• The Business Impact of COVID-19 on Pediatric Practices

The Business Impact of COVID-19 on Pediatric Practices

PCC works with independent pediatricians across the country to help them run their practices, get paid for the vital work they do, and keep them informed about trends and changes in the industry. The COVID-19 pandemic has rapidly and radically changed how and where independent pediatricians are seeing their patients.

We have aggregated data from our clients across the U.S. to better understand how the COVID-19 pandemic is changing, how independent pediatric practices treat their patients, and how they will fare financially.

Below, we have a few charts that illustrate these radical changes. As we gather more data, we will add our insights into the changes we expect to see, and will also provide ongoing recommendations for the things your practice can do to adjust to practicing during this pandemic in the coming months.

PCC clients: please note that you each have your own personalized COVID-19 Dashboard comparing your data to your peers (as well as some additional measures).  

How has your practice been impacted? Please contact us at consulting@pcc.com and let us know!

Weekly Visit and Charge Impact

The core of the pediatric practice business model is seeing patients and charging payers for the visits performed. Thus, the first thing that we investigated was: how are the number of visits and the amount of charges changing as a result of this pandemic?

Weekly Visit and Charge Variation Compared to Baseline

A dramatic drop in visit productivity and charges began during the week of 3/16, which was the start of the heightened social distancing. Starting the week of 4/13, well visits and total charges started to bounce back.

In this chart, we use the weeks of 2/17 through 3/8 (before the effects of the pandemic were widespread) to create a weekly baseline standard.

What we can see is pretty steady and normal visits and charges through the first half of March, with a slow drop off during the second week of March. However, starting on the week of 3/16, we see a dramatic drop in the volume of well visits, sick visits, and charges generated from visits. This matches to the date many areas began requiring increased social distancing.

In the week of 4/13, we are starting to see some improvements. Well visit volume has begun to climb, and with them, charges. We hope that this is an indication that pediatricians have been successful in convincing more of their families that their offices are safe and that well care is still important.

However, sick visits do not show the same growth that well visits do. We suspect this is due to a couple of factors.  First, stay at home orders intended to reduce the spread of COVID-19 through contact with infected people have the same effect on other illnesses. Second, March is a typical time period for flu season to subside, leading to a natural drop in sick visit rates.

While charges show the money that is expected in the future, payments show us the money coming in the door now. Payments almost always lag charges (except for the portion patients pay at the time of service). When charges decrease, you can expect to see payments decrease in the future. Looking at the patterns we are seeing in weekly charges and payments, we can see this play out:

AVG Weekly Charges and Payments Per Practice

Weekly charges for an average PCC client dropped dramatically in mid-March, but started rebounding during the week of 4/13. Payments, however, have shown a slower and steadier decline, as they lag behind charges by as much as 2-6 weeks.

As we saw in the previous chart, charges really drop off starting the week of 3/16.  And, again, the good news shows for charges shows up here as well as we see them beginning to tick up.

Payments, however, have shown a slower, steadier decline as they lag charges by as much as 2-6 weeks.  Therefore, despite the good news of increased charges, the impacts of the decrease in charges during March are still to be felt for many practices.  Those practices that have not yet applied for assistance should do so ASAP as payments continue to decline over the coming weeks.

The chart below is another way to view the changes in visit volume over the course of this pandemic. However, particularly interesting is the change in the average amount charged for a well visit. It went up!

AVG Weekly Visit Volume Per Practice

Starting the week of 3/16, a typical PCC practice has seen a dramatic drop in sick visit volume, but this has leveled-off in April. While well visit volume also dropped off starting in mid-March, the decline wasn't as drastic as the drop in sick visits, and average weekly well visit volume has been on the rise since mid-April. Average charge volume for a typical well visit has increased since 3/16, suggesting a greater focus on doing well visits for kids needing vaccines.

We suspect that the increase in average charge per well visit represents a change in the types of well visits being performed. AAP guidelines and the anecdotal consensus of independent pediatricians posting in the AAP’s Section on Administration and Practice Management (SOAPM) listserv indicate a focus on providing the well visits that include vaccines. Since vaccines must be purchased, they add cost to these visits and push the overall charge per visit higher.

Is that a good thing? It depends on how your practice’s vaccine business works. If you have seen Chip Hart’s talk on the business of vaccines and have implemented his suggestions, then your vaccine pricing is a small bright spot in these turbulent times. Now would be a good time to review your vaccine cost and pricing to ensure that you are not losing money by giving vaccines. Vaccinations are now a larger part of your business than they were before, and it is time to ensure they make you money.

The Emergence of Telemedicine

One of the biggest changes that COVID-19 has brought is a rapid adoption of remote visits. We are very early in our collection of data on the use of remote visits, but we can clearly see dramatic adoption of phone, portal, and audio-visual visits starting in mid-March, when social distancing and stay-at-home orders started going into widespread effect. Throughout the month of April, you’ll see that usage of telehealth services has crossed over 40% and has remained fairly steady since then.

Sick Visit Modality Breakdown

The COVID-19 pandemic has brought a rapid adoption of remote visits into pediatric offices.

We are hard at work digging deeper into the impact of remote visits on the types of visits independent pediatricians are seeing and what the eventual impact on charges, payments, and cash flow will be.

Stay tuned for updates and additional insight to be shared here soon.