The Covid-19 epidemic has had a significant impact on patient volumes as hospitals have had to delay scheduled procedures and some have even had to furlough staff. In this episode, Radio Advisory host Rachel (Rae) Woods talks to Anna Yakovenko, who leads best practices research on hospital strategic and operational challenges for the Advisory Board, about what hospitals can expect patient volumes to look like for the rest of 2020.
Rachel Woods: So you said that you don't expect volumes to come back to pre-Covid-19 levels, at least not this year. What are you expecting? What are the forecasts showing you?
Anna Yakovenko: Well to be honest, that changes every day given what's happening, but we've built out two potential scenarios to model out what we think could happen. The first scenario is that at a national level, we'll see an overall plateau of cases. Previously, we thought this scenario would be a gradual decline of cases before we saw cases go up again, but it's been upgraded to plateau.
And the second is the potential of a second wave.
Woods: Let's go through each of these scenarios in a little bit more detail, staring with what was a gradual decline that we're now calling the plateau. What's the impact you're seeing there?
Yakovenko: We predict that we'll continue to see a gradual increase in volumes throughout the year, getting close to pre-Covid-19 volumes. We do think outpatient visits will climb at a higher trajectory, both because they fell the most and because those who delayed care will begin to return, and we're actually seeing that born out in some of the data now.
In addition, outpatient surgeries will continue to see an increase probably eclipsing inpatient surgeries, especially those affected by Covid-19 pushing inpatient surgeries to outpatient.
Woods: That makes sense, because, like you said, outpatient surgeries are where some of the scheduled procedures might come back, and it also might just be a natural push from inpatient to outpatient.
Yakovenko: Exactly. But there's a big "but" here—that recovery trajectory looks very different if the spikes we're seeing regionally break out across more states at the same levels.
Woods: I think we should actually pause and have a conversation on that topic, because we are seeing more states' Covid-19 volumes increase. What're you hearing?
Yakovenko: I just looked at CDC data that was updated July 1, and the number of patients in an inpatient care location with Covid-19 has really hit all-time high in a number of states. And that's including two of our nation's largest states, Texas and California, and the rise in those states has been so significant that you can see that nationwide hospitalization numbers that curve is ticking up after over two months of steady declines.
Woods: So does that mean that there's potentially a third scenario that we would look at? That's not just a second wave, not even a plateau, but an actual national rise in cases?
Yakovenko: Yea, in that case you can potentially think about it as a second wave, just coming earlier. So when we initially looked at when we thought the second wave would come, we thought it was going to be mid-fall, around the same time that you see the flu tick up. And if we keep seeing these numbers, we can see that second scenario, that second wave of Covid-19 hit earlier.
Woods: And if that's the case, what's the impact going to be on volumes?
Yakovenko: Well, we still predict a gradual recovery, but then we think we'll see a dip in volumes—not remotely the level of dip that we saw in March and April, but a dip nonetheless. We've already seen in Texas, Gov. Greg Abbott (R) reinstating a ban on elective surgeries in eight counties. So if we see that happening more, if we see consumer fear come back, we could see a dip here.
Woods: So far, I'm cognizant of the fact that we've been talking about the national view, you've even caveated that from the outset. I'm curious, is there some practical advice you could offer to leaders in individual markets who are trying to look at the 2020 outlook for their own systems?
Yakovenko: Yea, absolutely. I think as you consider your predictions, take the time to understand how the drivers of volume are faring in your market.
You can do that in a few ways: First, I think you want to be ahead of the actual case count. Remember that what we do today often doesn't show up in hospitals for several weeks, so paying close attention to social distancing that's occurring in the market. And there've been several tools released to the public to monitor that. Second, track the calls or visits you're getting that display key Covid-19 symptoms. That way, if you see an uptick in those calls, you'll know in a week or so you're going to start seeing an increase in Covid-19 cases.
Other things to consider are how your consumers are feeling about getting care. For example, pulse surveys of your market, conversations with your physicians, that should give you a glimpse of this and how it's changing. And finally, I think I would take some time to model out several scenarios of unemployment and insurance loss, specifically in your market, to understand what kind of impact that could have, because that can be very different from market to market as well.
Woods: And as there are different scenarios coming out of different markets, there are going to be different strategies that are implemented by executive teams. Are there any kind of no-regrets solutions that leaders should be doing regardless of how the scenario plays out at their home system?
Yakovenko: I think there are a couple of priorities that systems can take that are no regrets. One is to really expand capacity at the top of the funnel—actually providing extra space for services such as cancer screenings, medical specialist visits, opening up extended hours for those top-of-funnel visits, because that's what's going to get you to surgeries and more downstream services.
The second is really communicating with your consumers, addressing the fear factor, reassuring the community, communicating the risks of care avoidance, so that patients feel more comfortable coming in. And then over-communicating with your referring physicians is also something that you should be doing. Provide your physicians with talking points to reassure patients that procedures are safe. They are the ones that are overall going to have probably the biggest impact on how your consumers feel.