Healthcare professional revenue falls nearly 50% across nation during COVID-19 pandemic

NEW YORK, NY–June 10, 2020–In April 2020, in the midst of the COVID-19 pandemic, healthcare professional services declined 68 percent in utilization and 48 percent in revenue based on total estimated in-network amounts compared to April 2019 nationally. In the Northeast, the region hit hardest at that time by the pandemic, professionals experienced particularly sharp drops in utilization (80 percent) and revenue (79 percent) in April 2020. These are among the findings of FAIR Health’s third COVID-19 study, Healthcare Professionals and the Impact of COVID-19: A Comparative Study of Revenue and Utilization.

During March and April 2020, deferral of elective procedures and many routine in-person medical visits imposed a financial burden on healthcare providers and caused changes to their practices, such as a new emphasis on telehealth. To study these issues, FAIR Health drew on its repository of private claims data to analyze, on a monthly basis, changes in utilization and estimated in-network reimbursement amounts for professionals in the first four months of 2020 as compared to the same months in 2019 (adjusted by Consumer Price Index). The second part of the study focused on seven specialties: cardiology, dermatology, oral surgery, gastroenterology, orthopedics, pediatric primary care and adult primary care. For each specialty, FAIR Health analyzed changes in utilization and estimated in-network reimbursement amounts in the first four months of 2020 as compared to the same months in 2019, as well as changes in the five most common procedures in the first four months of 2020. Among the findings:

• Of specialties studied, oral surgery had the largest decreases in utilization and revenue in both March and April 2020. In March 2020, oral surgery utilization declined by 80 percent, and revenue based on total estimated in-network amounts dropped 84 percent; in April 2020, oral surgery utilization declined 81 percent and revenue 92 percent. Gastroenterology had the second largest decreases in all four categories.
• Of specialties studied, pediatric primary care had the smallest decreases in three of four categories: March 2020 utilization (52 percent), April 2020 utilization (32 percent) and April revenue based on total estimated in-network amounts (35 percent). Adult primary care had the smallest decrease in March 2020 revenue (47 percent).
• Comparing March 2019 to March 2020, utilization of professional services decreased 65 percent and professional revenue based on total estimated in-network amounts decreased 45 percent. In the Northeast, comparing March 2019 to March 2020, utilization of professional services fell 60 percent and revenue based on total estimated in-network amounts declined 55 percent.
• Across many specialties from January to April 2020, office or other outpatient evaluation and management (E&M) visits became more common relative to other procedures, both by utilization and total estimated in-network amounts. This may have been due in part to the fact that many of these E&M services could be rendered via telehealth, whereas certain other procedures that became less common required in-person visits.
• In oral surgery, a procedure specifically for telehealth–telephone E&M by a physician or other qualified healthcare professional, 11-20 minutes (CPT® 99442)–climbed from number 131 in utilization in January 2020 to number 1 in April 2020.
• Total knee replacement (CPT 27447) and total hip replacement (CPT 27130) ranked high in the orthopedic top five procedures by total estimated in-network amounts in January 2020. They fell out of the top five by April 2020.
• For pediatric patients 0-4 years of age, there was little change in preventive care visits from March-April 2019 to March-April 2020, whether from the standpoint of utilization or of revenue based on total estimated in-network amounts. Decreases in these months were much greater for preventive care visits for older pediatric patients (5-17 years of age) and adults (18 and older).

FAIR Health President Robin Gelburd stated: “As with past studies in our COVID-19 series, we again use FAIR Health’s vast data repository to illuminate the impact of the pandemic. We hope this report will be useful to stakeholders throughout the healthcare sector, including providers, payors, policy makers and researchers.”

This is the third in a series of briefs released by FAIR Health on the COVID-19 pandemic. The first brief examined projected US costs for COVID-19 patients requiring inpatient stays, and the second the impact of the pandemic on hospitals and health systems.

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About FAIR Health

FAIR Health, a national, independent nonprofit organization that qualifies as a public charity under section 501(c)(3) of the tax code, is dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 31 billion claim records contributed by payors and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. FAIR Health licenses its privately billed data and data products–including benchmark modules, data visualizations, custom analytics and market indices–to commercial insurers and self-insurers, employers, providers, hospitals and healthcare systems, government agencies, researchers and others. Certified by the Centers for Medicare & Medicaid Services (CMS) as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health includes among the private claims data in its database, data on Medicare Advantage enrollees. FAIR Health can produce insightful analytic reports and data products based on combined Medicare and commercial claims data for government, providers, payors and other authorized users. FAIR Health’s systems for processing and storing protected health information have earned HITRUST CSF certification and achieved AICPA SOC 2 compliance by meeting the rigorous data security requirements of these standards. As a testament to the reliability and objectivity of FAIR Health data, the data have been incorporated in statutes and regulations around the country and designated as the official, neutral data source for a variety of state health programs, including workers’ compensation and personal injury protection (PIP) programs. FAIR Health data serve as an official reference point in support of certain state balance billing laws that protect consumers against bills for surprise out-of-network and emergency services. FAIR Health also uses its database to power a free consumer website available in English and Spanish and an English/Spanish mobile app, which enable consumers to estimate and plan for their healthcare expenditures and offer a rich educational platform on health insurance. The website has been honored by the White House Summit on Smart Disclosure, the Agency for Healthcare Research and Quality (AHRQ), URAC, the eHealthcare Leadership Awards, appPicker, Employee Benefit News and Kiplinger’s Personal Finance. FAIR Health also is named a top resource for patients in Dr. Marty Makary’s book The Price We Pay: What Broke American Health Care–and How to Fix It and Elisabeth Rosenthal’s book An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. For more information on FAIR Health, visit fairhealth.org.

Contact:

Dean Sicoli

Chief Communications Officer

FAIR Health

646-664-1645

[email protected]