Hospital, Outpatient Visits Fell Up to 60% During COVID-19 Crisis

Stay-at-home orders and other COVID-19 precautions have had a negative impact on both inpatient and outpatient visits, according to new research.

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Outpatient visits for more than 50,000 providers declined by nearly 60 percent in mid-March when COVID-19 cases started to rise exponentially, researchers from Harvard University recently reported in a Commonwealth Fund study. The volumes have remained low through mid-April.

Similarly, hospital visits also saw a substantial decline, with TransUnion Healthcare reporting decreases between 32 and 60 percent in March 2020 for over 500 hospitals across the US.

Much of the declines in hospital and outpatient visits can be attributed to the cancelation of elective procedures. CMS and state governors recommended that healthcare organizations cancel or postpone elective, non-emergent procedures and services to prevent the spread of the highly contagious novel coronavirus.

Hospitals and physician practices alike have adhered to the recommendations and patients have similarly followed stay-at-home and social distancing orders.

A separate TransUnion Healthcare analysis of patient behavior during the COVID-19 crisis showed that more than one in four patients (27 percent) said they had an elective surgery, appointment, or procedure delayed or canceled due to COVID-19.

Of these patients, nearly half indicated that they will only reschedule once they no longer believe there is a high risk of COVID-19 infection or once guidelines advise it is safe.

The precautions are keeping patients and providers from being exposed to the virus, but they are also having a negative impact on the bottom line.

“Elective procedures represent a large portion of a hospital’s revenue,” said Jonathan Wiik, principal of healthcare strategy at TransUnion. “Our latest research sheds light on the challenges that providers are facing as a result of decreased utilization and the subsequent financial impact.”

Hospital operating margins have already fallen by 150 percent year-over-year in the month of March alone, according to the latest financial performance report from Kaufman Hall.

Physician practices are in a similar boat. Practice revenue has declined by an average of 55 percent since the beginning of the COVID-19 crisis, the Medical Group Management Association (MGMA) reported earlier this month.

Providers have been leveraging telehealth to offset the cancellation of some services and to keep their organizations running. However, telehealth volumes have not been enough to completely offset the drop in in-person visits, researchers from Harvard found.

Among the independent single-provider practices, multispecialty groups, federally qualified health centers, and large health systems analyzed, nearly 30 percent of all visits were provided via telehealth by mid-March. But the drop in-person visits was significantly steeper than the decline in all types of visits, including telehealth.

The decline in visits was generally larger among surgical and procedural specialties, including ophthalmology, otolaryngology, dermatology, and surgery. In contrast, researchers observed smaller outpatient visit declines in adult primary care, obstetrics/gynecology, oncology, and behavioral health.

The research underscored the impact elective procedures have on the bottom line. Of all visits in a typical week before the pandemic, 47 percent are with primary care physicians (adult and pediatric) and the other 54 percent of visits are spread across more than 25 specialties.

“The healthcare industry is facing immense challenges and pressures as a result of the COVID-19 pandemic, especially from a safety, clinical, and financial perspective,” said Dave Wojczynski, president of TransUnion Healthcare. “As healthcare utilization rates continue to decline in much of the country, healthcare providers are doing their best to ensure that capacity exists so that they can treat COVID-19 patients, while simultaneously implementing a measured approach to resume elective procedures.”

CMS has already issued guidance on resuming elective services in certain areas. But before providers can allow for more in-person visits, their communities must report declines in either the number of documented COVID-19 cases or positive tests in a 14-day period per new White House guidelines. States and regions must also meet other criteria in order to start reopening local economies.

Healthcare providers may be eager to restart elective procedures to not only pick up financial performance, but to ensure their patients are getting the care they need. However, it may take more than reopening the local economy to get patients to come into the office.

“Our initial research indicates it may take some time before patients are ready to reschedule the elective procedures and appointments that were canceled as a result of the pandemic,” Wojczynski stated.