DIVERTED ESSENTIAL PATIENT VISITS

Essential Patient Curve Model

The Essential Patient Care Curve model aggregates diversion of outpatient visits in the US caused by the increased demand for healthcare resources during the COVID-19 outbreak in Spring and Summer 2020. Missed appointments during this period will result in a backlog of demand for care, peaking in May 2020 at over 60 million visits missed.

Normal operating efficiencies system-wide will slow due to additional protective measures for patients and providers. Just a 10% decrease in throughput post-surge results in a continued diversion of 47 million patient visits by the end of 2020 with as many as 9 million considered critical patients. Increasing that throughput by just 5%, reduces the missed patient visits to only 12 million missed patient visits.

Model assumptions are used to simulate likely scenarios for the unprecedented conditions the medical care system in the US will undergo in the coming months due to supply diversions caused by the worldwide COVID-19 outbreak.

Essential Patient Care Curve assumptions:

1- There are 880 million total outpatient visits to hospitals over the course of a year in the United States, and the visits are evenly distributed over each day of the year. Twenty percent of outpatient visits are deemed critical. This is based on 2017 data from Elflein in “Total hospital outpatient visits in the United States 1965-2017”.

Reference: Elflein, J. (n.d.). Total hospital outpatient visits in the United States 1965-2017. Statista. Retrieved from https://www.statista.com/statistics/459744/total-outpatient-visit-numbers-in-the-us/

2- Supply of outpatient appointments under normal conditions could increase by 15%. Ellis, et al. estimated in 2017 that the elasticity of supply in prevention visits is 2% while MRI and Specialist Visits are 29% and 32%, respectively. While in reality, this likely varies across levels of care, this model assumes a general factor and leaves a more fine-grained approach for later work.

The overall supply elasticity of 15% is a generous assumption given that care providers will likely not return to a normal operating capacity immediately after COVID-19-related patient diversions, due to concerns about disease-spread prevention. It is assumed that 100% of demand for visits will persist through the year and that one patient visit missed in April will result in one visit needed in August, for example. While there is likely some elasticity of demand (some patients may condense appointments or choose not to be seen), there are missed appointments in some cases that result in the need for increased visits within the year. This model assumes these mostly cancel each other out.

Reference: Ellis RP, Martins B, Zhu W. Health care demand elasticities by type of service. J Health Econ. 2017;55:232–243. doi:10.1016/j.jhealeco.2017.07.007

3- Supply of outpatient visits will be diverted correlated to the demand for hospital beds used in the US. This will increase until mid-April 2020, and decrease until summer 2020 in a smooth fashion given full social distancing which is mostly a reality across the US at the time of publication. This model assumes that at most 80% of patient visits will be diverted even at the peak of demand for hospital beds due to COVID-19-related demand. The diversion multiplier used in this model is a percent of the peak demand for hospital beds. As of 8 April 2020,  the Institute for Health Metrics and Evaluation (IMHE) predicted that the number of beds needed would peak on 11 April at 94,249 beds. The supply diversion multiplier models the intensity of diversion in this curve.

Reference: COVID-19 projections assuming full social distancing through May 2020. https://covid19.healthdata.org/united-states-of-america. Accessed April 8, 2020.

Outpatient Procedures Deferred/Lost Medicare Essential Patient Revenue/Daily Procedure Revenue Missed Model

The Medicare Outpatient Procedure model builds on the Essential Patient Care models by focusing specifically on missed Medicare patient visits and lost revenue at medical facilities across the country due to COVID-19 related care diversions. The model breaks these projections out by procedure level with five being the most critical care.

By 25 May, with only a 10% reduction in efficiency post-surge, the model projects that there will be a backlog of over 142,000 level five encounters, with a total of over 421,000 missed overall. At this point, patient care facilities will have lost $1.2 billion in revenue from Medicare procedures alone. Daily revenue loss at the peak of the curve is projected to top $34 million per day at US patient care facilities.

By the end of 2020, a backlog of 304,000 encounters remains including 102,000 Level 5, assuming a 10% reduction in provider capacity. This equates to an $870 million loss in revenue from medicare encounters foregone. Adding just 5% efficiency in the post-surge months, makes that backlog just 79,000 encounters by the end of 2020 with a projected revenue loss of $226 million.

Outpatient Procedures Deferred/Lost Medicare Essential Patient Revenue/Daily Procedure Revenue Missed Model Assumptions

1- There are 5.7 million total medicare outpatient procedures conducted in the US over the course of a year, and the visits are evenly distributed over each day of the year. This model assumes 2020 patient load and level breakouts are roughly approximate to 2017. The 2017 data is reported in CMS Medicaid Provider Outpatient Charge Data.

Reference: Outpatient Charge Data CY 2017. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Outpatient2017. Accessed April 8, 2020.

2- Supply of outpatient appointments under normal conditions could increase by 15%. Ellis, et al. estimated in 2017 that the elasticity of supply in prevention visits is 2% while MRI and Specialist Visits are 29% and 32%, respectively. While in reality, this likely varies across levels of care, this model assumes a general factor and leaves a more fine-grained approach for later work.

The overall supply elasticity of 15% is a generous assumption given that care providers will likely not return to a normal operating capacity immediately after COVID-19-related patient diversions, due to concerns about disease-spread prevention. It is assumed that 100% of demand for visits will persist through the year and that one patient visit missed in April will result in one visit needed in August, for example. While there is likely some elasticity of demand (some patients may condense appointments or choose not to be seen), there are missed appointments in some cases that result in the need for increased visits within the year. This model assumes these mostly cancel each other out.

Reference: Ellis RP, Martins B, Zhu W. Health care demand elasticities by type of service. J Health Econ. 2017;55:232–243. doi:10.1016/j.jhealeco.2017.07.007

3- Supply of outpatient visits will be diverted correlated to the demand for hospital beds used in the US. This will increase until mid-April 2020, and decrease until summer 2020 in a smooth fashion given full social distancing which is mostly a reality across the US at the time of publication. This model assumes that at most 80% of patient visits will be diverted even at the peak of demand for hospital beds due to COVID-19-related demand. The diversion multiplier used in this model is a percent of the peak demand for hospital beds. As of 8 April 2020,  the Institute for Health Metrics and Evaluation (IMHE) predicted that the number of beds needed would peak on 11 April at 94,249 beds. The supply diversion multiplier models the intensity of diversion in this curve.

Reference: COVID-19 projections assuming full social distancing through May 2020. https://covid19.healthdata.org/united-states-of-america. Accessed April 8, 2020.