All Primary Care Physicians, Nurse Practitioners and Physician Assistants, who work clinically throughout our 18 outpatient satellite locations were included in the evaluation (Table 2). In 2019, the provider distribution was 57 Nurse Practitioners, 1 Physician Assistant, and 143 Physicians. In 2020 the distribution was 58 Nurse Practitioners, 1 Physician Assistant, and 133 Physicians. In 2019, 49% of total providers had >80% clinical full-time equivalents. In 2020, that decreased to 47% clinical full-time equivalents. 46.8% reside within the Department of Family Medicine, 30.4% Internal Medicine, 14.9% Geriatric Medicine and 8% Medicine-Pediatrics.
Of the 201 clinicians, 69.5% were female and 30.5% were male. This remained consistent for 2020. The average age range of clinicians spans from 29-80. The age distribution was as follows: 2.99% were ages 29-30, 24.4% were ages 31-40, 20.9% were ages 41-50, 31.8% were ages 51-60, 18.9% ages 61-70, and 1% was over the age of 70.
The COVID pandemic created a need to change our delivery of care. On March 16, 2020, MHMS made the decision to deliver quality care through telehealth visits by telephone and permitted providers to remain safe at home in the process. While many other systems across the country invested millions of dollars to change their infrastructure, MHMS remained consistent to their mission; delivering high quality care, regardless of the ability to pay. The three months visit volume variance (March-May) 2019 to 2020 was (6.40%). Geriatrics observed a slight increase in visit volume from 2019 to 2020 at 2.52%.
Despite the unknown risk of reimbursement for telephone visits during the COVID pandemic, MHMS dramatically changed care delivery. Visit distribution from March 1, 2020 – May 30, 2020 to the same time period in 2019 shows a complete shift in in person versus telehealth visits. During March-May 2019, the percentage of telehealth visits was less than 1%. The shift to telehealth Mid-March 2020, shows an increase in telehealth by 35.9%. Telehealth visit volumes shifted to 87.4% for the month of April 2020 while leveling to 58.4% in May 2020 as patients needed services that required in person visits (Table 1). During this time period, providers were primarily performing telehealth remotely and were available for in-person care at least one day of the business week.
Table 1
Visit Distribution Combined
|
In Person
|
Telehealth
|
2019
|
|
|
March
|
99.83%
|
0.17%
|
April
|
99.78%
|
0.22%
|
May
|
99.75%
|
0.25%
|
2020
|
|
|
March
|
64.1%
|
35.9%
|
April
|
12.6%
|
87.4%
|
May
|
41.6%
|
58.4%
|
On average, Primary Care and Geriatrics had between 140-162 unplanned monthly call-offs in 2019. In the same three-month period in 2019, Primary Care and Geriatric providers tallied up 147 call offs, compared to 87 call offs during the same time period in 2020. Call off rate is number of call-offs divided by total number of providers by month.
The physician group showed a 24% decrease in call off rates for March, 52.1% decrease in April and 32.00% decrease in May when comparing 2019 to 2020 call off data. Similarly, the Nurse Practitioner group decreased call off rates by 30.30%, 63.13% and 60.00% respectively. This analysis shows that the average decrease in call off rate from March- May 2019 compared to 2020 was 40.81%, and the decrease in overall visit volume in 2020 was only 6.40% lower than the same time period in 2019 (Table 2).
Table 2: Call-off rates during the months of March-May in 2019 compared to the same time period in 2020
PERCENT CHANGE 2019/2020 CALL OFFS BY PROVIDER
|
Provider TYPE
|
MARCH
|
APRIL
|
MAY
|
TOTAL
|
MD
|
-24.00%
|
-52.17%
|
-32.00%
|
-35.61%
|
APRN
|
-30.30%
|
-63.16%
|
-60.00%
|
-47.22%
|
PA
|
100.00%
|
0.00%
|
-100.00%
|
0%
|
TOTAL % CHANGE
|
-25.42%
|
-57.14%
|
-45.65%
|
-40.81%
|