There has been a massive decline in outpatient office visits as patients have stayed home — likely deferring needed care — because of COVID-19, new research shows.
The number of visits to ambulatory practices dropped by a whopping 60% in mid-March, and continues to be down by at least 50% since early February, according to new data compiled and analyzed by Harvard University and Phreesia, a healthcare technology company.
Phreesia — which helps medical practices with patient registration, insurance verification, and payments — has data on 50,000 providers in all 50 states; in a typical year, Phreesia tracks 50 million outpatient visits.
The report was published online April 23 by The Commonwealth Fund.
The company captured data on visits from February 1 through April 16. The decline was greatest in New England and the Mid-Atlantic states, where, at the steepest end of the decline in late March, visits were down 66%.
They have rebounded slightly since then but are still down 64%. Practices in the mountain states had the smallest decline, but visits were down by 45% as of April 16.
Many practices have attempted to reach out to patients through telemedicine. As of April 16, about 30% of all visits tracked by Phreesia were provided via telemedicine — by phone or through video. That's a monumental increase from mid-February, when zero visits were conducted virtually.
However, the Harvard researchers found that telemedicine visits barely made up for the huge decline in office visits.
Decline by Specialty
Not surprisingly, declining visits have been steeper in procedure-oriented specialties.
Overall visits — including telemedicine — to ophthalmologists and otolaryngologists had declined by 79% and 75%, respectively, as of the week of April 5. Dermatology saw a 73% decline. Surgery, pulmonology, urology, orthopedics, cardiology, and gastroenterology all experienced declines ranging from 61% to 66%.
Primary care offices, oncology, endocrinology, and obstetrics/gynecology all fared slightly better, with visits down by half. Behavioral health experienced the lowest rate of decline (30%).
School-aged children were skipping care most often. The study showed a 71% drop in visits in 7- to 17-year-olds, and a 59% decline in visits by neonates, infants, and toddlers (up to age 6). Overall, pediatric practices experienced a 62% drop-off in visits.
Nearly two thirds of Americans over age 65 also stayed away from their doctors. Only half of those aged 18 to 64 reduced their physician visits.
The Commonwealth Fund: What Impact Has COVID-19 Had on Outpatient Visits? Published online April 23, 2020. Full text
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