Amid pandemic, health care visits still haven’t rebounded 

Emergency room visits in Massachusetts 20 percent below normal 

THE NUMBER OF people seeking health care in Massachusetts dropped dramatically when the coronavirus pandemic hit – and eight months later, it still hasn’t totally rebounded, according to new data from the Health Policy Commission.  

The data show that as of the end of September, emergency department visits in Massachusetts remained 20 percent below normal and inpatient hospital visits remained down by more than 10 percent.  

The continued drop in people seeking health care is having ripple effects across the health care industry, in provider finances and employment. Different types of medical practices have been affected differently, in large part based on how well they have adapted to the use of telemedicine. For example, behavioral health practices were roughly back to pre-pandemic levels, primarily due to increased use of telehealth visits. Other physicians’ practices reported seeing around 20 percent fewer patients than they were pre-COVID, split between in-person and telehealth visits.  

“Those doing well were those able to transition to telehealth and naturally increase patient volume in that way,” Health Policy Commission research director David Auerbach said at a meeting Wednesday. 

Auerbach said more research needs to be done to determine what type of medical care is being foregone and why. In March and April, the state forced providers to cancel elective procedures to accommodate an anticipated surge of patients with COVID-19. But since May, medical practices have reopened, though many patients remain hesitant to seek care. 

The data found that the drop in hospital discharges was dramatic in April, even for chronic and severe problems, and that drop continued into the summer. In April, 52 percent fewer people were hospitalized for heart failure than would normally be expected – but even as of June, that number remained 27 percent below normal. Admissions for heart attacks were down 41 percent in April and 17 percent in June. More recent data were not available.  

Elective procedures like hip and knee replacements were almost all postponed in April. But even as of June, knee replacements were down more than 50 percent and hip replacements nearly 30 percent. 

One type of visit that did rebound amid the pandemic: hospital discharges for alcohol-related disorders were up 2 percent in June compared to a baseline figure. 

Another potential exception to the decline, which was discussed by commissioners but did not appear in the data, is the growing problem of people with behavioral health problems waiting for hours or days in an emergency room until an inpatient bed opens up. This was a problem before the pandemic, but Lauren Peters, undersecretary for health policy at the Executive Office of Health and Human Services, said the pandemic exacerbated it. There is now increased demand for mental health services, but some psychiatric beds were taken offline to follow infection control and social distancing procedures and due to the decision by Heywood Hospital in Gardner to close its mental health unit. 

The data also show racial disparities in hospital visits, another indication of the uneven impact the pandemic is having. Black and Hispanic patients accounted for 38.3 percent of COVID-19-related hospital discharges, but only 20.5 percent of non-COVID-related discharges. 

One impact of people not returning for routine care is on the health care workforce. Health care employment in Massachusetts dropped 5.1 percent since February, compared to a 3.8 percent drop nationwide.  

Data show that many staff who were furloughed early in the pandemic were rehired, although that was not the case in behavioral health practices, where large number of non-clinical staff, as well as registered nurses and case managers were not rehired. Auerbach said this may be because some behavioral health clinicians moved to all-virtual visits, so support staff were no longer needed. 

In addition to looking at the quantitative data, the Health Policy Commission conducted a survey of 325 physicians’ practices. Many practices reported struggling with telehealth adoption, reduced patient volume, and physician burnout. Those practices that were thriving tended to be those able to transition to telehealth, particularly behavioral health practices, which reported greater patient needs and easier access to care through telehealth. 

During an earlier poll in May, many primary care doctors worried that they would have to close their practices for financial reasons. In the more recent survey, only a small number of primary care doctors responded but the main change several of them had made was moving to a concierge type of practice – where doctors charge a fee in exchange for more accessible personal attention.