-deductible plans as their only option in 2013, a 31% increase over 2012.

    High-deductible health plans, which place greater responsibility on consumers, are designed to promote cost-conscious decisions. A recent study reported families that switched from a traditional health plan to a high-deductible plan spent an average of 21% less on healthcare in the first year.

    The ACA, with its new insurance marketplaces, accelerates the move to consumer-driven plans. Many of the newly insured say they are willing to accept plan features such as higher deductibles in return for lower monthly premiums – as found in the new bronze and silver plans.

    • Chip Hart
      Chip Hart says:

      I certainly don’t disagree that the HDHPs will have an effect on medical spending! However, I don’t think they were at all responsible for a 20% drop in your January 2014 visit volume when compared to January 2013. If we accept the numbers you provide above, there might be a 1-4% impact on your visit rates, no?


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  1. […] copays), the industry is clearly shifting the financial burden more to the patients. And I’ve written about the constant assumption that those high deductibles are keeping kids out of the office. Surely, […]

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