One of the big actuarial challenges for insurers setting rates for 2021 and a massive current challenge for hospitals is that elective surgery counts crashed in March as hospitals cleared space to prepare for an income surge.
From Credit Suisse Hospital Volume Tracker:
April Survey: March Inpatient Volumes Down 10.9% year over year; Outpatient Visits Down 13.5%
Inpatient surgeries down 11.7% in March (down 4.0% for the full first quarter); outpatient surgeries down 15.1% (down 2.5% for full Q1
— Altarum SHSS (@Altarum_SHSS) April 20, 2020
I am betting that April inpatient volume will be down, year over year, by an even greater amount than March. Many hospitals were still performing some elective/deferable procedures in the first week or two of March. The brakes did not get slammed until the middle of the month. April, most hospitals have been in full COVID-19 mode with all flexible resources reserved for incoming pandemic patients.
I expect insurers to report that their first quarter results will either be in line with expectations or significantly more profitable than expectations as a good chunk of claims that they expected to pay never happened in the last two weeks of March. At the same time, hospitals and physician practices are in a massive hole if they are in primarily fee for service payment regimes because their marginal visits evaporated.
There are two big questions for both insurers and hospitals: how many and when these March and presumably April cases will return?
An answer to that question if a multi-hundred billion dollar answer.
MattF
Also, note that the ER cases that come in are sicker and require more care.
Raven
My gp’s office called and asked if I was good with a virtual visit and I said “sure”. Since I went on Medicare I’ve made a couple of specialist appointments without a referral. I wonder if that’s a problem for my primary?
David Anderson
@Raven: Telemedicine as a whole, has significant financial/revenue cycle challenges for clinicians, especially PCPs.
Incitatus for Senate
I’m sure I’m not the only one sitting on some minor surgery, so to speak. All those problems still need fixing, but it’s difficult to know when to do it. My concerns as a patient are both the spread of COVID and the availability of supplies and personnel. It would be nice to get some guidance from the medical community, when do they want to start electives?
raven
@David Anderson: Thanks