US hospital outpatient volumes show stability in face of late COVID-19 surge

Outpatient visits to U.S. healthcare providers remained relatively stable amid a surge in COVID-19 cases in the latter months of 2020, according to a report published by healthcare policy research group The Commonwealth Fund.

The report, a collaboration between the fund, Harvard University researchers and healthcare technology company Phreesia Inc., looked at visit volumes from more than 50,000 providers that are Phreesia clients. Overall, the number of weekly outpatient visits in 2020 declined 5% to 6% when compared to the outpatient visit volume pattern over the last four years, the researchers found.

During the year, outpatient visit volumes dropped as low as 58% of the baseline week of March 1. In the last few months of 2020, however, researchers found that these volumes had largely recovered despite a surge in COVID-19 cases. In December 2020, weekly volumes ranged from even with the baseline to 3% below the baseline.

"Coming on the heels of the holiday season, this COVID-19 surge affected nearly all states, exacerbating several challenges already facing care providers: treating patients exposed to the virus or infected by it; managing patients with non-COVID-19-related illnesses; keeping providers and staff healthy and ensuring the financial viability of their practices," the report's authors wrote.

Visit trends were largely consistent across the country except for the South Central census region, which includes Texas, Oklahoma, Arkansas, Louisiana, Kentucky, Tennessee, Mississippi and Alabama. Outpatient visits in this region were higher than the baseline over the last three months compared with other regions.

Executives from Nashville, Tenn.-based HCA Healthcare Inc. reported during a fourth-quarter earnings call that outpatient revenues for the company decreased 4% due to a decline in outpatient volumes. However, executives said they anticipate outpatient volumes will recover to above 2020 levels but below 2019 levels, and HCA is actively working to increase the number of outpatient facilities the company offers. The hospital operator plans to increase capital spending by approximately $850 million to support growth plans.

Dallas-based Tenet Healthcare Corp. said its fourth-quarter outpatient volumes were largely affected by a decline in emergency department visits. A recent report from Kaufman Hall showed that overall emergency department visits declined 24.7% year over year in January 2021.

The Commonwealth Fund's research also found that in December 2020, weekly visits for some specialty services increased above the baseline while others remained far below it. Visits for rheumatology and urology increased to 8% and 6% above the baseline, respectively. However, pediatric visits declined 24%, while physical medicine and rehab and behavioral health fell 11% and 10% respectively.

Universal Health Services Inc., which operates 334 behavioral health facilities and 26 acute care hospitals, said its behavioral health volumes have been affected both by COVID-19 patients in its behavioral facilities and an inability to take in more patients due to reduced staff.

"We have a strong belief that the biggest impact on our behavioral volumes in 2020 has been COVID and COVID-related dynamics. And when those dynamics ease in 2021, behavioral volumes should resume to pre-pandemic levels," CFO Steve Filton said during the company's Feb. 26 earnings call.

Telemedicine visits for behavioral health

As behavioral health volumes for providers declined, telemedicine visits for behavioral health needs increased 56% from the baseline in December 2020, The Commonwealth Fund found.

Total telehealth visits skyrocketed early in the pandemic, increasing as much as 12.5% from the baseline week of March 1-7. Since then, telemedicine visits steadily fell well into the fall season before rising again in the final two months of the year. In December, telemedicine visits were about 8% higher than total baseline visits.

"What the expansion of telehealth capabilities and behavioral reflects ... is that during the pandemic, people were reluctant to access the system to seek assessment and to seek alternatives of care kind of through the traditional means. ER visits went down, visits to private psychiatrists were down, referrals from school systems were down in large part because in-person schooling was down significantly. And telehealth helps, I think, to augment some of those other activities," UHS CFO Filton said.

When it comes to UHS' behavioral offerings, however, Filton said he does not anticipate telehealth can fully replace what a behavioral clinic can offer, adding that virtual mental care visits often cannot go beyond initial assessments or a typical 50-minute session.

Other specialties that experienced an increase in telemedicine visits during December 2020 included endocrinology, with a 25% increase in visits from the baseline, and neurology and rheumatology, with increases of 17% each from the baseline.