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
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