Recently, as we explored the possibility that patients might be canceling or missing well visits at a higher rate (they aren't), followed by an examination of the rate of vaccine refusals (they are increasing rapidly), I was compelled to ask myself: what's happening to well visits as a result of all these refusals?

I was thinking about it this way: if we add even one minute to the average length of a well visit, that can really zap a practice - you could find yourself short a visit every day. It doesn't take much to move the needle.  Especially when practices are stretched so thin right now.  So, I asked the mad scientists to look into it and the results are interesting.

First, figuring out the length of the visit spent on a well visit is tricky business for a couple of reasons.  To do it with real accuracy, we would have to:

1. have perfect discipline from everyone in the practice to track the status of a patient throughout the visit [not happening]

2. have each practice across the country use the same visit reason statuses, and in the same way, to indicate the process of a patient moving through your office [not happening]

3. track time spent on a visit after the patient leaves [not happening]

Not happening.  But what we can do is make a good guess about the length of time a patient spends in the office overall and leverage the law of large numbers - it's imperfect for the reasons above (especially a.), but if we look at the median time a patient spends being marked arrived to marked gone, maybe we get some insight.   We also dug into questions like...is there a difference between kids <2yo and everyone else? [no]  Does median vs. average make a difference or change over time? [not really]

Here's what that looks like for well visits from PCC clients going back to well before COVID:

Pick a line, doesn't matter - the blue line is all well visits, the orange line is just for kids under 2 (where a lot of those vaccine refusals happen).  You should recognize a steady downward trend starting in 2016 until a low in 2023Q2.  Then, the visit times seem to bounce and perhaps there's a slow upward trend.

A trend that seems to coincide with the refusal rates we shared earlier!

But is it that simple?  I don't think so, but it's compelling nonetheless.  There are some unanswered questions here and some variables we have to consider:

• What changes to PCC's EHR happened during this time that could have changed the length of time patients stayed in the office?  Or changed the way their times were recorded?  Hard to say.  I'd like to say that we made improvements over time that sped things up, but I don't know about that.  Maybe we added some to make things slower?  Doubt it, but still.
• There is a correlation to length of visit and the overall patient volume.  As volume increases, overall, visit times drop.  The data isn't shown here, but it came through in our work.
• There is definitely a seasonality to it - check Q2 every year...it's the fastest well visit time, every year.

But here I am.  Looking at the rate of vaccine refusals and seeing them kick off the same time that well visits start to take longer.  Can't prove it, but we can feel it.

What do you think is going on?