Volumes rebound slower in the ED than in other hospital areas

Hospitals' outpatient and inpatient volumes recovered significantly in June from their April lows, when the COVID-19 pandemic forced most facilities to suspend procedures, a new report finds.

Outpatient volumes were back up to 93% of their pre-COVID levels during the last week in June, according to a report from revenue-cycle management provider TransUnion Healthcare, which gleaned data from more than 500 hospitals across the country. Inpatient volumes were 92% of pre-COVID levels during that time, and emergency department visits were 75%. The pre-COVID comparison period was the first eight weeks of the year.

"They're coming back quicker than I thought," said Jonathan Wiik, the report's author and TransUnion's principal of healthcare strategy.

But Wiik said he doesn't think volumes will ever reach 100% of their previous levels. Some patients continue to fear returning to medical facilities, and some of those who sought care elsewhere, like telehealth visits or primary-care clinics, or tried to let issues resolve on their own will continue to do that in the future.

That trend will be even more pronounced in emergency medicine, which Wiik said would actually be a positive outcome of the pandemic. TransUnion's report found that ED visits for low-acuity concerns are returning slower than those for high-acuity concerns. Visits to emergency departments for coughs, for example, are down 82% from pre-COVID levels, while visits for chest pain are down just 24%.

If that trend continues, it'll pull healthcare costs out of the system and lower costs for employers. ED care is expensive to deliver and is not a cost-effective setting for minor issues, Wiik said.

"Once you realize that the earache or headache or fever or rash is transient and goes away after a couple of days and maybe did not warrant an emergency room visit, as a patient, you're going to behave differently the next time that symptom presents," he said.

Emergency department visits have also been the slowest to recover for Norfolk, Va.-based Sentara Healthcare. The not-for-profit health system's total business on the provider side was down by about 25% from pre-COVID levels in May. But within that, emergency department visits were still down 40%, said Robert Broermann, Sentara's chief financial officer.

"We've slowly been recovering, but the emergency department volumes have been trailing," he said. "Which makes sense. The things where you're not sure if it's a life or death situation but the ED is the most convenient place to be, you could naturally see where people are more reluctant to go."

Also in line with TransUnion's findings, patients who visit Sentara's emergency departments but are not admitted—the low-acuity cases—are still down up to 18% in July, while ED visits for patients who are admitted has "pretty much returned to normal," Broermann said.

About 70% of 100 health system executives surveyed in mid-June said replacing lost patient volume and revenue was their biggest post-pandemic concern, according to the consultancy Advis.

TransUnion's report also found adults are returning for emergency department and outpatient visits faster than children. Adult emergency visits were down 16% during the last week in June from the first week in March, compared with 59% for children. On the outpatient side, adult visits were down 5% in that time and children's visits were down 34%.

Wiik chalks that up to the "mama bear principle": Parents don't want to take their kids in because they're concerned they might contract the coronavirus.