- Healthcare professional services revenue fell 48% in April compared to same time last year as the COVID-19 pandemic swelled in the U.S., according to a new study from nonprofit FAIR Health.
- That's off a 68% decline in use as patients eschewed in-office care and doctors increasingly deferred elective procedures, resulting in significant topline drag.
- The financial situation was particularly bleak for providers in the Northeast, the region hardest hit by COVID-19 at the time, with drastic drops in use (80%) and revenue (79%) that month.
The study providers a snapshot of health services usage in April, when the pandemic was gaining steam in the United States. Physicians across the country were funneling resources into prepping for an expected onslaught of COVID-19 patients as compensation fell amid the dip in non-essential procedures, sparking widespread furloughs and layoffs.
The pandemic has sparked a massive financial and economic fallout, including for small independent doctor's offices, cash-strapped rural facilities and hospitals servicing a disproportionate number of uninsured and Medicaid patients. One estimate from the Commonwealth Fund found visits to ambulatory care practices fell 60% by early April. Though volume has recovered somewhat since then, visits are still roughly a third lower than pre-pandemic levels.
FAIR Health found professional services utilization was flat in January and had a slight bump in February. But in March, amid a declaration of a national emergency, health services use fell 65% and revenue dropped 45%.
Researchers chalked the discrepancy between revenue and use percentage decline to a greater loss of inexpensive procedures as providers prioritized more expensive procedures, especially urgent ones, though overall volume fell.
In the hard-hit Northeast, usage fell 60% in March — slightly lower than the national average, which researchers said could be due to increased sickness in the region and more worried people seeking screening of COVID-19 symptoms. The revenue decrease of 55% was more serious than the nation as a whole.
Northeast states have seen a substantial slowing in new cases, even as coronavirus hospitalizations have surged in a handful of states since Memorial Day, largely concentrated in the South and West. Texas — one of the first states to ease its stay-at-home orders — reported two back-to-back days of record COVID-19 hospitalizations on Monday and Tuesday.
Every state is in some phase of reopening despite the very real threat of a resurgence in the fall, especially if the virus continues to bubble up in pockets across the U.S., experts say. The novel coronavirus has infected 1.98 million people in the U.S. and killed more than 112,000 to date, according to Johns Hopkins University's coronavirus tracker.
FAIR Health found many specialties saw an increase in office or other outpatient evaluation and management visits from January to April relative to other procedures, as many of the services could be delivered virtually, allowing providers to recoup a slice of lost revenue.
For example, in the specialty of oral surgery, a telehealth-specific procedure — "telephone E&M by a physician or other qualified healthcare professional, 11-20 minutes" — climbed from No. 131 in utilization in January to No. 1 in April, FAIR Health found.
By comparison, total knee replacements and total hip replacements ranked in the top five orthopaedic procedures by total estimated in-network amounts in January but had dropped out of the top five by April.
FAIR Health looked at total estimated in-network commercial claims nationally from January to April. The nonprofit hosts a repository of more than 31 billion claim records covering more than 150 million patients. Researchers also analyzed changes in use and estimated in-network reimbursement across seven specialties: cardiology, dermatology, oral surgery, gastroenterology, orthopaedics, pediatric primary care and adult primary care.
Of those specialties, oral surgery saw the most dramatic year-over-year decreases in use and revenue: In March, oral surgeries decreased 80% and revenue by 84%; in April, surgeries dropped 81% and revenue by 92%. Gastroenterology had the second largest declines.
Pediatric care was the least affected overall, reporting only a 52% drop in use in March and a 32% drop in April.
In an attempt to keep providers afloat, Congress has benchmarked a sum $175 billion in funding for hospitals and doctors through multiple rounds of legislation. Facing criticism of how it allocated the first few waves of funding, the Trump administration on Tuesday announced a more targeted distribution of $25 billion for providers serving a greater number of low-income, vulnerable patients.