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U.S. hospitals are losing $1.4B in daily revenue, due to patient volume decline

Data shows U.S. hospitals are losing $1.4B in daily revenue, due to patient volume decline

Hospital patient volumes dropped dramatically and quickly since the end of February as both patients and doctors reprioritized or delayed normal services. According to data gathered by the Crowe Revenue Cycle Analytics (Crowe RCA) software, with the exception of those in New York Cityand San Francisco, health systems across the United States experienced an average decline in patient volume of 56% between March 1, 2020, and April 15, 2020. This equates to an estimated national decline of $1.44 billion in net revenue per day for hospitals with more than 100 beds. The Crowe report, “Hospital Volumes Hit Unprecedented Lows,” looked further into this topic

Crowe is a public accounting, consulting and technology firm with offices around the world. The Crowe RCA solution captures every patient transaction for nearly 1,500 hospitals and more than 100,000 physicians nationally for purposes of automating hindsight, accounts receivable valuation and net revenue analyses. Within its benchmarking database, Crowe analyzed a portfolio including 45 states and comprising 707 hospitals within Medicaid-expansion states and 445 hospitals in non-expansion states, as of 2019. Crowe combines financial transaction information with 835/837 account-level data to produce comparative metrics.

“Hospitals and governments prepared for a surge in patient volume to treat those infected with the novel coronavirus,” said Brian Sanderson, managing principal of healthcare services at Crowe. “However, any possible surges that might have been expected due to COVID-19 patient volume appear to be dramatically offset by a significant decline in volume in all other areas.”

According to the report, in a sample of hospitals in San Francisco, one of the earliest cities impacted by the pandemic, outpatient volume increased 35% over a two-week period, and inpatient volume increased 21% during the same period (versus historical volumes) – and then dramatically decreased.

Nationally, the service mix impact is particularly remarkable. Currently, inpatient admissions are running more than 30% below norms (compared to January 2020). Emergency room visits are down 40%. Observation services are down 47%. Outpatient ancillary services are down 62%. And outpatient surgery volume is down 71%.

The report also shares findings from a few states. Although California has seen some hot spots of COVID-19 activity, overall patient volume is down 50%. Florida has seen overall patient volume drop 47%. Texas has seen overall patient volume drop 56%. And in Illinois, which has not yet seen the predicted surges of COVID-19 hospital care, overall patient volume is 59% below norms – driven by a 76% reduction in outpatient surgeries.

According to Sanderson, each hospital’s revenue recovery program likely will be unique, but all will need to address the following operational and clinical challenges:

  • The average hospital will need to run at 110% of previous capacity for six months straight to recover this lost patient volume.
  • Pent-up demand for elective surgeries will require prioritization to make determinations such as whether clinically critical or highest-efficiency procedures should come first, and which specialties will retain operating room block time.
  • Furloughed employees might not all return or all return at once, despite the need for higher throughput.
  • Several revenue cycle processes have changed due to temporarily relieved requirements for authorizations, copay forgiveness and new rules regarding charge capture and telehealth.
  • Many patients will be hesitant to return to clinical settings unless reassured that the environment is free from contagious elements. 


“In many ways, America’s hospitals are and will remain ground zero for the COVID-19 crisis,” said Sanderson. “Despite government monetary relief and supply assistance, the economic effects of March and April 2020 will affect the operations of our healthcare system long after the curve flattens or dissipates.”

To download a copy of the report, please visit Hospital Volumes Hit Unprecedented Lows.


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