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October 21, 2020

Charted: The rebound in outpatient visits is more complicated than you think

Daily Briefing

    Last week, the Commonwealth Fund released numbers that are likely to turn some heads: Visit volumes for outpatient providers are back to pre-pandemic levels.  

    How Covid-19 will impact medical groups

    The data, which are based on a convenience sample of visit volume for more than 50,000 providers, show that, after falling nearly 60% by early April, weekly visits passed their pre-pandemic levels during the week of Sept. 6—and held steady at or above pre-pandemic levels since then.

    Something expected but still striking in the data is who is driving the rebound. The data showed significant variation by age, with older patients who are more susceptible to the virus but are potentially less able to defer care because of other conditions driving the rebound at higher rates.

    Conversely, while telemedicine use spiked to nearly 14% between March and April, the data show a gradual decline in such visits. As of the week of Oct. 4, weekly telemedicine visits hovered between 6-7%. Though, as Commonwealth Fund notes, one of the biggest problems with telehealth is providers not tracking the data, so it's likely these visits could be higher.

    Still this data tracks with Advisory Board's findings. We looked at telehealth visits at a mid-sized health system, displayed here under the pseudonym Crestone Health System, and found visits are down significantly from a peak in April. However, they have not returned to their pre-pandemic levels, nor should we expect them to. Providers should be making no-regrets investments in telehealth, such as engaging all providers in telehealth and implementing a platform that adheres to pre-pandemic security regulations, to remain competitive in the market going forward.

    4 reasons to take this data with a grain of salt

    The data paint an optimistic picture for outpatient providers, but there are reasons to be skeptical.

    1. The data may not paint the full picture. While it may be true that outpatient visits are back to pre-pandemic levels, most providers we've spoken to are continuing to see their numbers hover below. As the Commonwealth Fund acknowledges, the findings are based on a convenience sample and were not designed to be nationally representative—so the volumes shown may not be the norm for other providers.

    2. The rebound trend is not occurring among smaller practices. Unsurprisingly, the data show that larger outpatient practices (those with at least six providers) are rebounding faster than small practices. In fact, the data show the rebound is only occurring among larger outpatient practices; smaller practices with five or fewer providers have yet to reach their pre-pandemic levels. This disparity should come as no surprise as larger practices are able to do more telehealth than smaller ones because of capital, technology, and variations in providers' comfortability practicing in-person or virtually.

    3. The effort behind the rebound could spur physician burnout. It's important to bear in mind that these numbers may actually reflect practices working overtime to make up for the earlier losses, and it's not clear how long practices will be able to maintain these accelerated workloads before they begin to burn out.

    4. Outpatient practices are still in for a hard year. Even if the numbers do pass muster, most practices took such a big hit in Q1 and the early part of Q2 that they're likely going to be low at the end of the year, even if they get back to full volumes. That will have repercussions for volumes and practices' bottom line, particularly since the federal funds many practices have received are loans that will eventually need to be paid back.

    Will the trends continue through the winter?

    It will be interesting to see whether these trends in outpatient visits continue as the United States heads into flu season. Public health experts have predicted the United States could be headed for a "twindemic" as flu season overlaps with an expected resurgence in Covid-19 cases.

    On Friday, U.S. officials reported more than 69,000 new coronavirus cases, which was the country's highest number of newly reported cases in a single day since July. In fact, many states are already reporting an uptick in cases that threaten to strain local health systems. If cases continue to climb, we could again begin to see patients who are wary of in-office visits—and who once again turn to telehealth as an alternative.

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