Impact of COVID-19 on Oregon’s health care providers Oregon Health Policy Board Informational Session September 2020 1
Today 1. Overview 2. Initial impact of COVID-19 3. Ongoing impact 4. Reflections 5. Financial support strategies 6. Ongoing monitoring 7. Q&A 2
Today Reminder 1. Overview This is an information session, not an 2. Initial impact of COVID-19 official Oregon Health Policy Board meeting. 3. Ongoing impact 4. Reflections Please type questions into the chat 5. Financial support strategies box, and we’ll discuss at the end. 6. Ongoing monitoring Submit public comment to OHPB: 7. Q&A HealthPolicyBoard.Info@state.or.us 3
1. Overview 4
COVID-19 has had a major impact on Oregon’s health care system and providers 5
Fewer patient visits COVID-19 has had a Lost revenue major impact Office closures on Oregon’s health care Laid off / furloughed staff system and Stress and burnout providers New ways of providing care 6
The Short-Term Provider Financial Sustainability (STFS) Workgroup Convened in early May to • Monitor state and federal financial supports • Coordinate across programs and agencies • Identify additional financial supports for providers Support communications to providers about resources • 7
2. Initial Impact of COVID-19 8
Outpatient utilization plummeted ~60% by early April https://www.commonwealthfund.org/publications/2020/apr/impact-covid-19-outpatient-visits Sources: Ateeva Mehrotra, Michael Chernew, David Linetsky, Hilary Hatch,and David Cutler, “The Impact of the COVID-19 Pandemic on Outpatient Visits: A Rebound Emerges,” The Commonwealth Fund and Phreesia. Data from from Phreesia’s clients, which include more than 1,600 provider organizations representing more than 9 50,000 providers across all 50 states.
The drop in outpatient visits varied by provider type Percent change in visits from baseline, by early April -30% Behavioral Health OB/GYN -46% -47% Oncology Primary Care -51% -55% Allergy/Immunology -61% Cardiology Pediatrics -62% -63% Urology -63% Pulmonology Surgery -66% -73% Dermatology Opthalmology -79% https://www.commonwealthfund.org/publications/2020/apr/impact-covid-19-outpatient-visits 10
Percent of Oregon Primary Care Practices reporting… a decline in patient volume >50% decline in patient volume Oregon 96.9% providers 89.8% 81.9% also 70.4% 62.2% 54.6% experienced this drop April 10-13 April 17-20 April 24-27 May 1-4 May 8-11 May 15-18 https://www.ohsu.edu/oregon-rural-practice-based-research-network/hot-topics 11
Percent of Oregon dental practices’ status, by week Initially, 98% of practices were closed 23-Mar 81.7% 15.9% 6-Apr 86.3% 11.8% 20-Apr 85.5% 11.8% By May 4 th , two-thirds of practices 4-May 63.9% 25.6% 7.5% were open, but most were seeing lower patient volume than usual 18-May 82.9% 10.0% 3.6% open and business as usual open but lower patient volume than usual closed by seeing emergency patients only closed and not seeing any patients https://www.ada.org/en/science-research/health-policy-institute/covid-19-dentists-economic-impact/survey-results 12
Percent change in commercial utilization and revenue (estimated allowed amounts) from 2019 to 2020 across all professional services. Drops in utilization 20% 7% 3% 3% 3% resulted in 0% decreased -20% revenue for -40% -60% -55% providers -60% -80% -79% -80% -100% Jan Feb March April Healthcare Professionals and the Impact of COVID-19: A comparative study of revenue and utilization. FAIR Health. June 2020. 13
Estimates of lost revenue for Oregon providers Primary Care Behavioral Health Expected Q2 2020 total revenue $227.7 - $243.9 million $87.9 - $94.6 million Estimated drop in revenue 50% 30% Estimated Q2 2020 $ loss $113.9 - $121.9 million $26.4 - $28.4 million Data source: Oregon’s All Payer All Claims data, CY 2018. All revenue calculated using allowed amounts. Primary care providers identified using definitions from Oregon’s Primary Care Spending Report, applied to all carriers. Behavioral health providers identified using Actuarial Services categorization. Total revenue adjusted for inflation using CPI-medical. Lower bound not adjusted, upper bound adjusted for 2019. Commercial revenue adjusted to account for self-insured population (ERISA) not in APAC data: 6-12% depending on churn. 14
