Regional differences emerge in hospital volume recovery from COVID-19

• Hospital outpatient volumes remain down 7% nationally, including a decline of 23% in the Mid-Atlantic.
• Nationally, emergency department (ED) volumes have had the smallest recovery and remain down 25%.
• Children and less-ill patients have been least likely to return to EDs.

Patient volume in the wake of the COVID-19 pandemic has recovered most slowly at hospitals in the Mid-Atlantic amid a speedy recovery in the country overall, according to a new analysis.

Overall findings on the effects of the pandemic, based on TransUnion Healthcare’s analysis of data from more than 500 hospitals from the week of March 1-7 to June 21-27, included:

• 7% decrease in outpatient visit volumes
• 25% decrease in emergency department (ED) visits
• 8% decrease in inpatient volumes

“The recovery was faster than I thought would happen,” said Jonathan Wiik, principal of healthcare strategy at TransUnion Healthcare.

Where the recovery has lagged

Outpatient volumes have remained much more depressed in certain regions, including:

• 23% decrease in the Mid-Atlantic
• 17% decrease in New England

TransUnion Healthcare‘s tracking identifies the Mid-Atlantic as New York, Pennsylvania, New Jersey, Delaware, Maryland and the District of Columbia. That area includes some of the hardest-hit states during the pandemic, with cumulative COVID-19 hospitalizations, according to the COVID Tracking Project at The Atlantic, of:

• 89,995 in New York
• 20,632 in New Jersey
• 11,485 in Maryland

Those states also had extensive orders to stop elective surgeries, and many among the local populations remain wary of returning to hospitals, according to local hospital leaders.

“That [region] has had a slower recovery; they’ve been shut down and more cautious longer,” Wiik said.

Among those states, Delaware hospital inpatient volumes are nearing pre-COVID levels, but volumes remain lower in EDs, said Wayne Smith, president and CEO of the Delaware Healthcare Association (DHA). Although the DHA does not track cumulative hospitalizations, total COVID-19 hospitalizations on July 15 were 53, he said.

“It’s declined a lot and continuing to trend in a very positive direction,” Smith said in an interview.

There currently are no restrictions or voluntary hospital suspensions of elective surgeries in the state, so the continued volume lag likely stems from patient reluctance to return for needed care, he said. The result is that hospitals have seen a marked increase in the morbidity of patients arriving for care in EDs.

“That was attributed to people’s reluctance to go anywhere, number one,” Smith said. “But number two, to access healthcare because they were afraid COVID people were also accessing healthcare.”

As part of the effort to encourage patients to return, the secretary of the state’s Department of Health and Social Services released a public service announcement July 6 — at the request of hospitals — urging residents “not to delay care.” Hospitals aim to let the public know about increased cleaning conducted in waiting rooms and examination rooms, among other safety steps.

Hospital volumes also remain depressed in New England states for reasons that are less clear. Cumulative COVID-19 hospitalization rates there, according to the COVID Tracking Project, include:

• 11,625 in Massachusetts
• 10,552 in Connecticut
• 2,070 in Rhode Island

ED volumes continue to sag nationally

Another nationwide finding that surprised Wiik was the continued lag in ED volume recovery, which appeared driven by drops in lower-acuity cases and in visits by children.

ED volume declines included:

• 16% for adults
• 59% for children
• 82% for coughs
• 40% for ear pain
• 24% for throat/chest pain

Some of the lag may reflect that patients are getting lower-acuity care in other locations, such as via home care, telehealth, urgent care centers or physician offices, Wiik said.

Children are still being taken for care of more serious conditions, as seen in inpatient surgery volumes. Adult visits for inpatient care had decreased 9% and child inpatient volumes by 6% as of late June.

“I think parents are afraid of bringing their kids into the ED right now,” Wiik said.

However, outpatient visits for children remained 34% lower, compared with only 5% for adult visit volumes. The share of outpatient isits by children is 7.3%, compared with 11% pre-COVID.

July volumes may stagnate or decline following recent reinstatements of mandatory delays in elective surgeries, Wiik said. About 20% of the country remains under some form of restriction on elective surgeries, he said.

Wiik expects hospital volumes will nearly recover by the end of 2020, but revenues likely will lag “well into next year.”

“Most of the hospitals I talk to are trying to figure out that path to profitability or recovery,” Wiik said. “That starts with getting these procedures back, and they have to get the procedural mix back” to a larger share of commercially insured patients.