U.S. hospital patient volumes move back toward 2019 levels, McKinsey survey finds

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While regional variations in patient volumes continue at hospitals throughout the U.S., many returned to 2019 levels in June and July of this year, according to results of a new McKinsey survey.

In the survey of healthcare leaders at 100 private sector hospitals, the numbers showed that emergency department and inpatient volumes have returned to 2019 levels, though respondents said they expect it to be roughly 5 to 6% higher in 2022.

Outpatient and procedural volumes were 3 to 4% above 2019 levels in July, and are expected to be 6 to 8% higher next year.

WHAT'S THE IMPACT?

More than a third of providers said they expected patient demand to exceed capacity in psychiatry and orthopedic surgery in the next six months, while roughly 25% said they expect the same challenge in cardiology and gastroenterology.

Plastic surgery and ophthalmology continue to have large decreases in outpatient volume when compared to 2019. To address these challenges, more than 50% of hospital respondents said they would expand their clinic hours to increase outpatient access.

Other provider responses include hiring more physicians, increasing physician productivity expectations, hiring more clinical support staff, increasing marketing to patients, and proactively calling patients who have delayed care.

About 20% of outpatient visits were shifted to virtual care in 2020, but that number declined to roughly 15% in the second quarter of this year, a figure that providers expect will persist.

A common refrain among 45% of respondents is that access to specialty care is worse today than it was in 2019, with more than 50% of hospitals saying they're expanding clinic hours in order to increase outpatient access. Thirty percent report increasing physician productivity expectations as a result of COVID-19.

Providers anticipate shifting 10% of surgical volumes to outpatient settings by 2023, such that about 57% of procedures would be outpatient.

Some COVID-19-related challenges remain, however, including a shortage of nurses and clinical support staff, and some patients continuing to delay care.

THE LARGER TREND

The findings from McKinsey track with the June Kaufman Hall Flash Report showing that volumes and margins both increased in that month compared to 2020. Patient volumes – outpatient volumes in particular – were up, but hospitals are still operating on narrow margins, the data showed. The median hospital margin index was 2.6% in May, not including federal CARES funding. With the funding, it was 3.5%. The median operating EBITDA margin for the month was 7.2% without CARES and 8% with CARES.

Increasing patient volumes contributed to year-to-date margin increases, especially compared to the low volumes seen with national shutdowns and restrictions on nonurgent procedures in the early months of COVID-19. While some volume metrics remained well below 2019 performance, others came close to pre-pandemic levels. Adjusted discharges were up 9.1% YTD compared to January-May 2020, but fell 7.1% YTD compared to the same period in 2019.
 

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Email the writer: jeff.lagasse@himssmedia.com