Even as the COVID-19 pandemic sunk most areas of Northwell Health's volumes in 2020, its urgent care clinics had a banner year, with demand easily surpassing 2019 levels.
Visits to New Hyde Park, N.Y.-based Northwell's GoHealth urgent care clinics spiked 40% year-over-year to 732,000 visits in 2020. Visits in November were more than 200% their 2019 level. In fact, April was the only month in which visits declined from the prior year. Northwell operates 52 urgent care clinics in New York under a joint venture with GoHealth.
Unfortunately for Northwell, the heightened urgent care demand wasn't enough to keep the not-for-profit system in the black. Northwell lost $26 million on operations on $13.4 billion in revenue last year, a -0.2% margin. That's compared with $188 million in operating income on $12.5 billion in revenue in 2019, a 1.5% margin.
Urgent care can be profitable, but if the visits don't generate referrals for specialty care or ancillary tests, it's probably more of a break-even scenario, said David Burik, a partner with Guidehouse who leads its Center for Health Insights.
In Northwell's case, the uptick was mostly for COVID tests, spokesperson Joseph Kemp wrote in an email.
"Because of the low rate of reimbursement associated with GoHealth visits, these visits did not have much of an effect in offsetting the volume declines in inpatient, ambulatory surgery, physician visits and other services," he said.
Urgent care clinics were a critical source of COVID tests for New Yorkers during the pandemic. Northwell offers COVID tests at all of its urgent care locations.
"That could easily bump up a visit line a lot, but probably wouldn't be so great on profit," Burik said.
A number of health systems are going all-in on urgent care in response to patients' demands for cheaper, more convenient services. It's also a good referral source for primary and specialty care. Trinity Health, for example, recently acquired a majority stake in a privately held Louisiana company that runs urgent care clinics.
Even though Northwell's operating revenue grew 7.6% year-over-year, expenses jumped 9.5%, rounding out the year at almost $13.5 billion. Staffing costs—the biggest expense category—increased 9.6% as the system as the system staffed up to respond to the pandemic. Supply expenses grew 10% from buying more personal protective equipment, lab supplies, pharmaceuticals and other pandemic-related expenses.
All told, Northwell said the pandemic had a $1.6 billion negative financial impact on the system in 2020, primarily because of reductions in patient volumes and the high cost of responding to the crisis. The system noted the effects aren't limited to 2020, and the full extent isn't yet known.
Northwell recorded $1.2 billion in Provider Relief Fund grants under the Coronavirus Aid, Relief and Economic Security Act. The system received another $1 billion in accelerated Medicare payments, which started being repaid this month.
In addition to the federal relief, Northwell is also pursuing recovery money from its insurers. The system is suing two property insurers for refusing to cover hundreds of millions of dollars' worth of pandemic-related damages.
Most other areas of Northwell's volumes were down throughout 2020 and didn't fully recover by the end of the year. Discharges bottomed out at 65% of their 2019 levels in May, and ended the year at 89%. Ambulatory surgery visits hit just 5% of 2019 levels in April, but by December were at almost 101%. ER visits, which may never fully recover, hit a low of 48% in April and had recovered to just 82% by December.