Back to normal: Medical practices’ visit volumes are rising in 2022, but so are costs

Despite the Omicron wave ringing in the new year, medical practices largely report that visit volumes have eclipsed 2021 levels thus far in 2022.

A May 10, 2022, MGMA Stat poll found that 55% of practices report their 2022 visit volumes are above 2021 levels, while another 30% said this year’s levels are about the same as last year. Only 16% noted they are below the visit volumes they saw in 2021. The poll had 450 applicable responses.

Medical group leaders whose volumes are at or below 2021 levels cited several challenges inhibiting growth:

• Patient reluctance to come in after the Omicron surge or in fear of developing subvariants of coronavirus. As one practice leader told MGMA, “patients prefer telemedicine or in-person visits in uncrowded facilities due to COVID concerns.” Another medical group leader cited a surge in cancellations and no-shows that exceeded 2021 levels following the surge in COVID-19 cases this past winter.
• An overall drop in visits among practices that previously had a high percentage of COVID-19 testing and vaccine administration. “Our COVID vaccine and testing volume has reduced, but our actual MD services have gone up,” one respondent said.
• Visits taking longer due to patients who deferred care and have more complex issues to treat.
• Lack of appropriate staffing to handle higher volumes. Several practice leaders cited provider resignations and terminations in recent months have led to open positions that have been difficult to fill amid a tight labor market for several roles, clinical and administrative.
• Patients opting against visiting due to financial concerns (e.g., high-deductible health plans, rising costs elsewhere). One practice leader told MGMA, “High-deductible plans keep folks away from the doctor; it’s money out of their pocket now.” One of the most-cited factors was rising gasoline prices: Per a May 10 short-term energy outlook from the U.S. Energy Information Administration, the futures price of refined crude oil byproduct (a component of petroleum used in gasoline across the country) was up 51 cents per gallon on May 5 from April 1. The average retail price of a gallon of regular gasoline throughout 2022 stands at $3.82, well above the $3.02 average from 2021.

For the organizations that are ahead of last year’s volumes, the most-cited factors for the growth included:

• People getting back to normal. Fewer COVID-19-related closures in other areas of society (e.g., schools) that would cause child/family care issues for workers that disrupted worker scheduling. Additionally, multiple practice leaders told MGMA that there have been reduced surgical scheduling limitations as certain COVID-19-related restrictions have been lifted in the new year.
• Sick visits are back. A return to in-person schooling and offices reopening leading to an increase in typical sick visits, be that for cold, flu and/or COVID-19.
• Psych is strong. Among practices offering some form of mental/behavioral healthcare, there continues to be an increased demand among patients struggling with pandemic-related stress.

Recovery comes with resurgent costs

A recent report from Kaufman Hall also points to improved financial performance tied to rising visit volumes in the first quarter of 2022, as reported by Fierce Healthcare, with work RVUs (wRVUs) per full-time-equivalent (FTE) physician up 7.4% from the previous quarter — when Omicron COVID-19 cases surged — and up 15.4% year over year. The Kaufman Hall report also pointed to increasing physician compensation tied to the productivity gains.

However, several large hospital and health systems’ first-quarter reports point to significant impacts to operating margins due to rising costs from staffing and other areas. The increased competition among employers for workers already led to more than half of practices budgeting more than usual for workers’ cost-of-living (COL) increases for this year (per a Dec. 14, 2021, MGMA Stat poll), with an average COL increase of 5%.

Inflation continues to wreak havoc on medical groups’ spending, as the April 2022 Consumer Price Index (CPI) report showed a 8.3% increase last month, coming after the March report showed an 8.5% annual increase from 2021, which was the largest annual gain since December 1981. The decrease from 8.5% growth to 8.3% marked the first time since August 2021 that the pace of inflation eased, per Bureau of Labor Statistics (BLS) data.

These pressures make it important for medical practice leaders to be mindful of upcoming changes in physician reimbursement to ensure the cost to deliver care is covered by payments for services.

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