Analysis: Non-COVID Hospital Admissions Again Steeply Declined in Fall 2020

Admissions to hospitals for non-COVID-19 reasons fell significantly again in November as coronavirus cases continued to surge, suggesting that more people were delaying care as a result of the pandemic. This was a core finding in an updated analysis recently revealed by Epic Health Research Network (EHRN) and the Kaiser Family Foundation (KFF).

The recent decline follows a big drop in overall admissions nationally last spring after the onset of the pandemic, which was followed by a rebound in admissions in the summer, the analysis showed. The latest drop-off has been steepest in the Midwest and West, it additionally found. In both regions, non-COVID-19 admissions were at roughly 76 percent of predicted levels at the end of November, as COVID-19 cases rose in many parts of those regions.

This new analysis updates a study from October and is based on electronic medical record (EMR) data from EHRN. It includes all inpatient hospital admission volume from Dec 31, 2017 to December 5, 2020, involving patients who either were discharged or died as of January 13, 2021. Data are aggregated weekly and pooled from 34 healthcare organizations in the U.S., representing 97 hospitals that span 26 states and cover 20 million patients.

Overall, non-COVID-19 hospital admissions fell to approximately 80 percent of predicted levels nationally by the week ending December 5, 2020, the data showed. Non-COVID-19 admissions reached a low of 63 percent of predicted admissions for the week ending April 11, 2020, but by mid-summer had rebounded to 92 percent of predicted levels.

Ultimately, the decrease in hospital admissions from March 8 to December 5, 2020 represented 8.5 percent of the total expected admissions for all of 2020. Total admissions were on pace to be 8.9 percent below the predicted volume for the entire year.

Researchers noted that the federal government is giving additional financial support to hospitals and other providers to help them weather the decline in healthcare utilization sparked by the COVID-19 pandemic. This includes grants for hospitals from the $178 billion provider relief fund and a 20 percent increase in Medicare inpatient reimbursement for COVID-19 patients.

According to the KFF/Epic analysis, “This drop in admissions was not something that hospitals could have anticipated at the beginning of the year and the steep decline in admissions early in the pandemic may have been difficult for some hospitals to weather.” It added, “Smaller hospitals, public hospitals and rural hospitals are among those most likely to face financial challenges in the wake of revenue loss related to COVID-19. Some of these hospitals may be at risk of closing or merging 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.”

What’s more, the decline in non-COVID-19 admissions also signals that people may be delaying care in ways that could be harmful to their long-term health, researchers stated, noting that spending on healthcare services declined in 2020. A recent report from the Medical Group Management Association (MGMA) and Humana “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.

A separate report from Prealize, an artificial intelligence (AI)-enabled predictive analytics company, looked at claims data for more than 581,000 patients between March and August 2020, and predicted that 2021 will see an influx of newly diagnosed and later-stage conditions. For example, cardiac diagnoses will increase by 18 percent for ischemic heart disease and 14 percent for congestive heart failure, according to the report’s estimates, and cancer diagnoses will increase by 23 percent.