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Outpatient Visit Volumes Recovering Faster than ED, Inpatient Visits

Analysis  |  By Alexandra Wilson Pecci  
   June 01, 2020

The uneven recovery may prompt revenue cycle leaders to reevaluate their resource allocation.

Outpatient, emergency, and inpatient hospital visit volumes continue to trend upward, but at a rate that may be frustratingly slow for cash-strapped organizations.

They're also recovering unevenly, which may prompt revenue cycle leaders to reevaluate their resource allocation.

The latest analysis of more than 500 hospitals from TransUnion Healthcare reveals outpatient hospital visits bottomed out during the week April 5-11, down 64% from pre-COVID-19 volumes.

Since then, outpatient visits have recovered, though they were still down 31% during the week of May 10-16.

Emergency department and inpatient hospital visits are also trending upward but at a slower rate. Emergency department visits recovered 22% of lost volume from April 5-11 through May 10-16 and are now down 40% from pre-COVID-19 volumes.

Inpatient volumes show a 35% return during this time and are down 20% compared to pre-COVID-19 volumes.

Traditionally, health system leaders have focused heavily on more profitable inpatient volumes. However, the differences in recovery rates between hospital visit settings may require revenue cycle leaders to focus their energy and resources elsewhere.

"It will be important for leaders to continue monitoring these utilization trends, particularly when looking at specific treatment settings, and align resources appropriately," James Bohnsack, senior vice president and chief strategy officer of TransUnion Healthcare, tells HealthLeaders. "There may be a need to align to profitable outpatient volumes which tend to be higher."

Similarly, leaders may also need to focus their efforts on the patients who are returning fastest, since the new analysis shows a generational difference in patient visit rates.

In the time since TransUnion Healthcare observed the lowest visit volume levels, Baby Boomers (born between 1944 and 1964) and the Silent Generation (born before 1944) continue to lead the way, recovering 50% and 47% of the lost volume respectively, from the weeks of April 5-11 to May 10-16.

Millennial (born between 1980 and 1994) and Gen Z (born between 1995 and 2002) hospital visits recovered 44% and 43% of the volume decline during the same timeframe.

With those factors in mind, HealthLeaders asked Bohnsack to share action items for revenue cycle leaders based on how visit volumes are recovering:  

Generate cash, fast: "Focus on areas that can generate ROI (cash) in the shortest time possible. Accounts receivable (A/R) that may have historically gone untouched should be a focus, and it will be important to deploy existing resources to work those accounts."

Find revenue: "Consider the following areas for additional revenue: clinical denials/appeals, outpatient claims at lower balances; Medicare cost reports from past years; transfer diagnosis-related groups, IME/GME, retro Medicaid qualifications for self-pay, etc."

Prioritize patient engagement: "Review and refine patient engagement strategies from all angles. Every patient communication touch point should be reviewed and refined. It will also be important for health leaders to ask themselves [the] following questions:

  • How do you arm your staff with the right talk tracks to rebuild patient confidence? 
  • Do you have a multi-modal engagement approach for educating patients on the amounts owed and collecting those amounts? 
  • Are you prepared to efficiently process a high volume of Medicaid and charity applications? 
  • Do you have easy to access and well-established discounting and charity qualification processes?"

Alexandra Wilson Pecci is an editor for HealthLeaders.

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