Hospital visits rebound, but some patients still need convincing

Hospital volumes are rebounding, with the exception of emergency room visits, as providers work to convince patients it’s safe to get routine care as the COVID-19 pandemic rages on.

But as some patients continue to defer care and health systems understand that the current conditions are more of a “new normal” than a temporary change, they are realizing service adjustments like investment in telemedicine will require a new way of thinking.

While providers adjust their virtual services to accommodate, some care still requires in-person treatment. Hospitals are desperate to get the message out that they are clean and able to have patients return safely.

Outpatient visit volumes at U.S. hospitals had nearly returned to normal in mid-August, although inpatient volumes remain at 8% below pre-pandemic levels, according to a Tuesday report from TransUnion Healthcare.

Emergency department visits still lagged considerably at 25% below normal levels. That’s unchanged from the level during the week of June 21. ER visits were especially down for less-acute diagnoses.

Jim Bohnsack, chief strategy officer at TransUnion Healthcare, said he sees this as a positive sign that patients are “accessing care in more cost effective and logical settings.”

Elective surgery case volumes rebounded faster than expected in July and early August, likely because of a backlog from the earliest months of the pandemic, but are still below 2019 rates, Madeleine McDowell, principal at consultancy firm Sg2 said Monday at an American Hospital Association conference, where patient reluctance to return was a frequent topic.

Child inpatient volumes were down only about 2% compared to before the onset of COVID-19 in the U.S. but pediatric outpatient visits were down about 23%, according to Transunion. Child ER visits were also significantly low at 58% of normal volumes.

The analysis looks at volumes during the week of Aug. 16 at more than 500 hospitals across the U.S. Pre-pandemic volumes are measured using the first eight weeks of the year, through Feb. 29.

Getting patients back into brick and mortar care settings

Bohnsack said he has noticed a large increase in marketing from providers around the message that precautions are being taken to ensure safety for patients seeking all types of care.

During the AHA conference, UW Health CEO Alan Kaplan said he worked with the Wisconsin Hospital Association to send a message that returning for care is safe.

“Hospitals have managed infectious diseases since our inceptions — so we’re experts at it,” he said. 

It also helped to establish medical professionals in the community as experts on the novel coronavirus through media appearances, he said.

McDowell said the Medicare population has been especially reticent to return for regular care. “What this is suggesting is that high-risk populations are delaying surgeries until they know that it is safe and we may be able to see that number uptick in the fall and winter,” she said.

Bohnsack said providers are constantly monitoring returns of care by service line, but he expects rebounds to continue.

“People are realizing there’s a balance there between fear of contracting the disease,” and deferring care, he said. “If there’s a heart or stroke or something very acute happening, they need to get care.”

Shifting to investment in telehealth

Martin Lucenti, chief medical officer for Vizient, said at an AHA panel that now is the time for providers to seize the momentum on virtual care, not slide back into old habits. “There are those that are really using this as a springboard to change, but there are others that are really falling right back into old patterns, and we believe … they’re going to fall behind their peers and the marketplace.”

McDowell noted that providers are also likely to reconsider their physical space and devote more of it to telehealth needs. Patients want to see a professional setup for doctors on their video link that clearly looks like a clinic — with good lighting and few audio distractions.

Kaplan said previous assumptions that telemedicine is best for younger patients with non-acute issues have not borne out. Instead, people of all ages and those with chronic conditions are using those services and preferring them.

The pandemic has made Kaplan rethink methods for treating upper respiratory infections and other contagious diseases in general, he said, questioning why those patients would be told to come to a crowded clinic. “I was basically telling them to come on in and infect everyone around us,” he said.

Kittitas Valley Healthcare CEO Julie Peterson, however, warned it won’t be enough to simply shift resources to virtual care. More work to ensure patients can receive those services will be necessary. “Telehealth is not access in a rural community,” she said. So telehealth should be incorporated into care and not seen as a pure replacement.

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