ED, Inpatient Volumes Stuck Despite Some Hospital Visit Recovery

Fear of COVID-19 transmission and greater use of alternative care settings are stalling hospital visit recovery across key service lines, while others are starting to near pre-pandemic levels, according to experts at TransUnion Healthcare.

In a new analysis of over 500 hospitals, the company found that hospital visit volumes for more treatment settings “slowed to a standstill” for most of the summer.

In particular, emergency department (ED) visits remained down by 25 percent through mid-August compared to pre-pandemic levels. This was the same level observed eight weeks prior, the company noted.

Additionally, inpatient volumes did not improve, staying at about 8 percent below pre-pandemic levels in mid-August – roughly the same level recorded in late June.

Meanwhile, outpatient visit volumes recovered over the summer, down by just 2 percent compared to earlier in the year before COVID-19.

“As we track healthcare utilization, we’re seeing hospital visit recovery for emergency department and inpatient settings stagnating below normal levels which may reflect patients’ continued concerns with the safety of hospital settings due to COVID-19,” said David Wojczynski, president of TransUnion Healthcare.

Slow hospital visit recovery, however, will harm some providers more than others based on their key service lines. For example, children’s hospitals could be at great risk if volumes do not pick back up.

Healthcare visits by children continue to lag at the greatest rate, even in the outpatient setting, TransUnion Healthcare found.

The analysis showed child ED visits being down 58 percent in mid-August compared to 16 percent for adult ED visits. Outpatient visits for children were also down 23 percent versus just 1 percent for adult outpatient visits.

Child inpatient volumes, however, have almost returned to the pre-pandemic normal, down only 2 percent by the week of August 16th. Adult inpatient volumes were down by 9 percent by that time.

“In addition to parents’ concerns of COVID-19 transmission, a number of factors may contribute to the sustained, low levels of child visits including limited in-person education and a lack of organized extracurricular activities,” said James Bohnsack, senior vice president and chief strategy officer at TransUnion Healthcare. “As a result of the combination of these lower levels of child visit volumes and suspended non-urgent medical procedures, revenues for many children’s hospitals have flattened amidst the pandemic.”

Children’s hospitals have received targeted funding from the federal government during the COVID-19 pandemic totaling $1.4 billion. But the providers do not think it will be enough to offset dramatically low visit volumes.

“The pandemic’s impact on children’s hospitals continues and its adverse effects on children’s health will be enduring, requiring ongoing mitigation through future relief. We look forward to working with both Congress and the administration as our country, and its children, works to recover from this crisis,” the Children’s Hospital Association said.

According to the Association’s own calculations, children’s hospitals are on track to lose $10 billion by the end of 2020 because of the pandemic.

The road to recovery will be a long one, Bohnsack acknowledged.

“Hospital providers must implement the appropriate engagement and revenue recovery strategies to address these financial difficulties in the short term and to achieve pre-COVID-19 volumes in the long term,” Bohnsack said.

At AdventHealth, a “digital front door” is connecting patients to the health system and ensuring they receive care when they need it in the most appropriate setting, which during a pandemic could be patient homes, PatientEngagementHIT’s Sara Heath reported.

The health system leveraged patient engagement technology to implement a 24/7 call center, an AI-powered chatbot, and other consumer-facing capabilities that helped channel patients to virtual care pathways.

Flexibilities granted by payers have made virtual care options a major source of revenue for hospitals during the pandemic and, for this reason, some hospital visit volumes are stagnating.

Hospitals should be identifying ways to bring it revenue through alternative care settings since, based on recent hospital visit recovery trends, patients seem to be getting more comfortable with using telehealth and other non-hospital facilities for care.

The TransUnion Healthcare analysis, for example, found that volumes for higher-acuity diagnoses have returned faster than for low-acuity diagnoses.

“This shift is promising for the healthcare industry, particularly when considering the consistent issue of emergency department over-utilization in the United States, as it could lead to reduced healthcare costs overall if it endures beyond COVID-19,” the company stated.