Fluctuating Patient volume

[Pain Applicant1]

Is this common? I've been really lucky since I've been mostly busy since opening day but this week I'm noticing a lower volume for some reason. When this happened in the past, I've noticed that it correlated with back to school, holidays, or vacation times but this time of year there really shouldn't be anything that should limit my referrals. Does everyone else randomly cycle with pt volumes?

---

Members don't see this ad.

 

[emd123]

I've always had some fluctuation but have noticed a little more lately, also. Not sure what it is other than maybe the usual waves or are deductibles dragging people down? Or maybe they all heard about that Lobel guy and are moving to Georgia, who knows.

 

[bedrock]

Volume is down for everyone right now. I've spoken with pain docs and surgeons in multiple states, that all have complained of low volume this spring compared to the last 5 years.

Likely due to a combination of ****tee obamacare plans that no physician will accept due to low reimbursement, and also every increasing deductibles on regular insurance, so many patients say they can't afford a procedure or surgery right now as they'd have to pay for it all by themselves due to the deductible.

I expect the fall will be busier as people use up their deductibles.

What's crazy about all that, is that these same people who will endure pain to avoid a medical procedure to save $400, will go and pay their vet $1000 to check out their cat without a second thought.

 

[jonnylingo]

Volume is down for everyone right now. I've spoken with pain docs and surgeons in multiple states, that all have complained of low volume this spring compared to the last 5 years.

Likely due to a combination of ****tee obamacare plans that no physician will accept due to low reimbursement, and also every increasing deductibles on regular insurance, so many patients say they can't afford a procedure or surgery right now as they'd have to pay for it all by themselves due to the deductible.

I expect the fall will be busier as people use up their deductibles.

What's crazy about all that, is that these same people who will endure pain to avoid a medical procedure to save $400, will go and pay their vet $1000 to check out their cat without a second thought.

Or shell out thousands for the DRX9000 decompression treaments at their local chiro. But a $20 PT co-pay? fuggitaboutit.

 

[stim4u]

Volume is down for everyone right now. I've spoken with pain docs and surgeons in multiple states, that all have complained of low volume this spring compared to the last 5 years.

Likely due to a combination of ****tee obamacare plans that no physician will accept due to low reimbursement, and also every increasing deductibles on regular insurance, so many patients say they can't afford a procedure or surgery right now as they'd have to pay for it all by themselves due to the deductible.

I expect the fall will be busier as people use up their deductibles.

What's crazy about all that, is that these same people who will endure pain to avoid a medical procedure to save $400, will go and pay their vet $1000 to check out their cat without a second thought.

you are right. But high profile economists don't know why health care costs are so low currently. The dems like to say its obamacare, even though it was not in true effect.
The high deductible issues are the real reason, and I started seeing this with patients and with my own health plan in early 2009..... many board members predicted this long ago; reduced access of care due to cost....

 

[Tenesma]

1) If you are doing honest work, and treat your patients with compassion - then don't focus on these volume shifts --- in every practice, even a mature practice, there are ebbs/flows that are completely unrelated to you as a doctor.

I used to monitor this activity daily/weekly/monthly - only to get heart ache/depressed if my numbers dipped X amount - I have learnt that it is better not to pay too much attention to that.... Now clearly if month after month after month there is a worrisome trajectory then the situation clearly needs to be analyzed

2) There has been a drop across the board amongst all specialties in these 3 months - the high-deductible plans are EVERYWHERE now... and they have contributed to a lot of patients avoiding/delaying care....

It still amazes me though how a patient can afford a trip to Switzerland for a ski trip but doesn't want to pay 400$ deductible for an MRI....

3) Silver lining: as the american population becomes habituated to paying cash for all these high deductible plans, it won' tbe such a psychologic leap to an all cash practice.

 

[Pain Applicant1]

Interesting insight, thanks!

 

[futurdoc12345]

Hey all, I'm a MS3 interested in anesthesia/pain...I was wondering with a pain practice, how many weeks do you guys have for vacation. I know its pretty much up to you how many weeks you want off, but what do people average? I love how anesthesia you can have 7-8 weeks, but would love to go into pain and have my own practice, but I'm guessing will have to cut my vacation weeks in half...thx

 

[clubdeac]

Hey all, I'm a MS3 interested in anesthesia/pain...I was wondering with a pain practice, how many weeks do you guys have for vacation. I know its pretty much up to you how many weeks you want off, but what do people average? I love how anesthesia you can have 7-8 weeks, but would love to go into pain and have my own practice, but I'm guessing will have to cut my vacation weeks in half...thx

You answered your own question. Cut the vacation weeks in half. It all depends on how much you want to make unless you work at the VA and get paid vacation.

 

[PinchandBurn]

Hey all, I'm a MS3 interested in anesthesia/pain...I was wondering with a pain practice, how many weeks do you guys have for vacation. I know its pretty much up to you how many weeks you want off, but what do people average? I love how anesthesia you can have 7-8 weeks, but would love to go into pain and have my own practice, but I'm guessing will have to cut my vacation weeks in half...thx

if you are going to be an employeed doc...just think 4 weeks (including holidays).

