Non-COVID-19 Hospital Admissions Have Only Partially Rebounded

Hospital admissions for conditions other than COVID-19 are still far below pre-pandemic levels and could stay that way for some time, according to a new study in Health Affairs.

The study conducted by a research team from Sound Physicians, Dartmouth College, and the Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine found that non-COVID-19 hospital admissions were 15.9 percent lower by June/July 2020 compared to a baseline volume from the first few weeks of February.

Additionally, all medical admissions across Sound Physician’s network, which researchers deemed nationally representative, were 8.3 percent below baseline by the summer. Researchers noted that there was a resurgence of COVID-19 cases in some regions at that time.

The levels were a marked improvement from early during the pandemic when non-COVID-19 hospital admissions were nearly 43 percent below baseline in April – the nadir period, according to researchers.

Since then, admissions have crept up, but when they will return to normal remains to be seen.

“It is too early to determine the extent to which hospitalizations will return to baseline levels,” the research team said in the study. “A new, lower norm is conceivable if clinicians become more comfortable with alternatives to inpatient admission, including home-based care with remote monitoring.”

Greater use of telemedicine, fear of contracting the virus by both physicians and patients, and potentially lower transmission rates of non-COVID-19 diseases following stay-at-home orders likely contributed to the declines in non-COVID-19 hospital admissions from March all the way through July, the research team speculated.

Provider organizations have especially leveraged telemedicine during the pandemic to ensure access to care and keep patients engaged despite shelter-in-place orders. In many cases, organizations turned on virtual care platforms in a matter of days.

The virtual care services have become very popular among patients and providers alike during the pandemic thanks largely to temporary telemedicine coverage expansions from CMS and private payers.

Providers are now finding how telemedicine fits into practice after the pandemic. But for struggling hospitals, that could mean a loss of revenue-driving services.

When non-COVID-19 hospital admissions reached a nadir in April, hospital financial performance also plummeted.

Kaufman Hall reported in its National Hospital Flash Report for April that the hospital operating margin sunk to -19 percent even with an infusion of federal aid from the CARES Act. Overall, the margin fell by 282 percent compared to the same period the previous year and was 326 percent below budget.

“April was the worst month ever for hospital finances,” Jim Blake, managing director at Kaufman Hall, stated in the report.

Hospital financial performance has since picked up, just as non-COVID-19 hospital admissions did. But recovery has also stalled, according to the latest National Hospital Flash Report on August data.

Hospitals may have to make do with a lower level of hospital admissions after the COVID-19 pandemic. But the facilities still have to make sure their services are accessible to all.

The study found that, early during the pandemic, non-COVID-19 hospital admissions fell across all patient groups defined by age, race and ethnicity, Medicaid and self-pay status, and income. But admissions rebounded differently across the groups.

For example, non-COVID-19 hospital admissions during late June and early July were about 32 percent below baseline for patients residing in zip codes with more Hispanic residents.

“This pattern may reflect the large Hispanic populations in the South and Southwest, where COVID-19 infection rates resurged in late June, but a larger concern is that it may reflect access challenges for Hispanic populations,” the researcher team wrote.

Non-COVID-19 admissions also dipped by 20 percent for self-pay patient during the rebound period, which researchers said, “could reflect changes in health care decisions and/or access among people who became uninsured due to job loss during the pandemic.”

“Health system leaders and public health authorities should be focusing on how best to ensure that patients with conditions that require hospital care obtain it during the pandemic,” the study concluded.