Pediatric Benchmark: Sick-to-Well Visit Ratio

A long time ago, PCC came up with the concept of an important pediatric clinical measurement, the Sick-to-Well Visit ratio.  The concept was straightforward: how could we encapsulate, in a single number, a practice's focus on providing preventive care?

The ratio and another (intentional) use - it's a really good indicator of the financial health of a practice.  There are exceptions - queue Lynn Cramer - but unless a practice has a strong chronic disease management program in place, I can tell a lot about a practice based on this simple number.

Originally, we calculated the ratio the easy way: we added up 99201s through  99215s and divided them by 99381s through 99395s.  There are all kinds of problems with this, though the results were better than nothing.

Today, we're a little smarter.  The big change we've made is recognizing the growth of -25 modified code usage.  Obviously, when trying to measure the preventive care focus of a practice, we don't want to count well visits with attached sick visit codes as sick visits.  So, now we count all visits that have a well visit in them as a well visit (even with additional, modified E&M codes).  The results are interesting.  Thanks to Igor, as usual.


Original New
2003 2.67 2.61
2004 2.34 2.31
2005 2.44 2.41
2006 2.35 2.32
2007 2.33 2.31
2008 2.23 2.21

So, anyone want to tell me what happened on 2004?!