Overall health spending, which includes hospitals and ambulatory settings, remains 7% below expected levels through at least June 2021, the report found. That shows pent-up demand for care that was delayed last year has so far not driven an uptick in admissions.
KFF's report relies on data covering almost 10 million admissions recorded in Epic's health records platform. Averaged over the first quarter, hospital admission rates were 89.4% of what would have been expected in the absence of the pandemic.
It's not clear exactly why this lull is still happening, but healthcare experts have a lot of theories. One thing's for sure: There's more than one driver.
Kevin Holloran, a senior director with Fitch Ratings, said he wasn't surprised by KFF's findings because they're in line with what he's seeing. Most of the not-for-profit health systems Fitch analyzes are at between 90% and 95% of their pre-pandemic volumes, he said.
"I think on some level it's permanent," he said. "It will be a readjustment, if you will, of volumes."
Holloran cited the example of Renown Health, a system in Reno, Nevada that recently announced it will lay off 166 of its 7,000 employees and postpone filling 176 positions because of lower volumes during the pandemic that have not fully returned.
"They had a realization that volumes would be a bit soft, probably permanently, and adjusted their size to reflect a new volume level," Holloran said.
Nowhere is that more obvious than emergency department and urgent care visits, which are still hovering between 65% to 75% of pre-pandemic levels, Holloran said. He thinks that's because many people are now comfortable getting that care virtually, over the phone or in a typical doctor's office.
It could be that people are still putting off care to avoid the risk of getting infected with COVID-19 or because providers' appointment slots are backlogged, Amin said.
But it's also clear that some of the care people skipped during the pandemic—screenings like mammograms, for example—won't be made up, said Suzie Desai, a senior director with S&P Global Ratings.
"So some of those are gone, in a way," she said, "and this is your new baseline and you move up from there. Or maybe you do get back to 2019 levels, but the question is when?"
Whatever happens, KFF noted healthcare providers are the ones suffering in the current state of low utilization, while insurers are benefiting financially from having to pay fewer bills. Hospitals are getting a temporary boost from the $178 billion in Provider Relief Fund grants Congress approved and HHS is distributing, but they might struggle once that money runs out, the report noted. Meanwhile, insurers reported higher profits in 2020 relative to prior years.