Healthcare professional revenue falls nationwide amid COVID-19

In the midst of the novel coronavirus (COVID-19) pandemic, healthcare professional services declined 68 percent in utilization and 48 percent in revenue based on total estimated in-network amounts compared to April 2019 nationally, according to a new comparative study of revenue and utilization by healthcare cost education organization, Faith Health.

During March and April 2020, deferral of elective procedures and many routine in-person medical visits imposed a financial burden on healthcare providers and caused changes to their practices, such as a new emphasis on telehealth.

The study looked at a repository of private claims data to analyze, on a monthly basis, changes in utilization and estimated in-network reimbursement amounts for professionals in the first four months of 2020 as compared to the same months in 2019. The study also focused on seven specialties, cardiology, dermatology, oral surgery, gastroenterology, orthopedics, pediatric primary care, and adult primary care.

For each specialty, the researchers analyzed changes in utilization and estimated in-network reimbursement amounts in the first four months of 2020 as compared to the same months in 2019, as well as changes in the five most common procedures in the first four months of 2020. 

In the Northeast, the region hit hardest at that time by the pandemic, professionals experienced particularly sharp drops in utilization (80 percent) and revenue (79 percent) in April 2020.

Of specialties studied, oral surgery had the largest decreases in utilization and revenue in both March and April 2020. In March 2020, oral surgery utilization declined by 80 percent, and revenue based on total estimated in-network amounts dropped 84 percent. In April 2020, oral surgery utilization declined 81 percent and revenue 92 percent. Gastroenterology had the second largest decreases in all four categories.

Pediatric primary care had the smallest decreases in March 2020 utilization (52 percent), March 2020 revenue based on total estimated in-network amounts (32 percent), April 2020 utilization (58 percent), and April 2020 revenue (35 percent).

Comparing March 2019 to March 2020, utilization of professional services decreased 65 percent and professional revenue based on total estimated in-network amounts decreased 45 percent. In the Northeast, comparing March 2019 to March 2020, utilization of professional services fell 60 percent and revenue based on total estimated in-network amounts declined 55 percent.

Across many specialties from January to April 2020, office or other outpatient evaluation and management (E&M) visits became more common relative to other procedures, both by utilization and total estimated in-network amounts. This may have been due in part to the fact that many of these E&M services could be rendered via telehealth, whereas certain other procedures that became less common required in-person visits, the researchers said.

For pediatric patients 0-4 years of age, there was little change in preventive care visits from March-April 2019 to March-April 2020, whether from the standpoint of utilization or of revenue based on total estimated in-network amounts. Decreases in these months were much greater for preventive care visits for older pediatric patients and adults.

This is the third in a series of briefs on the COVID-19 pandemic. The first brief examined projected U.S. costs for COVID-19 patients requiring inpatient stays, and the second the impact of the pandemic on hospitals and health systems.