Emergency department visits have decreased significantly since the start of the COVID-19 pandemic as patients have stayed home or sought other healthcare options to avoid the risk of infection.
According to the Centers for Disease Control and Prevention, in March and April of 2020, the number of ED visits in March and April 2020 declined by 42% from pre-pandemic levels.
A Washington University School of Medicine study of 1.2 million non-COVID ED visits in the St. Louis region found a decrease in medical and surgical visits ranging from 40% to 52%, with no significant differences between higher- and lower-acuity visits.
Erik Swanson, senior vice president of data and analytics for Kaufman Hall, said while there has been some recovery in ED visits since the early months of the pandemic, levels are still about 15% to 20% lower than previous averages.
Dr. Brendan Carr, chair of emergency medicine at Mount Sinai Health System in New York, said a large portion of the decline can be attributed to people interacting less and going out less, leading to lower numbers of accidents, illnesses and infectious diseases.
"Not going out means not wrecking your car, falling down the steps, getting sick, or changing your diet and making your heart failure act up," Carr said.
He added that the increased number of deaths among nursing home patients and those with chronic medical problems due to COVID-19 likely contributed to a lack of emergency care as well.
The Washington University study, conducted through June 2020, stated that ED visits by privately insured patients and Medicaid patients fell 46% and 44%, respectively, while Medicare patients' ED visits decreased by 31%.
There were no observable differences in ED visit decreases by race, according to the findings.
The CDC found that in March and April 2020, ED visits were more than 60% lower for patients up to age 11, compared with ED visits by those 18 and older, which decreased by 17%.
Swanson said while the decline in ED visits "definitely had a major impact" on organizations' finances earlier in the pandemic, and there is still a long road to recovery, conditions are slowly improving.
"As time has progressed, recovery has occurred, hospitals have reconfigured themselves to at least begin to improve their margins even in light of these continually depressed ED volumes," Swanson said.
Dr. Jonathan Hansen, clinical director of Johns Hopkins Bayview Medical Center's ED, said even though the department's volumes have decreased, the workload has remained relatively similar because of the additional time and effort required to test and treat COVID-19 patients.
Hansen and Dr. Edana Mann, associate clinical director of Johns Hopkins Hospital's ED, said there are many new options for patients to see a physician or seek care using their computers, phones and access points for telehealth, which are incentivized by payers.
"The payer pressure will continue to move to people outside of ED settings," Hansen said.
Carr said the alternatives to ED visits are enabled by payment structures that allowed telehealth to expand rapidly during the pandemic.
"A lot of folks learned how to navigate the healthcare system in ways other than through the emergency department," Carr said. "If you can go online and talk to a doctor for a lower-acuity thing, or if you're more afraid of the ER … than an urgent-care center, people are going to be more likely to use alternative types of acute unscheduled care."