Physicians seeing patient visits rebound in 2012

David Hess, MD, knew things were getting better when he started to hear his patients telling him in the office about their vacation plans instead of the reasons why they hadn’t been to see him.

For many months since the economic recession took hold, Dr. Hess saw some of his patients only by chance at the grocery store or the softball field. In the small town of Glen Dale, W.Va., where he and his wife own a pediatric and family medicine practice, those types of meetings hardly could be avoided.

Dr. Hess said he heard many apologies from patients along the lines of, “Sorry I haven’t been in to see you lately, Doc. I just couldn’t swing the co-pay. My wife got laid off from her job.”

But something changed in early 2012, when insured patients started showing up again, Dr. Hess said. “The majority of people are feeling like the choke hold is off a little bit.”

Dr. Hess’ perception of a turnaround in visits is reflected in reports from insurers, consultants and analysts that track patient volume across the country. Their figures show that patients returned in greater numbers to their doctors’ offices in early 2012 after years of recession-driven declines in the rates of physician visits.

Physician visit volume rose by 4.8% over the second quarter of 2012, according to a June 23 research note from Credit Suisse investment analyst Charles Boorady. That figure was based on research by Parsippany, N.J.-based market research firm IMS Health in addition to Credit Suisse estimates. During the same quarter in 2011, according to Boorady’s note, the trend was steeply downward, at an 8.9% decline.

There were glimpses of the same type of recovery in the latest polling by Gallup gauging Americans’ ability to afford health care, along with other necessities. In March, 80.9% of respondents said they had no problem affording needed health care, up from a low of 77.7% when the recession hit in late 2008 but still slightly lower than in February 2011.

In a particularly good sign for primary care physicians and advocates of a primary-care-driven system, patient visits to family doctors, internists, ob-gyns and pediatricians rose again in May and June. That’s according to data from Truven Health Analytics, formerly Thomson Reuters Healthcare. With the exception of pediatrics, volume for those specialties has been rising or holding steady since November 2011, according to Truven figures. Pediatric visits declined in February, March and April, a reversal from the same period in 2011.

For some busy physicians who already work at capacity, a rise in demand for care may have gone unnoticed, said Glen Stream, MD, a family physician in Spokane, Wash., and president of the American Academy of Family Physicians. “It’s not like they’re sitting around waiting for patients to show up.”

Dr. Stream said it’s still too early to conclude that the first signs of increased volume are going to be part of a sustained trend, or to know how long such a trend will last. But over the longer term, he expects to see a rise in demand for primary care due to the aging population and the start of health coverage guarantees, mandates and subsidies in 2014.

Benefit redesigns drive patient visits

Other experts say the noticeable shift in patient visits is about more than the economy recovering from the most recent recession. It also may be due in part to renewed support for primary care that recently has come from employers, insurers and the government.

Under the Affordable Care Act, for example, many insurance plans must cover most preventive care services at no out-of-pocket costs to patients. Dr. Stream mentioned the preventive care benefit as one explanation for a rise in primary care visits.

In his company’s most recent earnings call with investors, UnitedHealth Group CEO Stephen Hemsley suggested that the improving trend in patient visits might be due partly to insurers’ efforts to “encourage more appropriate use of health system resources.”

The growing number of employers enrolling their workers in high-deductible plans, while covering preventive services and other primary care at no additional out-of-pocket costs, has encouraged patients to focus on the importance of obtaining primary care, said Raymond Fabius, MD, chief medical officer for Truven Health Analytics. “The uptake in both the more traditional PPO with differential co-pays and then the uptick of high-deductible health plans has started to, I believe, achieve a turning point. That’s what I think we’re seeing.”

Whatever the reasons for the change in patient volume, it is a welcome development for Dr. Hess. He splits his time between the practice he co-owns with his wife and his work as a hospitalist at Reynolds Memorial Hospital, also in Glen Dale. He said the return of his insured patients has caused him and his wife to begin thinking about expanding their practice, and in turn has prompted them to think of better ways to serve families in the community that are headed by working, insured adults.

“When private insurance patients start coming back in, then you can see that in your numbers,” he said. “Things are easing up.”