Looking at utilization across care settings, it seems patients are likely eschewing lower-acuity care, said Christopher Kerns, vice president of executive insights at the Advisory Board. About 45% of patients intend to skip their annual physical this year, according to a May PricewaterhouseCoopers survey of 2,500 consumers.
Nearly 20% said they are likely to avoid the ED despite showing signs of a heart attack or appendicitis and 34% say they are likely to avoid the ED even if they have a cut that may require stitches, a June Optum survey of 7,000 consumers found. Providers are expecting cases to be more severe in the second half of the year, which will require more complex and expensive care, Kerns said.
Health system strategic planners expect unavoidable ED utilization to recover to 96% of its pre-pandemic levels this year and avoidable ED utilization to recover to 93%, according to an Advisory Board survey sent out in May.
Franklin, Tenn.-based Community Health Systems is currently seeing its highest number of COVID-19 admissions in Texas and Florida as it manages varying degrees of surge in Mississippi and Alabama. The 97-hospital investor-owned chain’s ED visits were still 20% off as of June but had improved from a 45% decline in April.
Most of that was due to a decline in lower-acuity cases; higher-acuity cases have largely recovered, executives said during a second-quarter earnings call.
But hospitals and systems that haven’t received federal aid will likely see revenue declines over the short term, said Mark Armstrong, a shareholder at consultancy LBMC. “They will notice a financial impact until they adjust to the new reality,” he said, adding that hospitals may have to adjust ED staffing levels and other resources.
In Fort Worth, Texas, there was a 55% increase in heart attacks from May 2019 to May 2020, but 911 calls were down 21%, according to data from Medstar, an emergency medical services company. Of those patients, the number pronounced dead on the scene was up 65% over that period.
“Many people were afraid to call 911 and consequently many suffered serious cardiac problems, strokes and even death,” said Stephen Love, CEO of the Dallas-Fort Worth Hospital Council, adding that the council worked with healthcare providers to raise awareness that it was safe to go to the ED. “Now, many of our hospitals are reporting emergency department volume normalizing in comparison to last year.”
Armstrong is hopeful that fewer people will be coming to the ED with other illnesses like the flu as they are being more cautious, washing their hands more, social distancing and wearing masks. “It stands to reason that those precautions have mitigated other illnesses they would’ve gotten,” he said.