In the past year, the Covid-19 pandemic pushed CV service lines to think about care delivery differently as cases surged across the country. To learn more about the impact of Covid-19 on CV programs, we surveyed Cardiovascular Roundtable hospital members—first in April 2020 and then again in November 2020. Here are our top four takeaways from the results.
1. Early pandemic volume declines have tapered—for now.
CV volumes for in-person provider visits, emergency visits, and outpatient diagnostics and imaging took a dive when the pandemic started. In April, CV programs experienced a significant decrease (>30%) in volumes in all areas of care. This change in utilization wasn't surprising as health systems canceled elective procedures and appointments to protect resources and free up staff for Covid-19 related cases and hospitalizations. Care avoidance also contributed to volume decreases as patients associated the hospital with an increased risk of exposure to Covid-19. Fast forward to November 2020, when programs reported that volume declines began to taper. Most CV programs reported either a slight decrease in volumes (>10%) for some services or no change in volumes compared to pre-pandemic levels. As hospitals began to offer more services, volumes started to return slowly. However, CV programs should continue to monitor their volumes as Covid-19 surges may continue to fluctuate.
Answers represent response majority.
2. CV programs are continuing to shift care beyond the hospital.
In April, 44% of CV programs reported that they shifted care to other provider settings within their health system, and 12% of CV programs reported that they shifted care to other provider settings outside of their health system. When we resurveyed these programs in November, more programs indicated they had continued to shift care to facilities off their hospital campuses. The proportion of CV programs that shifted care to other sites within their health system increased to 64%. Meanwhile, the proportion of services shifted outside of the health system remained the same.
There are many reasons CV programs shifted care off-campus—from increasing hospital capacity for higher acuity patients and patients with Covid-19 to allowing more opportunities for patients to receive care in settings they perceived to be lower-risk for viral transmission. Even as recently as January 2021, more people are afraid of contracting Covid-19 (58%) than having a heart attack or stroke (42%). Many CV programs are concerned about the consequences of care avoidance, fearing that the lack of disease management could lead to a life-threatening cardiac event. In response, CV programs are continuing to offer care in other provider settings, such as a physician's office or an ambulatory surgical center (ASC), to ease patient anxiety.
To learn more about how to support your CV ambulatory strategy, click here to access our CV ambulatory market landscape research.
3. 100% of respondents are using telehealth for CV virtual visits.
In April, telehealth was already being used by most CV programs in response to the pandemic. Anecdotally, we heard CV programs had three-year telehealth strategic plans they implemented in a matter of three days in response to facility closures and care postponement. Fast forward eight months later, and this trend continued. In November, 100% of CV programs leveraged telehealth for provider-patient virtual visits. In addition to redirecting care outside of the hospital to provider offices and ASCs, telehealth has proven to be another valuable tool to support this ambulatory shift.
First, deploying telehealth for virtual visits enables patients to stay home, which minimizes travel and reinforces social distancing protocol. Since virtual visits reduce the need for in-person contact, they mitigate the risk of Covid-19 exposure for both the patient and their provider. Furthermore, expanding virtual visits can be an effective way to address care avoidance. CV patients are avoiding care because they fear Covid-19 exposure, but they still require follow-up care to prevent a severe cardiac event. Virtual visits are a practical alternative to in-person visits that can alleviate patient anxiety while ensuring that patients receive adequate support from their providers.
To learn more about how telehealth can support your CV strategy, click here to access our CV telehealth strategy toolkit.
4. Priorities for CV programs have changed throughout the pandemic.
In our survey, we asked CV leaders their top three concerns related to the medium- to long-term impact of Covid-19. In April, the top concern was rescheduling delayed procedures and visits. Starting in March, heath systems canceled CV elective procedures and visits as a part of their overall effort to protect bed capacity and save resources for Covid-19 patients. But, for the CV service line, "elective" procedures and visits are still imperative because they prevent serious cardiac events. Knowing this, CV leaders worried that these cancellations would adversely affect their patients' health and overall care. Additionally, providers needed to think through how to navigate a backlog of procedures and appointments for the future. However, as health systems began allowing more in-person services, priorities shifted over the summer and fall.
When we resurveyed members in November, the number one concern was staff and provider burnout. For many health systems, burnout has been a challenge and priority even before the pandemic. But now, CV leaders recognize that Covid-19 has further exacerbated burnout among their staff and providers. Covid-19 has placed additional stressors on an already demanding workload for the health care workforce.
As volumes and priorities shift throughout the pandemic, we are continuing to monitor trends and changes in CV utilization to keep CV leaders informed. Stay tuned for our updated forecasts in the coming weeks as we continue to track the latest changes with Covid-19.