Hospitals face steep revenue declines amid patient volume losses

Hospitals and healthcare providers are facing higher costs to care for complex COVID-19 patients while also suffering the loss of other procedures like elective surgeries that could help offset these higher costs.

Strata Decision Technology used its new National Patient and Procedure Volume Tracker to analyze where hospitals are seeing patient volume declines in key service line areas. The analysis looked at more than two million patient visits and procedures from 51 healthcare delivery systems in 40 states. The number of COVID-19 cases varied across the 228 hospitals in the analysis.

Patient encounters from a two-week period in March and April 2020 to the same time period in 2019, finding the number of unique patients who sought care in a hospital setting fell 54.5% on average across all service lines and in every region. This decline is likely due to the cancellation of elective surgeries during the pandemic, as well as concerns about patient and healthcare staff safety. Admission rates dropped 44% in hotspot markets and 32% in low markets.

Most of the top 10 inpatient procedures and surgeries took a major hit, with primary knee replacements falling 99%, lumbar/thoracic spinal fusions declining 81%, and primary hip replacement procedures declining 79%. Meanwhile, mechanical ventilation procedures increased 24%, as severe cases of COVID-19 required.

“The top [10] procedures account for over 50% of the total payments made to hospitals,” the report read.

Inpatient and outpatient encounters were also deeply affected. In the 30 days prior to May 9, 2020, daily emergency visits fell 22.62%, daily inpatient admissions were down 7.94%, daily observation visits were down 7.67%, and daily outpatient visits were down 10.72%.

Preventive wellness visits, which cover a wide variation of services and screenings, dropped 75% in the cohort group.

The 228 hospitals measured have lost an estimated $1.3 billion in revenue during the two-week study period compared to the previous year, or $60.1 billion per month in revenue loss for hospitals nationwide when the figure is extrapolated.

Hospitals are also facing a higher proportion of patients who are uninsured and self pay. As much as 9% of patients in the cohort studied are uninsured­––an increase of 114%, the report stated.

According to Strata Decision Technology, there are signs in the raw data that patient volumes in May could rebound, but a slow-paced recovery is likely. Furthermore, patients missing crucial care continues as a trend, and year-over-year service line volumes continue to drop further in most cases.

In a weekly volume comparison by service line from the beginning of April to mid-April, breast health and nephrology saw the biggest declines, each dropping 24.6%. Cancer was the next highest service line for patient volume declines, behind “not assigned,” with a 19.7% drop.