After patient volume collapsed amid the coronavirus pandemic, some see signs of recovery

• Overall patient volumes declined at hospitals by more than 50% amid the coronavirus pandemic.
• Outpatient volumes may be beginning to turn around as hospitals restart elective procedures.
• Hospitals face challenges in restarting elective procedures, including staffing, equipment and patient fears.

Hospital patient volumes declined steeply in March and April amid mass suspension of elective procedures, industry watchers and hospital executives say. But signs of recovery have emerged in May.

As the coronavirus pandemic spread in the spring, many hospitals and health systems responded by suspending elective procedures to save capacity, supplies and staff to treat COVID-19 patients. However, suspension of nonemergent procedures has caused hospitals to lose a large share of their annual revenue and led to aggressive cost-cutting.

The declines in hospital patient volumes, according to industry trackers range from:

• 33%-62% at more than 500 hospitals in March, according to TransUnion Healthcare
• 64% cumulative in outpatient visits by the second week of April, according to TransUnion Healthcare
• 54% in unique patients seeking care at 228 hospitals in March and April compared with a year earlier, according to Strata Decision Technology

The volume declines have affected some of the highest-margin service lines the most, such as a 99% reduction in primary knee replacements, said Dan Michelson, CEO of Strata Decision Technology.

One surprise to Michelson was Strata’s finding that hospital volumes declined more in COVID-19 “hotspot” areas than they did elsewhere, possibly because more-widespread fear among the local population kept away more potential patients.

Edward-Elmhurst Health, a two-hospital system outside Chicago, derived 40% of its overall patient volume from elective procedures before the pandemic, said Denise Chamberlain, CFO. And during the pandemic, service line volume declines have ranged from 50% to 80%.

Similarly, patient volumes at 460-bed Eisenhower Health in Rancho Mirage, California, declined by 50% soon after the state ordered a halt to elective procedures, said Ken Wheat, senior vice president and CFO.

Is volume recovery beginning?

In more recent weeks, as states have allowed hospitals to restart their elective procedures, some facilities have seen small recoveries in outpatient volumes, even as inpatient and emergency department (ED) volumes have stayed down or declined further.

That trend began to manifest with a 4% increase in outpatient volumes during the second and third weeks of April among hospitals tracked by TransUnion Healthcare.

“The inpatient and ED [volumes] have pretty much stayed down” since then, said Jonathan Wiik, a principal at TransUnion Healthcare.

Since Eisenhower was allowed to restart elective procedures in late April, its volume decline relative to pre-coronavirus levels has lessened from 50% to about 30%.

“It’s still a significant shortfall for us,” Wheat said.

ED volumes at the hospital have recovered more slowly, from initial 50% declines to about 40% now.

Edward-Elmhurst Health, where COVID-19 patients have “plateaued” at levels far below available beds, hoped to regain some patient volumes this week, when it expected to have met the various state-mandated criteria for restarting elective procedures, Chamberlain said. Those requirements include the availability of enough beds to accommodate a resurgence of COVID-19 cases.

How to get patients back

The challenges in getting patients to return to hospital settings vary by patient and location, but obstacles include a lack of staff, lack of equipment, testing equipment shortages, scheduling challenges, patient financial challenges and patient wariness about the safety of those settings.

In terms of which patients may be most amenable to returning, TransUnion patient surveys have identified a bit of a conundrum: Younger patients traditionally form the smallest cohorts of elective patient but also are the most willing to return to hospital settings.

For instance, among the one-third of millennial patients who had procedures delayed, 46% “want to come back as soon as possible,” Wiik said. That compared to 39% among all other age groups.

“They’re probably the least spooked about returning to get their elective procedure done — their knee revision, MRI or whatever they might need,” Wiik said.

Keys to restarting patient volumes, according to Wiik and Michelson, include:

• Improving financial-clearance processes amid historic unemployment
• Prioritizing restart of procedures for life-threatening conditions
• Monitoring and predicting volume demand

Edward-Elmhurst Health’s biggest obstacle to restarting elective procedures has been a shortage of nurses. With COIVID-19 cases requiring high nursing ratios, some nurses are out recovering from the virus and others are self-quarantining after exposure.

“It’s something that we really didn’t think would be an issue, but it is,” Chamberlain said.

To address patient perceptions, Edward-Elmhurst Health has responded, in part, with greeters who ensure all patients entering have their temperature taken, are asked about symptoms, are given masks and are given hand sanitizer.

The leading obstacle Eisenhower faced in restarting elective procedures was the amount of PPE supplies that had to be kept in reserve for potential COVID patients.

Wheat suggested hospitals restarting elective procedures take precautions, including:

• Spending time on the front end working out details of processes, such as testing
• Keeping patient safety top of mind

“That’s obviously top of mind for your patients and employees, as well as your communities, and it can get away from you really quickly,” Wheat said about safety precautions.