By Robert Holly | October 8, 2020
Hospital admissions across the U.S. fell dramatically in spring with the onset of the COVID-19 virus. That sudden drop, in turn, caused patient volumes to plummet for home health providers that work primarily with acute referral sources.
While hospital admissions rebounded in summer, they remain far below pre-pandemic levels, according to a recently published study in the journal Health Affairs. But that may actually be positive news for the home health industry.
To study hospitals’ admission patterns during the public health emergency, a team of researchers analyzed more than 1 million medical admissions from Sound Physicians, a large, nationally represented hospitalist group. Sound Physicians contracts with almost 4,000 physicians across a wide range of hospital settings, though most commonly with community hospitals containing between 100 and 500 beds.
The researchers specifically narrowed in on admissions across 201 Sound Physicians hospitals in 36 states, comparing 2020 coronavirus-skewed numbers with baseline figures from 2019.
During the initial coronavirus surge in spring, non-COVID-19 hospital admissions fell by about 43%. All medical admissions — counting those triggered by COVID-19 — declined by about 34%.
“Volumes fell in part because hospitals purposefully curtailed elective surgery and other non-critical medical services,” the researchers wrote. “But hospitals have also reported puzzling declines in admissions for acute medical illness, including stroke and acute myocardial infarction.”
Even among hospitals experiencing a minimal impact from COVID-19 admissions, non-COVID-19 medical admissions fell by 39.5%, the study found. For hospitals with the greatest COVID-19 impact, non-COVID-19 admissions fell by 50%.
Generally, admission declines were similar across different demographic subgroups of patients. Additionally, admission declines happened across medical conditions, though some conditions experienced sharper declines compared to others.
“In our analysis, the three medical conditions for which non-COVID-19 admissions declined the least were stroke, altered mental status, and pancreatitis — conditions generally associated with new or severe symptoms not easily ignored or effectively managed at home,” the researchers observed.
By this year’s summer rebound, non-COVID-19 medical admission volumes had returned to within 16% of baseline figures, though admissions for certain non-COVID-19 conditions — pneumonia, COPD and sepsis, for example — remained well below pre-pandemic norms.
And here’s where the potentially positive news for home health providers kicks in.
In their Health Affairs piece, the researchers speculated that hospitalization rates may not return to pre-pandemic levels for quite some time — not due to patients’ COVID-19 concerns, but rather due to the growing confidence physicians and hospitalists have in home-based care.
“It is too early to determine the extent to which hospitalizations will return to baseline levels,” researchers noted. “A new, lower norm is conceivable if clinicians become more comfortable with alternatives to inpatient admission, including home-based care with remote monitoring.”
The fact that hospital admissions haven’t quite rebounded could also signal good things to come for home health providers because their volumes have recovered compared to pre-pandemic levels. Take Encompass Health (NYSE: EHC), for instance.
With more than 320 combined locations, Encompass Health is the fourth-largest provider of Medicare-certified home health services and a top-11 provider of hospice services.
For the week of April 12, Encompass Health’s home health operations saw less than 4,100 total episode starts — a substantial dip for the home health giant.
“If you look at what happened to just hospitals’ census during those first few weeks of the pandemic, … we weren’t just having the decline in elective procedures,” April Anthony, who leads Encompass Health’s home health and hospice segment as its CEO, previously told Home Health Care News. “As we well know now, people were seeing fewer heart attacks. We were seeing fewer strokes — just everything across the board was suppressed there for a time. People were scared to seek care, even when it was a very legitimately needed situation.”
By August, though, its volumes were actually higher than pre-coronavirus levels, with more than 5,300 total episode starts for the week of Aug. 16. That came despite hospital admissions still being down overall, as highlighted by the Health Affairs study.