News: Medicare service utilization plummeted from March to May 2020

CDI Strategies - Volume 15, Issue 11

A recent Avalere Health report shows decreased Medicare utilization in the early phase of the COVID-19 pandemic, HealthLeaders reported. The report was based on Medicare fee-for-service (FFS) claims data from a random sample of 20% of Medicare FFS beneficiaries and compares claims volume during the first six months of 2020 and the first six months of 2019.

Compared to 2019, Medicare FFS claims dropped in March, April, and May 2020:

  • March 2020: Inpatient claims increased 4%, professional claims decreased 13%, outpatient claims decreased 18%, and overall claims decreased 14%
  • April 2020: Inpatient claims decreased 23%, professional claims decreased 42%, outpatient claims decreased 51%, and overall claims decreased 44%
  • May 2020: Inpatient claims decreased 12%, professional claims decreased 25%, outpatient claims decreased 32%, and overall claims decreased 26%

Compared to 2019, Medicare FFS claims started to rebound in June 2020:

  • June 2020: Inpatient claims increased 4%, professional claims increased 3%, outpatient claims decreased 1%, and overall claims increased 3%

A combination of factors drove the precipitous drop in Medicare services utilization in April 2020, according to Thomas Kornfield, MPP, a senior consultant at Washington, DC-based Avalere Health. “April 2020 is when the lockdowns were most severe. At that time, there was also a lot of uncertainty about what was safe and what was not safe in healthcare facilities, which reduced utilization,” he told HealthLeaders.

Two factors were likely responsible for the steep decline in Medicare outpatient services during the early phase of the pandemic: beneficiaries deciding to delay elective care and the overall halt to elective procedures in the beginning of the pandemic.

There were a pair of primary drivers for the rebound in Medicare services, according to Kornfield. First, June 2020 was when some states began to relax lockdown restrictions and the public’s understanding about effective safety measures (e.g., mask wearing) increased. Secondly, healthcare providers better understood how to care for non-COVID-19 patients safely.

Healthcare providers and researchers should try to monitor and address the impact of deferred care, Kornfield said.

“It is going to be important to look at what the deferred care means in terms of higher healthcare costs down the road,” he said. “At this point, the impact of the deferred care is unknown."

Editor’s note: This articles was originally published by HealthLeaders. Additional ACDIS coverage of COVID-19 can be found here.

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