April 2020
Volume
Volume by Region *
Looking at hospitals by region, volumes were down both year-over-year and to budget for all regions spanning Discharges, Adjusted Discharges, Adjusted Patient Days, ED Visits, and Operating Room Minutes. Results were relatively clustered across each of these metrics. For Discharges, the West saw the greatest decreases, down 13% year-over-year and 20% to budget, while the Northeast/Mid-Atlantic had the lowest decreases, down 11% both year-over-year and to budget.
For Adjusted Discharges, the Midwest saw the greatest variances, down 19% year-over-year and 21% to budget. This may be due in part to relatively lower rates of COVID-19 cases in the region for the month compared to the number of procedures cancelled. The South and Great Plains saw the least variances for this metric, down about 9% year-over-year and 13% to budget.
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
Adjusted Patient Days ranged from a decline of 14% year-over-year in the South and Northeast/Mid-Atlantic to 19% year-over-year in the Midwest. The Midwest also had the greatest decrease to budget at 20%, while the South had the least decrease at 12%. ED Visit declines ranged from 18% year-over-year and 19% to budget in the Northeast/Mid-Atlantic, to 11% both year-over-year and to budget in the Midwest.
Operating Room Minutes saw greater variance in decreases across different regions. The Midwest saw the greatest declines, down 26% year-over-year and 35% to budget. The Great Plains had the least year-over-year decrease in Operating Room Minutes at 4%, and the West had the least decline to budget at 23%.
For Average LOS, the Northeast/Mid-Atlantic was the only region to see a year-over-year increase at 5%, but the region was down 7% for this metric compared to budget. The West and Great Plains saw Average LOS increase to budget but decrease year-over-year, while the Midwest and South both saw decreases to budget and year-over-year.
National Volume Observations
Volumes were down across all measures at hospitals around the country in March, as patients and providers cancelled elective and non-emergent procedures to comply with calls for social distancing, minimize potential spread of the virus, and to ramp up capacity in preparation for COVID-19 patients. The cancellations include services such as heart or orthopedic procedures, which can account for as much of 80% of hospital revenues.
The cancellations drove significant declines in hospital occupancy rates, as nearly half of the nation’s hospital beds sat empty in anticipation of coronavirus patients to come. Median occupancy fell from 62% in February to 53% in March, and was down from 65% in March 2019. Looking at intensive care units (ICUs), occupancy rates fell to 62% in March, down from 68% in February and 71% in March 2019.
Overall Discharges decreased 11% year-over-year and 4% month-over-month, falling 13% below budget expectations. Adjusted Discharges fell 13% compared to March 2019, 8% compared to February, and were 16% below budget. Meanwhile, Adjusted Patient Days declined 15% year-over-year and 10% month-over-month, and fell 15% below budget expectations. Average Length of Stay (LOS) saw the least decreases of any volume metric, down about 3% both year-over-year and month-over-month, and just 1% below budget.
ED Visits also dropped as people stayed home, and many delayed or avoided care for fear of exposure to the virus. March saw ED Visits decrease 15% year-over-year and 10% month-over-month, falling 14% below budget.
Operating Room (OR) Minutes saw the most dramatic declines, as patients and providers cancelled or postponed procedures. Operating Room Minutes were down 19% compared to the same period last year, 17% compared to February, and fell 26% below budget.
Unless noted, figures are Actuals and Medians
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
Discharges
(13.3%)
(4.2%)
(11.4%)
discharges.svg
Adjusted Discharges
(15.5%)
(8.0%)
(13.0%)
adjusted_discharges.svg
Adjusted Patient Days
(14.7%)
(9.8%)
(15.1%)
adjusted_patient_days.svg
Average Length of Stay
(1.3%)
(3.0%)
(2.6%)
average_length_of_stay.svg
ED Visits
(14.3%)
(10.1%)
(15.4%)
ed_visits.svg
Operating Room Minutes
(26.4%)
(17.4%)
(19.2%)
operating_room_minutes.svg
Volume by Bed Size
Volume performance showed similar patterns looking at hospitals by size. Results were down year-over-year and to budget for all bed-size cohorts across Discharges, Adjusted Discharges, Adjusted Patient Days, ED Visits, and Operating Room Minutes. The nation’s smallest hospitals of 0-25 beds saw the greatest decreases for Discharges, down 15% year-over-year and 19% to budget, while the largest hospitals of 500 beds or more saw the least decreases, down 9% year-over-year and 8% to budget.
Year-over-year results for Adjusted Discharges ranged from a 10% decline for hospitals with 500 beds or more to a 15% decline for those with 100-199 beds. Results compared to prior month ranged from an 11% drop for hospitals with 300-499 beds, to an 18% decrease for smaller hospitals with 26-99 beds. For Adjusted Patient Days, hospitals with 0-25 beds saw the greatest decrease compared to the same period last year at 17%, while those with 200-299 beds saw the greatest decrease compared to budget at 19%.
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
ED Visits ranged from declines of 12% year-over-year and 13% to budget for hospitals with 500 beds or more, to 17% both year-over-year and to budget for hospitals with 300-499 beds. The smallest hospitals of 0-25 beds saw the least decrease to budget for this metric, down 11%.
For Operating Room Minutes, the smallest hospitals of 0-25 beds saw the greatest decrease to budget at 34%, but the least year-over-year decrease at 11%. Hospitals with 100-199 beds saw the greatest year-over-year decrease for this metric at 26%.
There was significantly more variation in Average LOS across bed-size cohorts. All cohorts saw year-over-year decreases in Average LOS ranging from less than 1% for hospitals with 300-499 beds, to 9% for those with 200-299 beds. Results to budget were more varied, with hospitals of 100-199, 200-299, and 300-499 beds all seeing decreases, and hospitals with 0-25, 26-99, and 500 beds or more all experiencing increases.
©2020 Kaufman, Hall & Associates, LLC
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