If you are going to be self employeed, you can have as much vacation as you want, but at the expense of your revenus.

 

[Jitter Bug]

Yep my clinic volume is down too. I spend more time talking with patients about copays and deductibles nowadays then practicing actual medicine. I have a blue collar population so it's more like rent/food vs doctor visits.

 

[Gauss]

major shift in payor mix since Jan. I would agree the deductibles are scaring everyone away, but the deductibles are huge now, not $400. Massive influx of the new healthcare exchange population and their coverage and networks are atrocious. They come in wanting the full workup and I bet once they get their bills they'll go to collections and vanish. It's almost comical.

 

[Ligament]

Volume will always be low in Jan/Feb/March as peoples deductibles have reset and elective care such as Pain Management is lowest priority. This has been consistent in my private practice since I opened it in 2010.

Plus the economy is still very bad.

Volume is even LOWER than usual due to Comrade Obama canceling the plans of a few million people and forcing them to sign up with a more expensive plan, often with higher deductibles than they had before.

Therefore it is doubly bad right now, thanks to Comrade Obama.

 

[Ducttape]

ive noticed no change in my volumes.

Medicare and Managed Medicaid volumes havent changed.




so the fact that you guys have noticed changes in your volumes - at least you arent seeing a lot of Care/Caid! Be Happy!

 

[Gauss]

Why I’m Jealous of My Dog’s Insurance
http://www.nytimes.com/2014/03/26/o...f-my-dogs-insurance.html?hp&rref=opinion&_r=0

 

[Mister Mxyzptlk]

It's definitely slower across the board. Despite the headline unemployment rate being 6.7% the job market is still dysfunctional, as reflected by the disproportionate number of people working part time who want full time. See Yellen's recent remarks about that.

The Affordable Care Act was really the Affordable Insurance Act in the sense that it tried to decrease premiums. However, if your premium is low and your deductible is high, you are functionally uninsured.

I am working on getting a license to sell health insurance. I will offer plans for $1/month with a $50,000 deductible.

 

[Gauss]

I consistently hear that premiums went up unless you got medicaid

 

[Jcm800]

its bad all over out there...

but hey, maybe they should come see us 3 times a week for follow ups, we can teach them to crack their knuckles and bill for hand manipulation... its the same thing...

 

[Apollyon]

I am working on getting a license to sell health insurance. I will offer plans for $1/month with a $50,000 deductible.

 

[Ligament]

Man, it's STILL slow! I'm down about 15-20% in patient volume compared to last year. Some of that is due to me not taking most Medicare patients, but not all of it...

Please tell me its not only me...getting scared.

It's very troubling. We are in a business where we (as a profession) are making less every single year, and now with Comrade Obama, the government itself is overtly hostile to us in private practice and doing everything it can to make us fail. Our own government wants us to fail. Think about that. It is difficult to think this is still America.

 

[hyperalgesia]

I think it's inevitable that we have to adapt and provide services that patients are willing to pay cash for. And then market directly to them. We have to break our dependence on Medicare/Medicaid/Insurance. Let these third-party payers be for the indigent population and for catastrophes.

Comrade Obama is just one of many who have successfully "transformed" this country into a Euro-wannabe-nanny state. I really think our (libertarians and conservatives) philosophy is fundamentally vulnerable. The people who are most enthusiastic about an activist, progressive, government-centric environment are the ones who go into and thrive in politics.

 

[emd123]

I think it's inevitable that we have to adapt and provide services that patients are willing to pay cash for. And then market directly to them. We have to break our dependence on Medicare/Medicaid/Insurance. Let these third-party payers be for the indigent population and for catastrophes.

Comrade Obama is just one of many who have successfully "transformed" this country into a Euro-wannabe-nanny state. I really think our (libertarians and conservatives) philosophy is fundamentally vulnerable. The people who are most enthusiastic about an activist, progressive, government-centric environment are the ones who go into and thrive in politics.

And repeatedly they collapse their own systems when their policies are enacted (see USSR, E. Germany, Greece, EU, etc) but continue to say, "But only if you let us do just a little more, just a little more of your money, we'll do it better this time..."

How much do you want to bet the recently shamed Sebelius who resigned, who drove the epic Obamacare-Train off the tracks, will resurface with some huge government job that amounts to a promotion.

If any of use performed this badly, we'd be sued out of our profession, lose our license, be thrown in jail and be a pariah for life.

Government: The only profession where it's routine to fail upwards.

 

[Mister Mxyzptlk]

That's not how it works. Sebelius will get a high-paid private sector job.

Ligament, it's slow here too. Nobody can afford health care.

