April 22, 2021

Emergency Department Visits Still Down Compared to Pre-Pandemic Levels

As most of you know, emergency department (ED) visits significantly fell last spring as the COVID-19 pandemic took full force. The Centers for Disease Control and Prevention (CDC) estimated a 42 percent drop in the number of ED visits from March 29 to April 25, 2020 compared to the same weeks in 2019. Anecdotally, ACEP heard from some EDs that reported even higher drops in volume, in the range of 50 to 60 percent during that period. In a survey of nearly 200 ACEP members conducted last fall, 64 percent of respondents stated that their ED volumes dropped between 25 and 50 percent and 30 percent of respondents stated that their ED volumes dropped over 50 percent.

This initial reduction in ED volume was caused in part by government’s call to stay at home during the first stages of the pandemic, which in turn led to fewer accidents and other traumatic injuries. Although having fewer accidents and injuries is definitely a good phenomenon, unfortunately, we have also seen that individuals that needed to seek immediate care for medical emergencies either delayed care or avoided care altogether due to a fear of being exposed to COVID-19 while in the ED. According to a survey conducted by the CDC, 40.9 percent of nearly 5,000 U.S. adult respondents reported having delayed or avoided any medical care in June of last year, including urgent or emergency care (12.0 percent) and routine care (31.5 percent), because of concerns about COVID-19.

While ED volumes have picked back up, they are still not back to pre-pandemic levels. According to a new CDC report released last week, after that initial plunge in ED visits in April 2020, “ED visits increased through July 2020 then stabilized in August 2020 at levels 15 percent below those during the same pre-pandemic period. During December 2020 to January 2021, numbers of visits declined again to a level 25% lower than those during the previous year (December 2019 to January 2020).” ACEP also has received some more recent data from the CDC, and ED volumes for February and March 2021 are still around 15 to 20 percent lower than they were before the pandemic (February 2020 to mid-March 2020).

So, what is the impact of this sustained reduction in ED volume on you as emergency physicians? Many of you have expressed concern at one point or another over the last year about the financial sustainability of your group. In the same ACEP survey mentioned above, one-fifth of respondents said that their group has laid off a physician, nearly one-third said that their group had furloughed a physician, and over half stated that their group had cut their pay for the same work. While you and your groups have received some financial support from federal programs, such as the Provider Relief Fund (PRF) and the Paycheck Protection Program (PPP), these resources have only covered lost revenue and increased expenses you incurred due to COVID-19 in 2020—not losses you are continuing to experience into 2021. As mentioned in a previous Regs & Eggs blog post about federal financial support, there are still billions of dollars left to be allocated from the PRF, and the U.S. Department of Health and Human Services (HHS) is required by law to distribute 85 percent of the remaining funds based lost revenues and increased expenses occurring in the third or fourth quarter of 2020 or the first quarter of 2021. Unfortunately, HHS has not yet announced how or when it plans on distributing that funding. Going forward, it will be extremely important for HHS to get these remaining funds out the door to help you, your groups, and others who need this support.

Although ACEP has written repeatedly to HHS about the impact of ED volume drops and the need for financial relief (we have also written to the Small Business Administration which administers the PPP), more work needs to be done. To help inform our future advocacy efforts and strategy, I want to hear from you. Is your ED still experiencing lower volumes and, if so, how is that affecting you and your group? What financial or other challenges still exist for you and your group now— over year after the pandemic first began? Thanks in advance for sharing your experiences with me!

Until next week, this is Jeffrey saying, enjoy reading regs with your eggs.

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