Outpatient Volumes Plateau, Except in COVID-19 Hot Spots

Healthcare providers suffered historic financial losses when COVID-19 forced organizations to close their doors to minimize the spread of the highly contagious virus. But outpatient visit volumes are starting to recover, even as new COVID-19 hot spots emerge, a new report shows.

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In the report, researchers at Harvard University, the Commonwealth Fund, and the healthcare technology company Phreesia analyzed data on changes in visit volumes for over 50,000 providers who are Phreesia clients, which include more than 1,600 provider organizations representing more than 50,000 providers across all 50 states.

In a typical year, these provider organizations have more than 50 million outpatient visits, or more than 1 million visits a week.

During the COVID-19 pandemic, however, outpatient volumes declined by nearly 60 percent by early April, the report stated.

The number of visits to the ambulatory practices started to rebound in mid-June, and by the end of July, weekly visits plateaued at 10 percent below the pre-pandemic baseline, which was defined as the week of March 1st through 7th.

Operating at about 90 percent of pre-pandemic outpatient volumes is a significant improvement for providers struggling to make up for revenue lost at the start of the pandemic.

However, the Commonwealth Fund noted in the report that the “cumulative number of lost visits since mid-March remains substantial and continues to grow.” This was especially true in new COVID-19 hotspots, where outpatient visit volumes start to decline again.

Providers in Arizona, Florida, and Texas saw a decline in office visits in June and July when the states reported surging COVID-19 cases. The decline was small compared to visit drop-offs at the start of the pandemic, but still substantial, according to researchers.

Meanwhile, outpatient volumes in other states with surging new cases held steady and rates in the Northeast – one of the first COVID-19 hotspots – continued to trail behind most of the nation, even with relatively low weekly new case counts, researchers reported.

Telehealth visits have also started to plateau since their peak in mid-April, the report showed. Although, telehealth volumes are holding steady well above pre-pandemic levels.

Outpatient volumes have a major impact on whether people are getting the care they need, as well as the financial stability of practices, the report stated.

Hospitals are slated to take at least a $323 billion hit by the end of the year because of plummeting volumes and other pandemic-related expenses, the American Hospital Association (AHA) recently projected.

At the same time, primary care practices have already lost $15 billion early on during the pandemic as visit volumes, and subsequently, revenues sank, Harvard Medical School and the American Board of Family Medicine reported.

Consistently low outpatient volumes could signal worse financial losses as providers continue to fight a global pandemic heading into the fall. But some providers may have a harder time than others, according to the report.

Some specialties, including dermatology, ophthalmology, and adult primary care, have returned to or exceeded their baseline rates by the start of August.

However, pediatrics and pulmonology are among the specialties remaining substantially below the baseline.

Researchers also noted significant differences in specialty visits trends during the pandemic. Dermatology, for example, saw one of the greatest initial declines in office visits but has rebounded above the baseline.

Behavioral health, however, experienced one of the smallest declines in office visits at the start of the pandemic and has only modestly rebounded. Office visits have recently plateaued at 15 to 20 percent below baseline, researchers reported.

There were also differences in outpatient visits by type of insurance, with the data showing robust visit volumes for Medicare patients and lagging visits volumes for Medicaid patients.

Additionally, the proportion of all visits per week for self-pay patients has grown since the start of the pandemic, the report revealed.

The trend could be explained by an increasing number of uninsured patients or more uninsured patients becoming ill and seeking care, the Commonwealth Fund stated.

Two-fifths of working-age adults do not have stable health insurance coverage, according to new survey findings from the organization. Many of these adults were insured at the time of the survey (12.5 percent), while some experienced a coverage gap (9.5 percent) and some were insured for the full year but high out-of-pocket costs or deductibles qualified them as underinsured (21 percent).

As new COVID-19 hot spots emerge and providers gear up for potential second waves of the virus, operating at partial outpatient volume capacity coupled with increases in self-pay patients could spell trouble for providers already struggling to make ends meet.