After health systems saw a massive drop in volumes due to the Covid-19 pandemic, patients are starting to come back. Healthcare providers saw a significant increase in inpatient and outpatient surgeries in May, according to a report released last week by Moody’s Investors Service.

Some care settings are making a faster comeback than others. For example, ambulatory surgery centers, which saw nearly all their procedures cancelled or postponed, began to reopen in May. At the lowest point, volumes were down a whopping 80% to 90%. Now, they have returned to 40% to 60% of pre-pandemic levels, according to the report.

In the longer term, they might see more patients than before “… as demand increases to perform procedures outside the hospital setting,” the report’s authors noted.

On the other hand, emergency room volumes have not rebounded much. In April, they were down roughly 50% to 60%. As of May, they were still down by 35% to 50%. This might indicate that patients were nervous to go into the hospital for less severe problems. Another potential explanation: people are just staying at home more.

“This could reflect the prevalence of working-from-home arrangements and people generally staying home, which is leading to a decrease in automobile and other accidents outside the home,” the report stated.

The report also highlighted a discrepancy in who is going back in for visits. Patients who already were seeing a physician before the pandemic are expected to be the first to return, to address known health needs. But patients who don’t already have a physician or a diagnosed condition might be slower to schedule appointments, potentially leading to higher acuity patients later on.

Even with a potential second wave of Covid-19 in the fall, researchers don’t expect to see another nationwide shutdown of elective procedures, as health systems have added testing capacity, expanded sourcing of protective equipment and established protocols for triaging Covid-19 patients.

But many facilities will face a financial challenge this fall, when they must start paying back accelerated Medicare payments. The Centers for Medicare and Medicaid Services gave health systems the ability to seek accelerated payments in March and April to offset costs related to the Covid-19 pandemic, but unlike the CARES Act grants, they are loans that must be repaid.

In the long-term, healthcare providers may face an impact to their bottom line as high unemployment levels are expected to reduce the number of patients on employer-sponsored health plans, which typically reimburse at higher rates than Medicaid or ACA marketplace plans. More uninsured patients could also lead to rising bad debt costs.

“While we believe volumes could normalize in early 2021, margins will remain challenged if unemployment continues to rise and people who lose their employer-sponsored health insurance shift to Medicaid, buy insurance on the exchanges, or become uninsured,” researchers wrote.

Photo credit: DaevichMikalai, Getty Images