Almost 55% fewer Americans sought care at hospitals in March and April due to the COVID-19 pandemic, according to a new cohort survey conducted by Strata Decision Technology.
The decline is the major driver behind an emerging clinical and financial crisis for the healthcare industry in the U.S., motivated by losses of insurance coverage, cancellation of elective procedures, resource constraints and concerns for patient and staff safety in hospitals. Strata, however, expects a resurgence in patients whose cases were deferred as states begin to reopen their economies.
"Hospitals across the country are eager to open their doors to elective procedures so they can serve their community, care for their patients, and survive economically, but how they get there is literally a hundred-billion-dollar question," said Dan Michelson, CEO of Strata Decision Technology, in a statement. "Many facilities will likely be hard-pressed to handle the surge while simultaneously maintaining capacity for COVID-19 patients. Having visibility into patient volumes across all of their service lines is key to understanding how to safely engage patients while balancing the clinical, operational and financial complexity and pressures imposed by COVID-19.”
The hospitals in the cohort together rack up $69 billion in annual operating expenses used to care for nearly 65 million Americans. Hospitals in general account for approximately 33% or $1.3 trillion of the $4 trillion in projected national healthcare expenditures in 2020.
Health systems in the cohort lost an estimated $1.35 billion in revenue over a two week period in March and April, compared to the same time last year. This equates on a national scale to a loss of $60.1 billion per month for all hospitals.
Evaluating two million patient visits, Strata observed an average decrease of 54.5% in the number of patients across all service lines of 51 healthcare delivery systems it consulted in 40 states. Each had varying rates of COVID-19 cases in their 228 hospitals.
Decreases in patient volume across all service lines are estimated to cost $60.1 billion per month for all hospitals on a nationwide scale.
Inpatient procedures and surgeries took the largest hits to revenue, with declines seen in knee (99%) and hip (79%) replacement surgeries, along with spinal fusions (81%) and repair of fractures (38%). Coronary stents and diagnostic catheterizations also went down by 44% and 65% respectively, while diagnostic volume overall declined by 60%. Such procedures are part of the top 10 inpatient procedures that account for more than 50% of total payments made to hospitals. Cardiology meanwhile experienced a 57% decrease in patient interactions, as did breast health by 55% and cancer overall by 37%.
A contributing factor is the 114% rise in uninsured or self-pay patients over the last 90 days from its previous 7% figure in January to 15% in May. The finding reflects the rise in the national unemployment rate, and such patients can expect to end up on Medicaid rolls, which will further strain state budgets.
This, along with stay-at-home orders and fears of contracting the virus, have led to drops in the number of people seeking both inpatient and outpatient care. Among these declines are patients needing treatment for congestive heart failure (55%); heart attacks (57%); stroke (56%); hypertension (37%); and diabetes (67%). The highest drop in patient visits were for services related to cataracts (97%); sleep apnea (91%); osteoarthritis (88%); and glaucoma (88%). A more than 75% decrease was also observed in volumes of patients seeking preventative wellness, gynecologic wellness and screenings, and GI benign neoplasms and polyps, including colonoscopies for the removal of polyps.
“The data is clear that the initial relief package given to hospitals and healthcare providers will not be enough,” said Michelson. “More funding will be needed to ensure that they can keep their doors open to provide essential care for the communities they serve while still preparing and caring for COVID 19 patients."
Increases were observed in normal delivery (1%) and C-section (2%), as well as mechanical ventilation (24%) due to treatment of COVID-19 patients.
Strata aims to keep track of declines in care with the launch of the National Patient and Procedure Volume Tracker, which monitors volume changes in patients across 225 clinical care families and provides weekly updates.
It also has put together a COVID-19 Cost Capture Recovery Model for understanding the cost and revenue impact of the virus; a COVID-19 assumption tracker with a consolidated list of assumptions of health systems for building a financial forecast that accounts for COVID-19 impact; COVID-19 Starter Set Dashboards; and a COVID-19 Resources website.