The 2020 coronavirus pandemic not only impacted and killed millions of people but also caused a dramatic decrease in utilization of primary care. The Boise Medical Group (BMG) in Idaho serves 10 community clinic locations, staffing primary-care departments as well as eight urgent-care clinics across these locations in the larger Boise area.

Historically, the group sees over 300,000 outpatient visits a year with an average patient panel size of nearly 1,000 patients per provider. The group has enjoyed an above-average new-patient growth rate that has allowed for consistent hiring of new providers each year. The providers are compensated on a plan that is based completely on productivity.

However, in early 2020 patients were hesitant to come to the clinic for annual wellness and preventive screenings. While emergency rooms and ICUs were filled beyond capacity, the preventive-care offices were struggling to stay open. In the first few months of the pandemic, volumes dropped by 50 percent. In addition to low patient volumes, the new-patient growth rate and the proportion of visits for pediatric patients dropped dramatically. This impact on volumes is shown in the following table:

BMG is losing money at an unprecedented rate. At the current pace of cash loss, the group would be forced to close its doors within 90 days. Because of BMG’s productivity plan, the group must decide whether it will allow its providers to take a 50 percent reduction in pay. The more that providers are paid above actual productivity, the quicker the group will deplete its emergency cash balance. The group is also considering reducing hours or terminating staff but is concerned about the effect this will have on morale. The staff is already emotionally drained because of fear of infection within the clinic. Volumes are expected to return with a dramatic increase, but it is unclear when the pandemic’s effects will fade and how much cash will be required to survive until then.

Questions 

1. What is the combined total decrease in visit volumes from 2019 to 2020? How much of a decrease in pay will this represent for providers who are on a 100 percent productivity plan?

2. How should the group handle compensation?

3. How might analytics inform decision making when determining how long the group can last with its current emergency cash savings balance?

4. How would a 25 percent decrease in business hours affect individual provider compensation?

5. How can BMG incentivize providers to boost its new-patient numbers and pediatric population?

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Boise Medical Group Volume Performance 2019-2020 Primary Care Visits Urgent Care Visits New Patient % Adult Population % Pediatric Population% 2019 357,352 112,111 17.82% 72.77% 27.23% 2020 214,989 67,854 12.22% 79.87% 20.13%