70% of Oregon respondents to a survey conducted by the National Council for Behavioral Health indicated they didn’t think Oregon hospitals reported over they could survive past 3 months $600 million in operating losses in March and April, and a 41% reduction in inpatient revenue Income for Oregon health care interpreters dropped by Over 50% of Oregon about 75% on average physicians report financial stress is at an all-time high 15
3. Ongoing Impact 16
Nationally, by August 1, outpatient visits rebounded to about 90% of what they were in March Source: Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on Outpatient Visits: Changing Patterns of Care in the Newest COVID-19 Hot Spots 17 (Commonwealth Fund, Aug. 2020). https://doi.org/10.26099/yaqe-q550
Most of the rebound is in-person visits All visits In person visits Source: Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on Outpatient Visits: Changing Patterns of Care in the Newest COVID-19 Hot Spots 18 (Commonwealth Fund, Aug. 2020). https://doi.org/10.26099/yaqe-q550
But the rebound varies by specialty Dermatology Adult primary care Behavioral health Pediatrics Source: Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on Outpatient Visits: Changing Patterns of Care in the Newest COVID-19 Hot Spots 19 (Commonwealth Fund, Aug. 2020). https://doi.org/10.26099/yaqe-q550
And by insurance type MEDICARE COMMERCIAL MEDICAID Source: Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on Outpatient Visits: Changing Patterns of Care in the Newest COVID-19 Hot Spots 20 (Commonwealth Fund, Aug. 2020). https://doi.org/10.26099/yaqe-q550
Oregon dental practices reporting their total collections as % of typical <25% 25%-50% 51-75% 76-99% 23-Mar 85.8% 7.1% 2.4% 3.6% 6-Apr 92.9% 2.4% 2.4% 2.4% 20-Apr 94.8% 3.2% 1.1% 1.1% 4-May 67.8% 21.2% 8.5% 2.5% 18-May 47.0% 30.8% 15.4% 6.9% 1-Jun 19.0% 36.4% 29.1% 15.5% 15-Jun 11.9% 20.8% 32.7% 34.7% 29-Jun 6.6% 14.1% 38.0% 41.3% 13-Jul 12.8% 9.6% 35.1% 42.6% 27-Jul 1.2% 10.6% 31.8% 56.5% 10-Aug 5.2% 2.6% 23.4% 68.8% 21 American Dental Association, Health Policy Institute. Economic Impacts of COVID-19 on Dental Practices biweekly survey. Data for Oregon respondents.
Percent of Oregon primary care practices responding to how many weeks or months of financial reserves they have remaining Source: Quick COVID-19 Primary Care Survey, conducted by the Larry. A Green Center and the Primary Care Collaborative. Data from Series 11 (May 22-25) 22
Source: Quick COVID-19 Primary Care Survey, conducted by the Larry. A Green Center and the Primary Care Collaborative. Data from Series 15 (June 26-29) 23
Oregon primary care practice stress in late July compared to the first month of the pandemic It seems worse - we are struggling 15.2% It seems worse - but we are sadly now used to it 13.0% It's the same - but over time, harder to bear 30.4% It's the same - but over time, we've adjusted 19.6% It's getting better 13.0% Other 8.7% Source: Quick COVID-19 Primary Care Survey, conducted by the Larry. A Green Center and the Primary Care Collaborative. Data from Series 17 (July 24-27) 24
Percent of Oregon primary care practices reporting that they have Seen higher levels of Been more involved in assisting with mental health concerns 100% 85% struggle paying bills 73% 28% housing insecurity 70% 40% domestic violence 35% 18% food insecurity 60% 43% Source: Quick COVID-19 Primary Care Survey, conducted by the Larry. A Green Center and the Primary Care Collaborative. Data from Series 19 (August 21-24) 25
4. Reflections 26
5. Financial Support Strategies 27
Provider Relief Fund allocations to date, in billions Congress appropriated $175 billion in Provider Relief Funds https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/general-information/index.html 28
As of August 3 rd ~$700M has been distributed to 3,235 Oregon providers from the CARES Act Provider Relief Hospitals and affiliates: $389.7M Other Providers: $311M Fund 37 recipients 3,198 recipients Oregon E-Board has allocated $50M of state Coronavirus Relief Funds for grants to rural hospitals in addition to above. https://www.oregon.gov/oha/FOD/Pages/Provider-Financial-Supports.aspx 29
3 providers received only $2! <$10 25 1,094 Oregon $10-$50 90 providers $51-$100 74 $101-$500 517 received less $501-$1,000 388 than $1,000 $1,001 - $10,000 1124 to date from $10,001 - $100,000 644 the Provider $100,001 - $1 million 317 $1-10 million Relief Fund 67 >$10 million 17 Federal distributions as of August 3, 2020. 30
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