Winter is coming.
I sent a message to our employees last week asking if anyone had seen my crystal ball that I left at the nursing station. No questions asked if it was returned to my desk. Don’t even care what it was used for.
So, currently I do not have the crystal ball. Leaving me to make the best educated guesses I can and plan for the winter and staffing. I find it best to ask other providers what their educated guesses are and double check to see if I am on the right page.
Goal this winter is flexibility with the schedule. Since our local governors have lifted the order on non elective office visits, and folks are learning to live with COVID so to say, my prediction is that Well Visit numbers should stay roughly the same as previous years in our area. We caught up this summer with missed Well visits from March-May. Currently we are on track with 2019 for Well Care and we consider ourselves lucky because I know this is not the case for other parts of the country. In March, I would have never imagined this possible. June, July, August was our busiest summer ever, and again I acknowledge this was not possible in many parts of the country.
Goal will be to double down on Well care, all hands on deck, this is the life line now more than ever.
For our office, roughly 30% of revenue comes from ill visit related events and 70% from well visit related events. Granted this excludes supply related cost (35% of gross revenue is related to vaccines). However, scheduling related 40% of scheduled time on ill visits and 60% on well visits.
So my current train of thought is that Well child care will roughly stay the same (hopefully). Hopefully increased effort to recall will offset decreased demand, and optimistically increased effort would result in increased demand beyond 2019 numbers.
For ill visits, it is the tale of two cities. We will have decreased demand due to social distancing, mask wearing, stay at home. However we will have increased demand due to need for return to school note to ensure it is not COVID (AKA socially responsible parent or CYA school lawyer)
For us, this summer our ill visits on average are down to 70% of average.
I do not know which force will be stronger. Decreased illness or need for a test and a note. If families appropriately social distance and wear mask, illness overall will be down no doubt. Just not sure what the demand for testing and notes will be.
From a budgeting standpoint, I like to work off worse case scenarios and then hope to be pleasantly surprised like we were at last P&L.
So there is the background and happy to elaborate on any aspects. So now the planning and questions.
When planning for provider schedules, I am thinking Well visits will be similar to 2019 and ill visits will be down 70%. From a budgeting standpoint this would be 30% visit revenue (from ill visits) times (70% of typical ill visit volume) = 10% roughly total decrease in revenue over next few months (darkest winter ever).
Remember my crystal ball is missing, so just an educated guess. If this is true, please nobody worry about how to account for your CARES or PPP money. It’s covered with COVID related losses.
So real question for planning for winter schedule. How to schedule providers and thoughts. Again understand very regional.
For this summer we have had 10 providers doing solely Well visits at our “clean offices” and 3-4 providers each day working at ill office (one of the providers is doing telehealth only). We have 3 offices. 2 are designated well only and one is ill only. For ill office, 80% has been in person, and 20% has been telehealth.
My gut is to see increased demand for telehealth provider ordering COVID testing, so expect to see increase in this utilization. However overall demand for ill visits to stay around 70% of typical.
So ask to other forum members is what do you expect your ill visit volume compared to 2019 to be this winter.
My gut is to plan to schedule 60% well visit time slots for the winter and 40% ill visit time slots (with 25-40% of ill slots planned for telehealth, flexibly can switch to seeing in person ill visits). This is opposite of our typical winter when 60% is geared toward ill and 40% to well.
So end to stream of conscious. Please produce my crystal ball and I will be ever so thankful.
If you do not have my crystal ball, I would gladly accept ideas and thoughts.