 

[SSdoc33]

Sebelius never held any real power anyway. She was just a figurehead. Did a crappy job nonetheless, but her resignation is really not a positive or a negative

 

[Ligament]

Ligament, it's slow here too. Nobody can afford health care.

Thanks man, good to hear from a successful and established dude like you. I'll keep trying to ride it out and fight with the state when I can.

 

[hyperalgesia]

Sebelius never held any real power anyway. She was just a figurehead. Did a crappy job nonetheless, but her resignation is really not a positive or a negative

I agree, which demonstrates the utter uselessness of her position. Too many figureheads and staff in our government. Can you imagine the Assistant Deputy Secretary Figureheads are actually Big Shots? They have secretaries, who are also big shots. If the secretary for the Assistant Deputy Secretary for the Department of HHS called your local hospital's CEO, he would probably take a **** in his pants. That's how f'd up this whole circus has become.

 

[Mister Mxyzptlk]

The elected officials come and go. The career bureaucrats persist. Nothing happens without their cooperation and their primary goal is status quo.

Perversely, bureaucratic power is measured in budget and headcount so the incentive is to accumulate a larger department.

Staying under budget is rewarded with a budget cut, not a raise, bonus, or promotion.

Failure is not punished. The person or department that failed gets a bigger budget so they can accomplish the goal.

There is nothing in government that rewards thrift or efficiency. Nobody in government has any of their own capital at risk. It's all OPM.

 

[hyperalgesia]

The elected officials come and go. The career bureaucrats persist. Nothing happens without their cooperation and their primary goal is status quo.

Perversely, bureaucratic power is measured in budget and headcount so the incentive is to accumulate a larger department.

Staying under budget is rewarded with a budget cut, not a raise, bonus, or promotion.

Failure is not punished. The person or department that failed gets a bigger budget so they can accomplish the goal.

There is nothing in government that rewards thrift or efficiency. Nobody in government has any of their own capital at risk. It's all OPM.

Spot on.

 

[Pain Applicant1]

I think I'm starting to pick back up again. I've gotten busy again in the past few days and fingers crossed that it stays. Anyone else starting to see a bucking of the low pt volume trend?

 

[Mister Mxyzptlk]

Yes. Past couple of weeks. No idea what caused the slump or the recovery.

 

[emd123]

Yes. Past 3-4 weeks busier. Not sure why. Deductibles met, maybe?

 

[powermd]

We had a busy Q1, a bit busier than last year. We were doing 1-2 kyphos per week! Suddenly we hit a dry spell, which often happens with the change in seasons. Hopefully people will start doing outdoor work soon and stirring things up!

 

[Pain Applicant1]

Weird and interesting how these trends may be national. I think people have either met their deductibles or they've psychologically accepted paying higher co-pays. At this point, I'm finding that I don't mind the slower days and having an hour or two without seeing patients is helpful to catch up on other business related stuff.

My employees tell me I complain when it's slow and then again when it's busy. Damned if I do, damned if I don't I guess. I think it's time for a vacay.

 

[Ligament]

I *think* it is picking up for me too here in Seattle. Not sure yet.

 

[yankeeh8r]

I think things are starting to pick up too. It's weird though, like some days will be full and other practically empty. No rhyme or reason to it. I am seeing more patients with private/employer sponsored insurance coming out of the woodwork. Lots of high-deductibles. They mostly haven't met them yet, though. But, it's getting that time of year where they want to be more active and the pain is too limiting. Still, I find myself being asked "what's that cost?" so much that I keep the cash pay price list on my desk so I can give them ballpark figures when they ask. It's insane.

 

[Ducttape]

No change in volume.

Caid patients seeking meds don't follow seasonal calendars, only clocks that start after 10am

 

[emd123]

Just talked to a neurologist who does a fair amount of Pain, that recently switched from private practice to an employed position.

He said it's 90% 'caid and self pay, everyone else refused to see. He didn't seem very happy about the change.

 

[lobelsteve]

Just talked to a neurologist who does a fair amount of Pain, that recently switched from private practice to an employed position.

He said it's 90% 'caid and self pay, everyone else refused to see. He didn't seem very happy about the change.

Why did he do it? Did he not know?

 

[Ducttape]

Money, perceived job security (most docs are just not equipped to run an office ), seeing shrinking volumes in PP, are a few reasons I can think of.

 

[emd123]

Why did he do it? Did he not know?

I think his practice was poorly run, and they just caved when the hospital came in and offered them what looked like a good deal. Him and one of the neurosurgeons he's with asked if I wanted to join with them, and I was like, .....

...uh....uh....

Not right now thanks.


Didn't your group just take a buy out, and go work for The Man?

 

[lobelsteve]

I think his practice was poorly run, and they just caved when the hospital came in and offered them what looked like a good deal. Him and one of the neurosurgeons he's with asked if I wanted to join with them, and I was like, .....

...uh....uh....

Not right now thanks.


Didn't your group just take a buy out, and go work for The Man?

Yup. And 5 months in and the honeymoon is not over.