The Effect of the COVID-19 Pandemic on the Economics of United States Emergency Care

Abstract

Study objective: We describe how the coronavirus disease 2019 (COVID-19) pandemic affected the economics of emergency department care (ED). Methods:We conducted an observational study of 136 EDs from January 2019 to September 2020, using 2020-to-2019 3-week moving ratios for ED visits, complexity, revenue, and staffing expenses. We tabulated 2020-to-2019 staffing ratios and calculated hour and full-time-equivalent changes.Results: Following the COVID-19 pandemic's onset, geriatric (age !65), adult (age 18 to 64), and pediatric (age <18) ED visits declined by 43%, 40%, and 73%, respectively, compared to 2019 visits and rose thereafter but remained below 2019 levels through September. Relative value units per visit rose by 8%, 9%, and 18%, respectively, compared to 2019, while ED admission rates rose by 32%. Both fell subsequently but remained above 2019 levels through September. Revenues dropped sharply early in the pandemic and rose gradually but remained below 2019 levels. In medium and large EDs, staffing and expenses were lowered with a lag, largely compensating for lower revenue at these sites, and barely at freestanding EDs. Staffing and expense reductions could not match revenue losses in smaller EDs. During the pandemic, emergency physician and advanced practice provider clinical hours and compensation fell 15% and 27%, respectively, corresponding to 174 lost physician and 193 lost advanced practice provider full-time-equivalent positions. Conclusion:The COVID-19 pandemic adversely impacted the economics of ED care, with large drops in overall and, in particular, low-acuity ED visits, necessitating reductions in clinical hours. Staffing cutbacks could not match reduced revenue at small EDs with minimum emergency physician coverage requirements. [

Changing temporal trends in patient volumes in a pediatric emergency department during a COVID-19 pandemic lockdown: a retrospective cohort study

“…If we can increase our understanding of the impact of societal factors, such as pandemic lockdown periods, on ED volumes, then we can continue to plan the judicious use of our limited ED resources. 7 Abbreviations: ED (Emergency Department). Emergency Severity Index (ESI), Generalize Lineaer Model (GLM).…”

“…If we can increase our understanding of the impact of societal factors, such as pandemic lockdown periods, on ED volumes, then we can continue to plan the judicious use of our limited ED resources. 7…”

“…6 With optimal staffing, both the mental health of workers as well as the financial health of an ED can be supported. 7 In our own ED, we typically scheduled an additional ED physician shift on Monday (as well as Tuesday) evenings, in addition to the other 35 weekly shifts. These two shifts, early on in the week, represent an additional 5.7% of scheduled weekly physicians hours, which might be necessary during traditional periods but might be avoidable in the future if a similar, extended lockdown period occurs.…”

“…[3][4][5] In one U.S. based, multi-center ED study, this lockdown period was associated with significant ED revenue decreases that led to a 15% reduction in ED physician hours when compared to a pre-pandemic period. 6,7 Given the economic vulnerability of U.S. EDs, which are primarily reimbursed on a fee-for-service model, it is critical that ED staff scheduling can anticipate temporal changes in patient volumes.…”

Changing temporal trends in patient volumes in a pediatric emergency department during a COVID-19 pandemic lockdown: A retrospective cohort study

“…The appropriate balancing of workloads across shifts is one strategy that might be effective in addressing the emotional burnout of healthcare providers in the pandemic [ 6 ]. With optimal staffing, both the mental health of workers as well as the financial health of an ED can be supported [ 7 ]. In our own ED, we typically scheduled an additional ED physician shift on Monday (as well as Tuesday) evenings, in addition to the other 35 weekly shifts.…”