Hospitals nationwide face severe financial challenges as cancellations of non-urgent procedures and other non-COVID care have contributed to sharp volume and revenue declines, driving the median hospital Operating Margin to -29% in April. There simply are not enough patients right now to support basic operations.
Governors in many states have begun to lift restrictions on non-urgent procedures. State restrictions, however, are not the only thing keeping patients away. COVID’s path will play a major role in healthcare demand—whether we see a quick recovery, a long slog, a second surge, or seasonal surges. Yet another critical determinant of demand will be consumer willingness to return to hospitals and clinics.
In addition, recent research findings indicate there is a significant “fear factor” for consumers. Widespread anxiety over potentially contracting the highly contagious virus remains a barrier for consumers debating whether, when, and where to seek non-COVID related medical care.
The findings from recent Kaufman Hall consumer surveys conducted in April and May provide important insights for healthcare providers asking the fundamental questions:
- When will patients return?
- How many patients will return?
- What can hospitals do to make patients feel safe to return?
The Fear Factor
Concerns over exposure to the coronavirus remain high. A majority of adults surveyed said they are moderately or extremely concerned about COVID-19 directly affecting their health, or the health of a family member or other loved one.
Thirty-seven percent said they were extremely concerned about being directly impacted by the virus, while 23% said they were moderately concerned, and 21% said they were somewhat concerned. Sixteen percent of respondents said they were only slightly concerned, and just 4% said they were not at all concerned about the virus affecting them or someone close to them.
When asked who they most trust for advice on staying healthy during the pandemic, primary care physicians and hospitals and health systems rate relatively high. Public health organizations—such as the Centers for Disease Control and Prevention and the World Health Organization—were the most trusted sources, selected by more than half of respondents. “Your doctor” was the second most trusted at 44%, followed by hospitals and health systems at 42%. Individuals’ employers and retail companies, such as Apple, Amazon, and Walmart, ranked lowest, at 7% and 5%, respectively.
The Rise of Virtual Care
Virtual visits have grown greatly in popularity during the pandemic. The number of virtual care visits is projected to reach 1 billion in 2020, up from initial estimates of 36 million, according to analysts at Forrester Research.
More than half of Kaufman Hall survey respondents said they would be comfortable or very comfortable seeking virtual care—making it the most popular choice right now. The proportion of people saying they would opt for virtual care has steadily increased. Only 8% of adults said they had sought virtual care prior to the pandemic, but those who indicated virtual care as their first choice for non-emergency care during the pandemic rose from 24% in April to 31% in May.
Increasing interest in virtual visits is not just concentrated among tech-savvy young adults. It is consistent across age groups; rising from 23% in April to 34% in May for adults under age 24, from 29% to 33% for ages 24-39, and from 28% to 37% for ages 40-54. The rates are lowest among adults ages 55 and above, but still increased from 18% in April to 24% in May.
When Will Patients Return to Hospitals?
There are no clear answers as to when a majority of healthcare consumers will feel comfortable returning to hospitals or other sites for in-person care. Despite a relatively high level of trust in the information provided by their local hospitals and health systems, people do not yet feel comfortable seeking care in such facilities.
Nearly 40% of adults surveyed said they would feel either uncomfortable or very uncomfortable seeking care at a hospital as coronavirus restrictions ease.For comparison, 37% of respondents said they would be uncomfortable or very uncomfortable going to a walk-in clinic, and 31% said they would feel uncomfortable/very uncomfortable visiting an outpatient surgery center. Emergency rooms were the most unpopular choice, with 45% of respondents saying they would be uncomfortable/very uncomfortable going there for care.
When asked where they would turn first for non-emergency, non-COVID related care during the pandemic, a majority of consumers (40%) said their doctor’s office, while 31% said they would opt for virtual care or a telehealth provider. Twenty-two percent said they would go to an urgent care center, while only 12% said they would go to an emergency room or walk-in clinic.
