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ED Volume Recoveries are Sluggish. That Might Not be a Bad Thing.

Analysis  |  By Alexandra Wilson Pecci  
   July 15, 2020

"Using emergency departments as primary care physicians' offices is not the most efficient use of anybody's time or money," says Jonathan Wiik, principal of healthcare strategy at TransUnion Healthcare.

Emergency departments aren't recovering their lost COVID-19 volumes as quickly as outpatient and inpatient settings, according to new data from TransUnion Healthcare.

The analysis of more than 500 hospitals across the United States observed patient volumes between March 1-7 and June 21-27.

It founds that outpatient visit volumes are down 7% during the week of June 21-27, recovering 88% of volume lost in the time since April 5-11 (when visit volumes reached their lows). Inpatient volumes show a 75% return, while down 8% compared to pre-COVID-19 volumes.

During this same period, emergency department visits recovered just 51% and are still down 25%.

On the surface, this might seem worrying, but digging more deeply into the data shows that the lost ED volume might actually signal an opportunity for hospitals.

That's because the data also shows that patients with high-acuity medical issues such as chest pain are returning to emergency departments at a faster pace than those with low-acuity concerns, like cough and ear pain.

"What that tells us is that patients are probably seeking alternative levels of care for less acute things that they used to go to the emergency department for," Jonathan Wiik, principal of healthcare strategy at TransUnion Healthcare, tells HealthLeaders.

Specifically visit volumes remain down 82% for coughs and 40% for ear pain. Higher-acuity diagnoses such as throat/chest pain have seen a greater return in volumes, down 24% compared to pre-COVID-19 volumes. 

Waste and overutilization of the emergency department has been a multibillion-dollar problem for a long time.

"I think hospitals and the market at large have been talking about more appropriate levels of care," Wiik says. "Using emergency departments as primary care physicians' offices is not the most efficient use of anybody's time or money."

Indeed, UnitedHealth Group research from last year found that two-thirds of hospital ED visits annually by privately insured individuals in the United States are avoidable. That's 18 million visits out of 27 million that don't need to be there.

That research also showed the average cost of treating common primary care treatable conditions at a hospital ED is $2,032, which is 12 times higher than visiting a physician office ($167) and 10 times higher than visiting an urgent care center ($193) to treat those same conditions.

That adds up to $32 billion in potential annual savings per year.

The healthcare industry has already over the past few months that lightning-fast changes are possible, with things like telehealth and remote work becoming overnight norms.

Wiik believes that COVID-19 presents a similar opportunity for hospitals and health systems to "leapfrog" towards meaningful change. A new editorial in The BMJ makes a similar argument, saying that COVID-19 may allow recovering health systems to prioritize "genuine need."

"Don't just switch everything back on once we get out of this mess to the way it was before, unless you liked it, and most people didn't," he says. "Take this opportunity to really transform and leapfrog your organization into something you want it to be."

For instance, hospitals might consider adding a fast-track urgent care option or extended hours at physicians' offices to keep patients who don't need emergency care out of the ED.

"Hopefully there will be some positive outcomes out of this," Wiik says.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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