Healthcare Demand Recovery Tracker

From The Chartis Group and Kythera Labs

The Chartis Group
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Chicago, IL 60654

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More Insights from The Chartis Group

The Chartis Group and Kythera Labs continue to analyze recent claims data feeds to monitor trends in demand recovery. In this installment, we examine physician visit volumes to provide insights into the magnitude and pace of utilization changes since the start of the COVID-19 pandemic. 

Physician visits — and new patient visits, in particular — often function as the “top of the funnel” for downstream elective procedures, tests and other services. Close monitoring of weekly volume trends in primary care and specialist physician visits can serve as an “early warning system,” enabling health systems and other provider organizations to anticipate and proactively address shifts in future elective case demand. The following five key findings emerged from our initial analysis of weekly physician visit volumes through the week beginning May 18, 2020:

Analytics Methodology

Underlying data provided by Kythera Labs are sourced from clearinghouse claims vendors which comprise a national representation of submitted professional medical claims. These claims include self-insured and fully insured health plans across most major commercial payors, Medicare Advantage and Managed Medicaid. The level of claims coverage varies by geography. Geographic and specialty utilization patterns may change over time based upon timing and mix of claims reporting by clearinghouse. Data is refreshed on a weekly basis, which includes data for the subsequent week, in addition to newly submitted claims from prior weeks.  Data includes claims incurred with completion rates applied to account for known lag in claims and billing submission.
 
Geography is defined based upon patient location. Regions depicted are defined by the HHS Planning region assignment of each patient state. Data excludes providers billing from US territories: Puerto Rico, Guam and the Virgin Islands. Physician specialties are determined based upon the specialty assigned to the rendering provider NPI.  Certain physician specialties are combined or excluded to form the specialties reported in the analysis.  Specialty category is defined by individual physician specialty as assigned to Primary Care, Surgical or Medical specialty. APP-defined practitioners have been excluded from this analysis.

Demand recovery is measured by the percentage change of physician visits reported by week as compared to the baseline period. Baseline period is defined as the average weekly visit volume submitted in the Pre-COVID time frame (January – February 2020, accounting for holiday weeks).

Return to the Chartis COVID-19 Resource Center

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The magnitude of volume disruption during the initial COVID-19 surge varied considerably by market.
Nationally, physician visit volumes reached their lowest point of 53 percent below pre-COVID-19 levels during the week beginning April 6. However, cities such as Cleveland, OH, Hartford, CT, and Portland, OR, experienced market-wide drops in volume that exceeded 70 percent while other markets like Jacksonville, FL, and Phoenix, AZ, experienced drops of less than 40 percent over the same period — reflecting the different timing and magnitude of market-specific COVID-19 outbreaks and varying state and local responses.

The pace of early demand recovery has also varied across geographies and is likely to diverge further.
By the most recent period (week beginning May 18), volumes had recovered nationally to within 28 percent of pre-COVID-19 levels. Individual markets like Denver, CO, have managed to turn physician visits back on rapidly — from a low of 50 percent below baseline during the week of March 23 to within 15 percent of historical levels in the most recent week. Meanwhile, others like Boston, MA, have been slower to reactivate. Boston physician visit volumes declined to 55 percent below baseline the week of March 23 and remained 37 percent below pre-COVID-19 levels in the latest period. Individual market utilization trends are likely to diverge even further in the coming weeks as certain parts of the country continue a steady recovery while others face new or resurgent spikes in COVID-19 cases, which could cause further disruption to provider visits.

New patient visit volumes have contracted significantly more than established patient visits during the COVID-19 period.
New patient visits were down 71 percent nationally during the peak decline week of April 6 vs. 50 percent for established patient visits. This disparity has continued into the most recent week of data with new patient visits still down 40 percent vs. 26 percent for return patients. New patient physician visits — particularly for procedure-based specialists — are a leading indicator of downstream elective ASC and hospital-based volumes. Low new patient demand can signal weakness in procedural volumes to come even while ORs and surgeon schedules are busy today working through pre-COVID-19 patient backlogs.

Psychiatry has proven to be the most resilient specialty during COVID-19 and OB/GYN, Hematology/Oncology and Neurosurgery the fastest to recover.
As noted in a previous blog post, Psychiatry experienced the smallest decline in physician activity relative to baseline, with a peak decline of 25 percent the week of March 23. Psychiatry appears to have recovered most of the lost volume, with volumes back to within 9 percent of baseline levels in the most recent week of data. Interestingly, while OB/GYN, Hematology/Oncology and Neurosurgery experienced more significant declines (41 percent, 43 percent and 49 percent respectively) than Psychiatry, they have quickly recovered to within 12 percent of baseline volumes in the latest week of data, likely reflecting the important and time-sensitive nature of patient care needs in those specialties.

Pediatric physician visit volumes have been slower to recover than adult patient visits.
Physician visit trends for pediatric (ages 0-17) and adult (18+) patients have shown to be quite different during the first three months of the pandemic. Visits to primary care physicians by pediatric-age patients declined to a peak of 69 percent below pre-COVID-19 levels during the week of April 6, while adult primary care visits were comparatively down only 45 percent. Since then, adult primary care visits have climbed back to within 19 percent of historical levels; however, volumes remain down 60 percent for pediatric primary care. Pediatric patient visits to specialists have recovered more quickly than primary care, but surgical specialty visits by pediatric-age patients (-27 percent) still significantly trail those by adult patients (-13.5 percent).

We created an interactive Demand Recovery Tracker dashboard below that allows you to explore some of these and other trends in physician visit volumes during the COVID-19 pandemic. As with our Telehealth Adoption Tracker, we plan to refresh the data behind this dashboard weekly.
 
If you are interested in learning more about how this data can be leveraged to monitor your own organization’s reactivation performance through our subscription-based Market Demand Recovery Monitoring Tool, please
 contact us.