Twenty-one percent of consumers in the May survey said they would delay seeking care, down from nearly 30% who said that they would delay care in the April survey. The decline in those who said they would delay care was most significant among older adults ages 55 and older, with the proportion who said they would prefer to delay care decreasing from 36% to 25% between April and May. There also was a significant decrease among commercially insured adults, with 17% saying in May that they would opt to delay care, down from 26% in April.
In terms of timing, more than a third of adults said it likely would be seven months or more before they would be willing to return to a hospital or outpatient care site for a non-urgent procedure, according to a report by Jarrard Phillips Cate and Hancock.
Asked specifically when they likely would be willing to schedule a non-urgent procedure at a hospital, 10% of adults said they would go now, while 12% indicated within 30 days, 17% within 2-3 months, 21% in 4-6 months, and 11% in 7-11 months. Nearly a quarter of adults surveyed said it would be a year or more before they would go to a hospital for an elective procedure. The numbers were higher among women, with 45% saying they would wait seven months or more, versus about a quarter of men. Just 14 percent of women said they are willing to schedule a non-urgent procedure within a month, compared to 33% of men.
Results were similar for scheduling a non-urgent procedure at a non-hospital care site, with 10% willing to have a procedure now, 14% within 1-30 days, 19% within 2-3 months, and 20% within 4-6 months. Looking further out, 9% said they might be willing to schedule an appointment within 7-11 months, and 23% said it would be a year or longer.
Consumers are more comfortable returning for a routine visit at a doctor’s office, with more than a third willing to return now or within 30 days. Only 8% indicated they would wait 7-11 months, and just 9% said it would be a year or more before they considered scheduling a routine doctor’s visit.
Ensuring Patient Safety
More than half (55%) of adults said they had delayed or skipped medical care since the start of the pandemic, according to the Jarrard report. While ambulatory care visits have rebounded somewhat since suffering a dramatic 60% drop in the first weeks of the pandemic, they remain about a third lower than they were prior to the pandemic, according to The Commonwealth Fund.
In the Kaufman Hall surveys, fear of contracting COVID-19 was the No. 1 reason cited by 54% of respondents for why they would delay care. Forty-three percent cited fear of having to go to a hospital as a primary reason for delaying care, while 35% cited fear of spreading the virus, and 33% cited concerns of violating social distancing guidelines.
Taking added safety precautions will be key for healthcare providers seeking to draw patients back to their facilities. When asked to rank the precautions that providers can take to reduce people’s fears about seeking in-person care, 63% of respondents ranked providing personal protective equipment for staff as extremely important, followed by additional room cleanings (60%), social distancing (59%), and regular COVID testing of staff (57%). The option to receive care at a non-hospital location rates as moderately to extremely important for 65% of consumers, but was not as important as the other operational changes within facilities.
Bringing Patients Back
Drawing patients back to in-person care sites will take time. As COVID-related restrictions continue to ease, hospitals and health systems will need to:
- Address safety concerns by ensuring they maintain the types of precautions that matter most to consumers.
- Ensure constant communication to effectively convey precautions and other organizational messaging on an ongoing basis, both internally and externally. Communications should be clear and engaging, telling stories that appeal directly to consumers to assuage fears and build trust.
The COVID-19 pandemic is driving major changes in the nation’s healthcare system, including in how consumers approach personal healthcare decisions. Many changes occurring now—such as the explosion in virtual care—will be permanent fixtures, to be integrated and vastly improved upon in future care delivery models. Other changes and innovations remain to be seen.
Regardless of the many unknowns, one thing is certain: navigating the future of healthcare will require intense focus on anticipating, understanding, and responding to consumers. More than ever, organizations will need to focus on these key building blocks:
- Enhancing their culture of caring
- Re-examining workflow to ensure a seamless consumer journey
- Having the right tools and technology to track and analyze consumers’ needs and preferences
In short, winning the future means winning back the trust and confidence of consumers. That requires a major pivot to a more consumer-centric business model, and new ways of tracking and measuring performance.