MGMA/Humana Report Underscores Impact of Deferred Care During Pandemic

Feb. 2, 2021
There’s an urgent need for providers to understand where care gaps are growing as COVID-19 cases have resurged, according to the report's authors

The country’s health problems didn’t disappear during the COVID-19 pandemic, but for thousands of medical practices nationwide, the patients needing treatment did, according to a new report from Humana and the Medical Group Management Association (MGMA).

The report, “No Time to Waste: Deferred Care and Pandemic Recovery,” is largely based on MGMA polling throughout the pandemic, and “paints a startling picture of the disruption caused by COVID-19,” according to researchers. For example, the research pointed to 97 percent of practices reporting a drop in patient volumes by early April, with safety (87 percent) ranking as the top reason patients cited for deferring care during the pandemic, followed by job/insurance loss (9 percent) and other issues (4 percent), such as elective surgery bans, visitor restrictions in clinics or noncompliance with mask/safety requirements.

As such, the researchers noted that the resurgence of COVID-19 cases in the final months of 2020 “shows an urgent need for healthcare providers to understand where care gaps are growing, as stay-home orders and other efforts intended to mitigate the spread of coronavirus complicate patient engagement strategies.”

They added, “While the expansion of telemedicine during the pandemic has helped maintain physician-patient relationships, there is work to be done to alleviate the concerns of patients who put off visits, procedures and other services amid COVID-19, for in-person care and virtual visits.”

More specifically regarding delayed and deferred care, by the end of June, 41 percent of U.S. adults delayed or avoided medical care, per a Centers for Disease Control and Prevention (CDC) report.  And even as in-person visits got back on track last summer, that didn’t necessarily mean patients were eager to go back into physician offices. A OnePoll/DocASAP survey in July found that 43 percent of patients were apprehensive about going back to see a healthcare provider in person.

The impact of these hesitations has been a “slow and uneven recovery” for medical practices nationwide, with visit volumes varying by specialty, according to the MGMA/Humana report. Referencing research published by The Commonwealth Fund, they showed that it took 27 weeks for total visits to ambulatory providers to reach pre-pandemic levels, and they remained stagnant through September and early October. What’s more, though visits to dermatology, adult primary care, ophthalmology and urology were growing by early October, specialties such as pulmonology, otolaryngology and cardiology still lagged far below the pre-pandemic baseline. 

Medical practices with more than six providers are outpacing the number of visits of practices with one to five providers, which might be a result of broader use of telemedicine among larger provider groups, the research revealed. Still, it’s important to note that while medical practices have expanded virtual visits, hurdles remain in getting some patients to embrace remote care. Despite more than half of patients (57 percent) reporting a medical condition that required immediate attention, about 60 percent of patients had not tried a virtual visit by July. The top reasons for avoiding them included:

  • Complaints that virtual visits are too impersonal
  • Not knowing enough about virtual visits
  • Concerns about the quality of care and/or online privacy.

Indeed, many healthcare leaders interviewed for this report said that despite expansion of reimbursement opportunity and availability of telemedicine regulatory waivers, the increase in virtual visits has not made up the difference for drops in procedures and other revenue generating services. A recent RAND Corporation study published in JAMA Open Network offers clear context, the researchers said: Despite phenomenal growth in telemedicine services, even for non-procedural based specialties, that increase “offset only approximately 40 percent of the declines in in-person office visits, suggesting that many primary care needs may be going unmet,” per the authors of that report.

The extent of deferred care, in terms of missed/canceled appointments or delayed procedures, varies by specialty and location:

  • Some specialties were hit hard by bans on non-emergency surgeries (e.g., gastroenterology, orthopedics), while other specialties reported general concern from older patients about coming into offices, which has decreased preventative screenings, such as in nephrology (for kidney diseases) and urology (for prostate cancer screening).
  •  For OB/GYN practices, practice leaders note that patients have put off bone-density scans, mammograms and other services that have been ordered but cannot be handled via a televisit.
  •  In neurology, patients deferred physical therapy, MRIs and nursing care. For practices lacking the ability to have patients receive an upright MRI, it can limit ability to diagnose and treat Ehlers-Danlos Syndromes, other connective tissue disorders, cerebral spinal fluid leaks and/or craniocervical instability, according to Fran Saperstein, chief operating officer, Center for Complex Neurology EDS & POTS, Phoenix.
  • Research on new and expecting mothers points to patients concern about in-person visits following delivery, which can impact vaccination rates and education about nutrition.

Meanwhile, atop all the physical health concerns, the pandemic’s impact on mental well-being is one more factor that can wreak havoc on the overall health of patients, the researchers stated. “Life disruption, furloughs, economic collapse and the constant fear of exposure to a life-threatening virus… is exacerbating anxiety and depression, which has been shown to affect management of physical chronic conditions such as hypertension and diabetes,” writes Jessica Scruton, R.N., vice president of clinical transformation, at the Texas-based solutions company Lightbeam.

Going forward, the report’s authors contend that continued patient engagement and communication will be needed. “Especially as COVID-19 cases remain higher through the winter months, it’s as important as ever to implement protocols to make patients feel safe when making plans to visit your clinic/facility.” They added that the key to organization growth is “winning over patients to remain engaged in their health, ensuring that they are willing to seek and receive care as needed. Even as vaccines and treatments for COVID-19 reach the public in 2021 and society begins to reopen, top-performing healthcare providers will stay productive and financially strong because they have laid a solid foundation for patient engagement and a sense of security that’s stronger than the pandemic.”

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