Your checklist for resuming elective procedures

1. Volumes are returning, but some worry about a second dip

On average, CSOs reported that their inpatient and surgical volumes are currently at 75% of pre-Covid-19 levels. These volumes comprise both procedural backlog as well as normally expected admissions. For most organizations, however, ambulatory volumes—including urgent care, primary care, medical specialist office visits—lag further behind. With upstream care slower to ramp up, some CSOs are preparing for a slight dip in non-Covid-19 volume in the summer months, a dip that could be more pronounced if their communities experience increases in Covid-19 cases due to businesses reopening and increased social mobility.

How to communicate with patients amid Covid-19

2. Lower ED volumes could reflect a more permanent change in behavior

Across almost all organizations, ED volumes are 30% to 40% below pre-Covid-19 levels. Patients who used to present to the ED with non-urgent issues now access urgent care or virtual visits. CSOs are watching the literature and tracking their encounter data to determine whether this could be a more persistent Covid-19-induced utilization trend.

3. Specific messaging is required to counter care avoidance of essential services

In our April pop-up forums, CSOs expressed greatest concern about the "fear factor" associated with seeking care during an epidemic. These concerns are proving true in several ways.

• Pediatric well visits are below expectations, which means that some children are missing necessary vaccines;
  
  
• Patients with MI and stroke symptoms in the ED are still lower than expected, with some organizations reporting not seeing MI or stroke patients for days at a time; and
  
  
• These trends are true even for communities with low numbers of Covid-19 cases.

CSOs are looking for ways to supplement their communication strategies with more targeted messages to encourage essential utilization of specific conditions and services.

4. Forecasting scenarios focus on two vectors: Covid-19 hospitalizations and economic anxiety

While we expect numerous variables will influence hospital and health system volume trends across the next 18 months, most CSOs are creating scenario plans that include different combinations of two primary variables:

• Covid-19 hospitalizations: Increases in hospital care will influence utilization of other services. CSOs are thinking through two scenarios: a second surge in the fall, or earlier (and potentially ongoing) flare-ups due to safety gaps in state and local re-openings and resumptions in business activities.
  
  
• Economic fallout and pace of recovery: We know from the Great Recession that health care utilization is closely tied with the unemployment rate, which is a leading indicator for insurance coverage disruptions, as well as care avoidance and care substitutions due to consumers' economic anxiety. Strategic planning teams are modeling forecasts for multiple unemployment scenarios.

Scenario plans that plot these variables together are helping executive teams with their six to18 month forecasts. Planning teams are updating their assumptions early and often. In fact, some CSOs are rethinking their forecasting practices altogether as what was once a yearly exercise is becoming a weekly necessity.

5. Telehealth forecasts remain opaque

Virtual visit volumes remain high, but several CSOs report some declines as physician offices reopen. Some now report an equal number of in-person versus virtual visits. CSOs express healthy skepticism that virtual visit volume will remain as high as it is today, but they do expect future utilization to well exceed pre-Covid-19 levels. Since adoption will hinge on reimbursement, CSOs are making efforts to lobby payers or work with state associations to make the case for continued reimbursement. They also expect consumer demand to shape reimbursement policies for the better. Attendees reported that physician preferences are mixed at their organizations. Some are more open to providing telehealth services now than ever before, but just as many physicians have been quick to revert back to providing only in-person care.

We plan to hold more of these small-group, confidential sessions in the coming weeks to discuss both near- and long-term planning issues. If you're a CSO and would like to participate, please reach out to prattm@advisory.com.

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