January 2014 Visit Volume

[Back from vacation!]

Starting in mid-January, we began to hear rumblings and then outright panic from our clients about their patient volume diving steeply.  Although most practices recognized the impact of the crazy weather and practice/school closings, the most common explanation I heard was that "high deductible health plans" are to blame for the big drop.  I know a few practices who laid off staff and even some who let clinicians go!

I suggest looking more closely at the data.

The first thing we decided to do here is to verify the change in volume.  Was January 2014 slower than January 2013 for pediatricians?  And if so, how?

Realize that this is a tricky thing to measure across many practices.  It's one thing to look at just your own practice - as you should - but more of a challenge when looking at a national data sample.There are many reasonable variables that affect a practice's volume.  How many work days are in a given month?  Were clinicians on vacation?  Has the practice gained or lost clinicians?  Has the practice added or subtracted clinical hours, like late nights or weekends?  We gathered the data for all PCC clients and narrowed our focus to those practices who were open full-time from January 2011 through January 2014 and converted their monthly visit totals to a daily average, normalizing for the number of weekdays in each month.  That delivered us this data (click for a bigger view)

There are a couple of things I want you to see here.

• Pediatric visit volume is cyclical with a sick season that hits between October and February.  Note the four peaks of this time range: Feb 2011, November 2011, October 2012 (and again in Jan 2013), and October 2013.  Once you account for the fact that we can't control when the sick season happens, you realize that comparing January 2014 (post-peak) to January 2013 (peak) doesn't make a lot of sense from a practice productivity standpoint.  Remember that your peaks and valleys may come at different times depending on your location.  For many practices coming off of the high Oct/Nov, January just felt bad more than it indicated a real problem.
• Note the red trend line (I hope you can't miss it).  There has been a clear downward trend in visit volume for PCC clients for some time.  Adjusting for clinical blips like H1N1, PCC's customer visit volume has slowed every year as far back as we have tracked it (over 10 years).  There are a couple of obvious reasons for this but the big one is right in front of you: increased focus on preventive care.  The PCC client Sick:Well visit has dropped from 2.7:1 to 1.8:1 - which means fewer visits but a much higher Revenue/Visit (essentially doubling in that time).

What does the chart not tell us?  A few things.  One special variable to is the weather.  With 22 weekdays in Jan 2014, all it takes is one missing day to create a ~5% drop.  Two days get you nearly 10%.  And although some practices never closed at all, many definitely suffered enough from bad weather to slow volume and not eliminate it.  And let's not forget that every time school closes, the viruses die off, too.

I have more data, quite a bit more, but let's bite off this chunk and see what people think.  Input welcomed, please.