While much of the focus has been on "flattening the curve" when it comes to COVID-19, experts warn hospitals should be prepared for another potential surge: pent-up demand for deferred care.
"We've had an increase in procedures that are being postponed and eventually those procedures will come back," said Tinglong Dai, Ph.D., associate professor of operations management and business analytics at Johns Hopkins Carey Business School.
While several health systems across the country have begun resuming procedures at some level, many reported their volumes are still extremely light.
But demand could potentially spike in the coming months as patients find they can no longer put off care. Dai is part of a team that is launching a study into the impact of delays in care among dermatology cancer patients at Johns Hopkins. They are also examining how health systems should respond.
"These cases are not going away. Some of them will become major procedures, if they were minor before," Dai told FierceHealthcare. "They are potentially going to be more difficult procedures and more costly procedures."
Dai's research echoes concerns raised across the industry about lagging hospital volumes in the wake of pandemic-related postponements of care. Health systems across the country have banded together to create public awareness campaigns to convince patients about the safety of returning to the hospital.
A study released Monday from TransUnion Healthcare, a global information and insights company, indicates that while overall hospital visit volumes are recovering, it is happening slowly, and hospital visit volumes remain well below the numbers observed prior to the pandemic.
Among TransUnion's findings: There's been a major generational divide when it comes to patients returning for care.
Older generations are returning to emergency departments more quickly than millennials and Generation Z patients, they said. For instance, patients who are baby boomers or part of the silent generation saw 31% and 32% recovery in emergency department volumes lost as a result of COVID-19 between April and May, respectively. Gen Z recovered 25% of lost volume, and millennials saw a 21% recovery.
Meanwhile, younger patients were more likely to return to outpatient and inpatient care. For instance, outpatient volume among Gen Z and millennial patients recovered more than 55%, while the older generations saw visit volumes recover between 52% and 53% of their volume. Inpatient volume among Gen Z and millennial patients recovered by 56% and 72%, respectively. Meanwhile, baby boomers and the silent generation saw a 32% recovery and a 22% recovery of lost volume, respectively.
This sluggish recovery, which saw emergency department and inpatient volume recovery outpaced by outpatient visits, raises concerns that patients who truly need care may be continuing to avoid hospital settings due to COVID-19 fear.
"A fear I have overall looking at the healthcare industry is, how much can these chronic and comorbid patients that needed ongoing health maintenance can put it off?" said James Bohnsack, senior vice president and chief strategy officer of TransUnion Healthcare. "And what might that mean is acute episodes will occur at a higher clip and tend to be longer lengths of stay and far more costly for health systems. They are going to take that onus on and all the while they’ve lost the highly profitable preventative diagnostic service lines."
Over the summer and into the fall, Bohnsack said he expects to see a U-shaped curve, not a V-shaped curve, meaning volumes will come back quite slowly. Bohnsack does not, however, expect that demand to come back in the form of a unsustainable surge. In Texas, where business has opened up more quickly than other in areas of the country, health system operators have indicated they prepared for the major surge that never materialized, ended up having unsustainably low census.
"They immediately jumped into, 'OK, what is our strategy to get these people back?'" Those patients did not materialize, and health systems are still figuring out how to change that even as they work toward their plans for the fall. "The open question everyone is grappling with is, ‘Is there going to be another spike and does that occur during the flu season?' And what does that mean?" he said.