Hospital Volume Recovery Sluggish Despite More Outpatient Visits

The COVID-19 pandemic led to a dramatic reduction in hospital volumes and consequently revenues, but the providers are slowly starting to recover as patients seek more outpatient care, according to new data.

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Hospital visits overall are starting to trend upward, an updated TransUnion analysis of over 500 hospitals revealed this week. The update showed that hospital visits, which in this analysis included outpatient, emergency department (ED), and inpatient services, were down between 20 and 40 percent between the weeks of March 1st and May 10th compared to pre-COVID-19 volumes. This is up from the 33 to 62 percent declines between the weeks of March 1st and April 12th.

The recent upward trend was driven by significant increases in outpatient visits, the authors stated.

Outpatient hospital visits bottomed out during the week of April 5th as communities made the decision to shelter-at-home and cancel or postpone all elective, non-emergent services. However, the updated analysis found that hospital outpatient visits were down just 31 percent the week of May 10th versus 64 percent about a month prior.

In light of this improvement, many hospitals are seeing outpatient visits nearing 2019 levels, Strata Decision Technology recently reported. Its National Patient and Procedure Volume Tracker, which contains data on 2 million patient visits across 228 hospitals, found that imaging and lab services started to recover from the pandemic by May 1st.

However, hospital volume recovery still have a way to go as patients continue to avoid inpatient and ED care.

ED visits recovered 22 percent of lost volume the week from April 5th through the week of May 10th. However, hospital ED volumes were still down 40 percent compared to pre-COVID-19 levels. Similarly, inpatient volumes experienced a 35 percent during the period, but were still down 20 percent, TransUnion Healthcare reported.

The slow recovery for inpatient and ED care may indicate that patients are deferring necessary care, said David Wojczynski, president of TransUnion Healthcare.

“As many hospitals resume elective procedures, we’re seeing positive signs of recovery for outpatient visit volumes. However, recovery for emergency department and inpatient is lagging, which may indicate that patients are deferring necessary care,” he said in the analysis.

Clinical service lines that saw the sharpest drops in volume as a result of the pandemic included those with life-threatening illnesses, including cardiology, breast health, and cancer care. These services have started on the road to recovery, but were still significantly down compared to pre-COVID-19 levels, the National Patient and Procedure Volume Tracker confirmed.

For example, cardiology experienced a 12 percent increase in volume by the start of May compared to the previous week. Breast health and cancer care also saw increases that week, ranging from about 12 to 17 percent.

Sluggish recovery could spell trouble for patients and hospitals.

“These deferrals will have implications for both patients and providers – high-acuity and chronically-ill patients risk waiting too long to seek care, and a continued reduction in visit volumes will further amplify existing financial challenges for hospitals,” Wojczynski stated.

The American Hospital Association (AHA) estimated that hospitals will lose about $50.7 billion per month through June as a result of COVID-19. Strata put that number closer to $60 billion in previous iterations of the Volume Tracker report.

The federal government has acknowledged that financial losses of this magnitude could devastate hospitals, creating even more healthcare challenges during the public health emergency. A key solution from policymakers has been claim reimbursement advances.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act activated Medicare’s Accelerated and Advance Payment Programs to offer providers more than $100 billion in upfront reimbursements, which served as loans against future Medicare payments. Many private payers have also followed suit, offering their own advance reimbursement programs.

But slower recovery indicated by new data may show that hospital volumes are not restored to a level that will allow organizations to repay the advance reimbursements later this year and sustain operations and clinical functions, Wojczynski warned.

“Considering the uncertainties ahead, it is more important than ever to thoughtfully re-engage with patients and communicate proactive actions health systems are taking to make sure patients feel confident and safe to seek care in hospital settings,” he said.