Commonwealth Fund Report: Clinic-Based Care Patterns Severely Impacted by COVID-19

A lot of elements of medical clinic operations are changing right now in the present moment. Indeed, a nationwide study by a team of healthcare policy researchers has found that the COVID-19 pandemic has rearranged many aspects of clinic-delivered care.

On June 25, Ateev Mehrotra, Michael Chernew, David Linetsky, Hilary Hatch, and David Cutler published an article entitled “The Impact of the COVID-19 Pandemic on Outpatient Visits: Practices Are Adapting to the New Normal,” on the website of the Washington, D.C.-based Commonwealth Fund.

Mehrotra et al write that “The COVID-19 pandemic has dramatically changed how outpatient care is delivered in health care practices. To decrease the risk of transmitting the virus to either patients or health care workers within their practice, providers had been deferring elective visits when possible. They also are converting in-person visits to telemedicine visits.”

In fact, they write, “In late April, we published findings demonstrating that early in the pandemic the number of visits to ambulatory care practices had declined by nearly 60 percent. In mid-May, we issued an update that indicated the beginning of a rebound in visits. In our third report, we describe visit trends through June 20. Many local and state restrictions on travel and nonessential services have now been lifted. Stores and other businesses have begun to reopen. At the same time, we have seen a surge of cases in new areas of the country. Outpatient practices have been adapting to this new reality, developing new ways of delivering care both in person at their practices and via telemedicine.

That said, they write that, “[W]hile visit numbers have rebounded, they are still substantially lower than before the U.S. pandemic began. Over the past three months, forgone visits have created “cumulative deficits” in both patient treatment and practice revenue.” In fact,  the researchers note, from the moment of the initial pandemic, “The number of visits to ambulatory practices had declined nearly 60 percent by early April. Since that time, the numbers have rebounded substantially, though the rebound may be beginning to plateau.”

Meanwhile, the data showed that telehealth visits made up about 14 percent of visits during the week of April 19, but that number had fallen to 7 percent in mid-June. And they emphasize that despite the decline, telehealth use is still substantially higher than it was pre-pandemic.

In fact, they state, “Initially, as in-person visits dropped, telemedicine visits increased rapidly. Since that peak in mid-April, telemedicine use has begun to decline, though it remains substantially higher than prior to the pandemic. We present telemedicine use in different ways in the following two graphs. The decline among in-person visits is steeper than the decline among visits of any type (telemedicine and in-person). The gap between the two lines is driven by the use of telemedicine.”

Interestingly, the impact of the pandemic on medical practices has varied considerably among medical practices operating in different clinical specialties. “In the past week,” researchers note, “visits to some clinical specialties, such as dermatology and rheumatology, have returned to their baseline rates. The cumulative decline in visits from the start of the pandemic is greatest among pediatricians, pulmonologists, and several surgical specialties.

The data was gathered for the Commonwealth Fund by professionals at the New York City-based Phreesia, which describes itself as “a health care technology company that helps ambulatory practices with the patient intake process, including registration, insurance verification, patient questionnaires, patient-reported outcomes, and payments. The data reported here come from Phreesia’s clients, which include more than 1,600 provider organizations representing more than 50,000 providers across all 50 states. In a typical year, these provider organizations have more than 50 million outpatient visits, or more than 1 million visits a week.”

The lead researcher on the team that analyzed the data is Ateev Mehrotra, associate professor of healthcare policy and medicine at the Harvard Medical School, Cambridge, Mass.