KFF Data: Hospital Admissions Projected to Drop 10% in 2020

New medical records data has helped shed light on the magnitude of the drop in hospital admissions and the more recent rebound in hospitalizations, according to a recent analysis by the Kaiser Family Foundation (KFF).

The new data provides additional information to help assess the economic impact of the COVID-19 pandemic on hospitals and insurers, while also providing more information to help assess the extent to which people are still delaying or forgoing care. KFF researchers analyzed trends in total hospital admissions and then separately analyzed non-COVID-19 admissions by patient sex, age, and region. They calculated actual admissions as a share of total predicted admissions in 2020 based on trends from past years.

This new analysis is based on electronic medical record (EMR) data from Epic Health Research Network (EHRN) and includes all inpatient hospital admission volume from December 31, 2017 to August 8, 2020, involving patients who either were discharged or died, as of September 13, 2020. The data is aggregated weekly and pooled from 27 healthcare organizations in the U.S., representing 162 hospitals that span 21 states and cover 22 million patients. Key findings include:

• Total hospital admissions dropped to as low as 69 percent of predicted admissions during the week of April 11, 2020 and then increased to a high of 94 percent of predicted levels by the week of July 11, 2020. As of August 8, 2020, admission volume has dipped slightly to 91 percent of predicted levels.
• Overall, the number of hospitalizations lost due to declines in admissions between March 8 and August 8, 2020, represent 7 percent of the total expected admissions for 2020. If the number of admissions remains at about 90 percent of predicted admissions, as they were on August 8, through the end of the year, total admissions will be 10.5 percent below predicted volume for the entire year. If there are new restrictions on non-emergency procedures in the latter part of 2020, the share of “lost” admissions likely will be higher.
• When looking specifically at non-COVID-19 admissions, people age 65 and older had about half as many admissions in late March and April compared to what was predicted. While their admissions have increased somewhat, they stabilized at approximately 80 to 85 percent of their predicted level in late July and early August—while admissions for people under age 65 were at about 90 percent of predicted levels during the same period.

According to the KFF researchers, several recent studies show that, beginning in March 2020, social distancing measures, concerns over hospital capacity, and fears of contracting COVID-19 led to sharp declines in healthcare spending.  Across all healthcare services, not including pharmaceutical drugs, expenditures were down 38 percent in April 2020, compared to April 2019. More recently, overall spending on healthcare has started to rebound and, by June, spending was only 10 percent lower than the previous year.

The researchers point to an EHRN analysis of EMR data conducted earlier this year that found similar patterns for emergency department visits for acute myocardial infarctions and stroke, with sharp declines followed by increases that brought those emergency department visits roughly back to expected rates.

What’s more, analysis of EMR data for breast, cervical, and colon cancer screenings showed an even sharper decline beginning in early March followed by an increase in screenings; even so, screening rates have remained far below 2019 levels.  By mid-June, weekly volumes for these cancer type screenings remained roughly 30 to 35 percent lower than their pre-COVID-19 levels.

Regarding hospital admissions, KFF researchers say that the drop was not something that hospitals could have anticipated at the beginning of the year, and suggests revenue losses that may be difficult for some hospitals to weather. However, they note, hospitals’ financial strength differs widely. One recent study they point to found that the median hospital had enough cash on hand to pay its operating expenses for 53 days in 2018, but the 25th percentile hospital only had enough cash on hand for 8 days. Smaller hospitals and rural hospitals are among those most likely to face financial challenges in the wake of revenue loss related to COVID-19, they added. “These hospitals may be more likely to close or merge if they do not have the financial resources to make up for declines in revenue caused by the declines in admissions shown in our data.”

Although provider organizations have qualified for various types of federal assistance during the pandemic, much of this money was not targeted to safety net hospitals operating on narrow margins, according to KFF’s research. Most notably, hospitals and other Medicare and Medicaid providers received grants from the $175 billion provider relief fund that is being distributed by the Department of Health and Human Services (HHS). Hospitals qualified for grants that were the equivalent to a minimum of 2 percent of revenue, and on average received grants that amounted to about 5.6 percent of revenue, according to the analysis.