Questions and Comments from Last Night (08/20 Seminar)

Some questions and comments from last night, annotated by me.

First, here’s a link to the Women In Pediatrics community and here’s a link to the Women In Pediatrics event, Reveal Your Undercover CEO. I really like their conference artwork:


Back to the Q&A:

Does the gap in well visits hold true equally for Medicaid enrolled and commercially enrolled children?

Good question - I don’t have that data handy, but it’s something to explore. While most Medicaid measures lag measures for kids covered by commercial insurance, that’s not universally true. Note, though, that the nature of the data I provide describes performance within our client practices - it does not reflect the status of children who aren’t covered. In other words, I think our clients do a really good job regardless of whether their patients are Medicaid or not (in fact, there is an interesting collection of high Medicaid practices at the top of our clients’ clinical performance dashboard). But our data won’t include the millions of kids who aren’t seen by our clients and who may not be seen by anyone. I hope that makes sense.

@nancy.zimble asks:

but isn’t that because we are doing more expensive well visits and still hardly any sick?

I believe this is in reference to the charge/payment gap and the answer is, fortunately, no. I don’t think so. Why? Because in a typical summer, your well visit volume goes up significantly as your sick visits drop and what we’re comparing here is volume week-to-week. July 2020 looks a fair amount like July 2019 just with a lot less sick, as you say, but that’s actually normal. Where the pain will hit is between now and December when your sick remains low.


Are PCMH payments considered capitation?

For the purpose of what I was describing, yes. Any P4P, capitation, PCMH, etc., recorded by our clients will explain why payments didn’t decrease at the same relative rate that charges decreased. I should have made that more clear. However, I don’t think it includes and CARES act, PPP money, etc., as our clients didn’t put that into our system as a rule. And to answer @abaumel, those are gross charges.


can these slides be posted on the forum?

You can find all the slides right here!

I’m going to open a topic for the questions for @hlavania.

Thanks for the answer and thanks for these incredibly helpful forums.
In our tiny 2 person practice we have done more well visits per doc than previous summers but we are still working only about 80% because total volume is low still and we try not to have both docs in the small office together often.
Looking ahead in scheduling and bills coming due , it is clear these well visits dropped off this week and are way down going forward and the huge vaccine bills are coming due for summer well child visits. Of course we have budgeted for the bills due and now we will again work on recall but with 4/7 of us over 60 we are not anxious to see potential covid kids if we can avoid it.
In Los Angeles our schools are not opening because our numbers are still too high so i suppose that also has contributed to wcc drop off - parents feel no urgency if no school - but we will catch some lapsed vaccines and wcc when we start giving flu shots . Of course it is disappointing that local target and cvs are giving flu shots now and we get just 20% of our order in early September - grrrr.
We are an older practice - heavy with teens and light in newborns - and as most of our college kids aren’t leaving home now, we will try to capture some follow up of anxiety and obesity in these older kids by telemed. We will take your suggestion to recall the 5-7 year olds that haven’t been coming because they didn’t need vaccines.
I am still feeling our practice is very much at risk in many ways but always encouraged and loaded with new ideas by the very helpful zooms.
Thanks again for the help.
Dr. Nancy