Tuesday, October 27, 2020

COVID-19 fears keep seniors away from hospitals still smarting from spring revenue hit

KRIS B. MAMULA Pittsburgh Post-Gazette kmamula@post-gazette.com OCT 26, 2020  5:40 AM

The suspension of non-emergency medical care due to COVID-19 earlier this year splashed red ink across hospital balance sheets as patients canceled appointments and shunned the emergency room, shrinking operating revenue for medical institutions nationwide.

Now, a new study has found people ages 65 and older were far more likely to stay away from the hospital than younger people during the spring surge in the U.S. pandemic. Seniors are especially vulnerable to the highly contagious disease, and fear of becoming infected was chief among the reasons for postponing care.

Emergency room visits for heart attack and stroke fell by 45% and 38% respectively, while routine screenings for breast, cervical and colon cancer showed an even sharper decline for people of all ages between early March and mid-June, according to a study by Epic Health Research and the Kaiser Family Foundation.

Locally, the Healthcare Council of Western Pennsylvania reported 98% of the nonprofit’s 60 member hospitals had fewer emergency room visits and 90% had fewer patient surgical procedures for the 12 months ending June 30. Fully half of the member hospitals reported a loss from operations because of lower patient volumes combined with the higher costs of preparing for COVID-19 outbreaks.

The regional results track the experience of many hospitals nationwide in weathering the pandemic.

“Hospitals are on course to see an overall decline in admissions this year of 10% or more,” Karyn Schwartz, senior fellow at Kaiser and co-author of the analysis, said in a prepared statement.

While that has meant less care for Americans and lower revenue for hospitals, she noted, “The substantial federal relief directed to hospitals should soften the blow to their bottom lines significantly.”

U.S. hospitals have had access to $175 billion in federal relief funds, as well as loans through the Medicare program. Moreover, they have received a 20% increase in Medicare reimbursement for treating COVID-19 patients.

And partly offsetting lost revenue from canceled appointments by seniors is reimbursement from private insurance, which many people under age 65 carry. Private insurance generally pays hospitals at higher rates than either Medicare or Medicaid, so the faster rebound in that population’s return to the hospital could ease short-term financial worries for hospitals.

The Kaiser-Epic study was based on electronic medical record data from 27 U.S. health care organizations, representing 162 hospitals spanning 21 states and covering 22 million people.

COVID-19 scares off older patientsWorries about getting infected with the new coronavirus kept people age 65 and older away from hospitals in the early days of the COVID-19 pandemic when compared to younger people. Patient volumes overall have not rebounded to pre-pandemic levels.Trend in observed non-COVID-19 admissions as a percent of predicted admissions, Jan. 4-Aug. 8:

Separately, the report from 60 hospitals in the Pittsburgh area for the year ending June 30 by the nonprofit Healthcare Council echoed many of the Kaiser-Epic study results.

Hospital volumes are “almost back to where they were, but emergency room visits are still a little off,” said Healthcare Council president A.J. Harper, adding the shutdown was “devastating” for the council’s member hospitals.

A spike in telemedicine consultations with doctors, choosing urgent care centers for treatment and overall better educated patients have eroded emergency department volume, he said.

For years, commercial insurers have encouraged members to seek care in a hospital emergency room only when it’s medically necessary because emergency care is generally the most expensive in a hospital.

Highmark’s True Performance program, for example, which has curbed medical spending by better matching the level of care to patient needs, saved $1.09 billion in emergency room and hospital admission expenses between 2017 and 2019. That sum includes $116 million in saved emergency room visits alone, according to Highmark.

Getting patients the right care at the right time has become a health care industry mantra, but fewer emergency room visits can cut into hospitals’ bottom line at a time when pandemic-related costs are rising. 

Nationally, for non-COVID-19 hospital visits, people ages 65 and older had about half as many admissions in late March and April compared to what was expected, the Kaiser-Epic study found.

Admissions for the over-65 group rose since then but still lagged at 80% to 85% of the anticipated visits by late July and early August. Admissions of people under age 65 reached about 90% of the number projected for the same period.

Another hit for hospitals’ bottom line: Cancer screenings, which often target older adults, plummeted in early March before recovering somewhat in the summer months. Screening rates have stayed far below 2019 levels, with weekly volumes by mid-June remaining 29% to 35% lower than pre-COVID-19 levels, the study found.

A July study by Epic Health Research found weekly volumes remained around 30% to 35% lower than their pre-COVID-19 levels for breast, colon and cervical cancer screenings.

COVID-19 case counts have begun to rise, both in Pennsylvania and across the country, with the arrival of cooler fall weather — raising the possibility of a second suspension of nonemergency medical care before the end of the year that would put many hospitals in a tailspin depending on the spread of the infection.

But if non-emergency medical care is not interrupted before the end of December, total hospital admissions are projected to be just 10.5% down from the anticipated volume for the year, the study found.

Smaller hospitals will be hurt most by the decline in the number of patients.

For the three months of April, May and June only, Healthcare Council’s 60 hospital members reported a 33.5% drop in emergency room visits, 30.2% fewer outpatient surgeries and 22.8% fewer admissions for acute medical problems.

For the 12 months ending June 30, as patients began returning to the hospital for care, emergency room visits were off 10.2%, outpatient surgeries were down 9.2% and admissions fell 7.9%, taking some of the sting out of the patient slowdown.

Hospital operating margins, which is the amount earned from providing core medical services, for the year ending June 30, were 2.3%, down from 3.9% a year ago, the Marshall Township-based Healthcare Council found.

Hospitals with fewer than 100 beds fared worse: The 27 hospitals in Western Pennsylvania that met that description had a negative margin from medical services. That’s been true every year since 2009 except for 2012.

The 64-bed Highlands Hospital in Fayette County and 49-bed Punxsutawney Hospital in Jefferson County were among the region’s rural hospitals that have struggled, reporting an average loss of 2.37% from providing medical care for the three months ending June 30, according to the Healthcare Council.

Kris B. Mamula: kmamula@post-gazette.com or 412-263-1699 First Published October 26, 2020, 5:30am

https://www.post-gazette.com/business/healthcare-business/2020/10/26/COVID-19-fears-seniors-hospitals-revenue-hit-healthcare-council-western-pennsylvania-kaiser/stories/202010200121

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