The comment I get the most lately - it's not really a question - is that practice volumes are down.  [Some] practices are feeling it - when your revenue drops by 5%, your ownership return can drop 10-15-20% easily and that hurts.  But I also see practices whose volumes have gone up considerably this year.  What's the reality?  Here's PCC client volume going back to 2024.

You can see the seasonal fluctuation in blue, but I've placed a red trend line that clearly identifies a downward trend in visits since 2024.  Digging into the data, the source of the decline is fairly obvious:

Same data, same chart, but now broken down by visit type (n.b.: "Other" visits are largely vaccine- or lab-only).  Forgive my poor color combinations, just follow my explanation: Other and Well visits are stable.  It's the sick visits that have declined.  

There are many explanations for why this may be happening, but to me the strongest and most likely factor here is that we are now returning to normal in a post-COVID space.  The widening viral gyre that started in the fall of 2020 and peaked in 2023/2024 is now starting to slow and the winter of 2025/2026 was a classic "weak flu" season.  It's just like, say, 2017 or 2018 (I can't remember which).  2019 was a monster flu season, then COVID hit, and then we've been on a pendulum ever since.  

I've heard a lot of speculation that the Medicaid disenrollment (and fear of ICE) may be contributing to the volume decline - that could be true, but that concept is not supported by the maintenance of the well-visit volume.  

I dug into this a little further and I see that 70% of our clients are seeing a visit decline relative to 2024-2025, but 30% of our clients are seeing volume growth.  I haven't discerned what the pattern is, but feel like the issue is acutely localized - I can see practices who are just blocks away from each other and their volume differences can differ by 10-20+%.

Time to fire up the preventive care recall engines again.