Outpatient and medical practice visits have fallen off a cliff since March due to the COVID-19 pandemic, according to a new study by The Commonwealth Fund conducted by researchers from Harvard University and Phreesia, a healthcare software company.
Altogether, outpatient visits declined by 57% between March 1 and March 29, although the trend appears to have moderated since then, with visits down 54% as of April 12. Children between the ages of 7 and 17 and adults over the age of 75 were much more likely than average to avoid such visits.
The use of telemedicine has risen significantly to take the place of these lost visits, but they still only have replaced a fraction of them so far, according to the study.
The COVID-19 pandemic has been successful in disrupting virtually every aspect of daily life and the routine practice of medicine in outpatient settings is no exception. Analyzing data from the 50,000 medical practices that use Phreesia software, the drop-off in the number of patient encounters is stark, with some medical specialties seeing drops of 75% or more.
Region mattered, with a 64% decline in New England and the Mid-Atlantic as of April 12, and a 58% drop on the West Coast. As for specific specialties, ophthalmology visits fell 79% as of April 5; dermatology down 73%; and general surgery down 66%, among others.
Telemedicine has been making headlines for its ability to replace many of these visits. And while it is clear its use has skyrocketed in recent weeks — it went from comprising virtually no visits as late as March 8 to 30% as of April 12 — it is not even close to completely replacing in-person encounters.
In-person encounters were down 67% as of April 12 (versus a 54% decline in all visits in total). That means telemedicine encounters still replaced less than 20% of the pre-COVID-19 volume of patient visits. Still, some companies such as Teladoc have been seeing patient visits more than double compared to early March.
There have been similar declines in hospital visits. A new report from Transunion Healthcare surveying more than 500 hospitals across the United States concluded they had dropped between 32% and 60%.
The financial pressures that accompany the drop-off in patient volumes have been enormous: As many as 20% of primary care practices could close. And while the CARES Act has provided some financial relief to providers and even more is planned, some have said it is coming too slowly and it won’t be enough.