News | Coronavirus

ED, inpatient volumes have stagnated since June, analysis finds

News | Coronavirus

ED, inpatient volumes have stagnated since June, analysis finds

  • Hospitals’ ED and inpatient volumes remain below pre-pandemic levels and have not improved since June.
  • Child patient volumes are lagging further behind, except for inpatient care.
  • Low-acuity care volumes remain far below pre-pandemic levels.

The collapse of hospitals’ patient volumes has continued to affect emergency departments (EDs) long after the end of most pandemic-related restrictions.

TransUnion Healthcare analysis of 500 hospitals found ED visits were down 25% through the third week of August, compared with pre-COVID-19 March 1-7 volumes. The same ED volume lag was found eight weeks earlier for the week of June 21-27.

The firm cited continued COVID-19 transmission fears and increased use of alternative treatment settings, such as telehealth.

 Other late-August data compared with pre-pandemic volumes included:

  • 8% decrease in inpatient volumes
  • 2% decrease in outpatient volumes

As with ED visits, inpatient volumes also stagnated at late-June levels.

“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.

At Fort Healthcare, a community hospital in Fort Atkinson, Wisconsin, ED volumes remain 10% below pre-pandemic levels.

The hospital’s overall patient volumes since the start of the pandemic peaked in June in response to “pent-up demand” after the spring suspension of elective services, said James Nelson, senior vice president and chief strategy officer..

“But people still weren’t getting their mammograms, colonoscopies and other preventive services,” Nelson said in an interview. “People were still delaying their hip and knee surgeries and other services.”

And the volume recovery has been concentrated in Medicare and Medicaid, while higher-paying commercial health plan volumes have remained down.

“The volumes are down, but the net revenues are going to be slightly more down because of the poor payer mix,” Nelson said.

Child healthcare lags the most

Healthcare visits by children continue to lag at the greatest rate, as seen in the following data:

  • 58% decrease in child ED volumes
  • 16% decline in adult ED volumes
  • 23% decrease in child outpatient volumes
  • 1% decrease in adult outpatient volumes

“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, chief revenue and strategy officer at TransUnion Healthcare. “As a result of the combination of these lower levels of child visit volumes and suspended nonurgent medical procedures, revenues for many children’s hospitals have flattened amidst the pandemic.”

The inpatient volume changes from March to August included:

  • 2% decrease in child inpatient volumes
  • 9% decrease in adult inpatient volumes

But those volumes are recovering in some places. Fort Healthcare had more inpatients in August than it had in March through July combined.

“So, we’ve seen overall positivity,” Nelson said.

However, the improved volumes at Fort Healthcare have created new financial challenges since the uptick has been accompanied by a larger share of seriously ill patents whose care requires costly increases in staffing ratios. 

“So, there’s no way to be very efficient in the care that we provide” to those patients, he said.

Declines are sharper in low-acuity care

TransUnion Healthcare found that volumes for higher-acuity diagnoses have returned faster return than for low-acuity diagnoses.

 Acuity-related ED volume changes from early March included:

  • 74% decrease in adult visits for cough
  • 31% decrease in adult visits for ear pain
  • 89% decrease in child visits for cough
  • 63% decrease in child visits for ear pain
  • 81% decrease in child visits for fevers
  • 50% decrease in adult visits for fevers
  • 19% decrease in adult visits for throat/chest pain
  • 34% decrease in child visits for throat/chest pain

These trends further underscore the likelihood that patients are seeking treatment in — and are becoming more comfortable with — alternative care settings, according to TransUnion Healthcare. The vendor described newer approaches as often more efficient and effective for nonemergent medical concerns such as cough, ear pain and fevers.

“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.

About the Author

Rich Daly, HFMA Senior Writer and Editor,

is based in the Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

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