DAMERON HOSPITAL ED VISITS DRIVER
DAMERON HOSPITAL ED VISITS REGISTRATION

There are multiple factors that support forecasts of limited or negative growth in hospital- based emergency utilization and growing financial pressure on emergency physicians. In a recent survey of emergency medicine physicians, about 25% of emergency medicine physicians whose pay decreased during the pandemic said they expected it to return to pre-COVID levels within the next year, while 42% expected it would take two to three years 24% predicted their compensation will never return to their pre-COVID income level. In the longer run, an important question relates to the degree to which the change in demand for hospital-based ED services is permanent or whether it will return to pre-COVID levels and growth trends after the pandemic passes.

Even those on salary may have seen reductions in their hours and compensation as a result of the reduction in demand.

According to AMA data, approximately 50% of ED physicians were salaried in 2018, suggesting that half have been directly exposed to the slowdown in demand for ED physician services. For ED physicians that are not on salary, they have likely experienced significant financial disruption and reduced financial security. In the short run, the demand for hospital-based emergency care and ED physician services has declined and stayed below 2019 for all of 20 and the first quarter of 2022 and the magnitude of the reduction has been substantial. These trends have a number of both short and long run potential implications for ED physicians, hospitals, health plans and consumers. Overall, this represents a reduction in ED volume of some 61.9 million visits compared to 2019, pre-pandemic levels. For context, these estimates, if applied nationally (compared to 2019 visit levels of 150 million according to CDC data ) equate to 26.9 million fewer hospital ED visits in 2020, 16.6 million fewer ED visits in 2021, and, if the 2022: Q1 rate is sustained throughout the year, 18.5 million fewer visits in 2022. This translates into substantially fewer ED visits compared to 2019. Overall, ED visits volumes across the study states declined in each year since 2019: 2020 declined by −18%, 2021 by −10% and the first quarter of 2022 is - 12% below 2019 levels. Moreover, the winter surges of 20 appear to have continued to reduce ED visits relative to 2019.

DAMERON HOSPITAL ED VISITS REGISTRATION

Our data, drawn from a unique real-time hospital registration platform covering 1000+ hospitals in a cross-section of states, show an initial steep reduction in ED visits during the first half of 2020 (compared to 2019 levels) with rebounding occurring in 2021, but never reaching pre-pandemic levels. This paper analyzes ED data covering the entire pandemic period through March 2022 to provide a complete, up-to-date picture of the effects of the COVID-19 pandemic on emergency department utilization. Previous studies of the COVID-19 pandemic have documented substantial reductions in emergency department (ED) visits, hospital inpatient admissions, physician visits, and other medical services compared to pre-COVID levels. These plans have incentives and tools to more aggressively manage and control how their members access health care including reducing utilization of hospital based-emergency services and are likely building upon the COVID-19 driven accelerated adoption of telehealth systems. In addition, enrollment in managed care and “value- based” health plans increased substantially in recent years. CDC data show that hospital ED visit rates (per hundred population) had grown consistently over time, from 35.5 in 1993 and then peaking at 46 per hundred population in 2015 and then declining to 40 per hundred by 2018. At the same time, there are growing efforts by health plans and health system planners to reduce utilization of hospital-based emergency services, especially for so-called “low-value” care. In 2018, approximately 70% of all hospital inpatient admissions originated in the hospital ED and one study estimates that EDs generate more than two-thirds of all economic activity in US hospitals, up from 40% in 2002.

DAMERON HOSPITAL ED VISITS DRIVER

In addition, the emergency department is the primary driver of inpatient admissions in most hospitals. In 2019, an estimated 150 million hospital-based emergency department (ED) visits occurred in the United States, up from 90 million in 1993, 108 million in 2000 and 137 million in 2015.

Hospital-based emergency departments have been a sustained source of overall hospital utilization in the United States.

Dameron hospital ed visits