Dive Brief:

• Outpatient visits held steady during the last three months of 2020 even as the country experienced a surge in COVID-19 cases, a new Commonwealth Fund report by researchers at Harvard and Phreesia, a health technology company, found.
• Outpatient visits largely returned to pre-pandemic levels after plummeting in the spring, but trends differed among age groups. While visits for adults remained stable through the end of the year, outpatient visits among kids ages 3 to 17 started to decline in the fall and ended the year markedly lower than in prior years.
• Visit trends also varied widely across specialties in 2020, with pediatric offices hit the hardest. However, visits to certain specialists exceeded pre-pandemic levels in the month of December, including visits to rheumatologists, urologists and adult primary care practitioners.

Dive Insight:

This latest research helps provide a more well-rounded view of how patient volumes were affected by the COVID-19 pandemic in 2020.

This analysis shows that patients continued to seek outpatient care during the final months of the year even as COVID-19 cases swelled in many parts of the country. While outpatient visits hovered near the levels recorded in early March, inpatient visits unrelated to COVID-19 cases fell in the last months of 2020, according to earlier research.

Still, while outpatient visits remained stable as the year closed out, the cumulative reduction in these visits throughout the pandemic was sizable, according to the latest report. There is no doubt researchers will study the long-term effects of these reduced visits for years to come.

Industry experts have voiced concerns about the long-term consequences of Americans delaying care, and many health systems have continued to urge patients to return for their yearly exams.

Visits to the pediatrician were the hardest hit, recording a 27% drop in visits during the pandemic. Other specialties were high on the list, including cardiology and dermatology. The researchers analyzed data from Phreesia, which provides services to more than 50,000 doctor offices nationwide, totaling more than 50 million outpatient visits a year.

Pediatrics was again the specialty most negatively affected in December, alone, with visits 24% below the baseline.

As COVID-19 cases ticked up, telehealth visits began to rise again in November and December after falling from a peak in mid-April. Telehealth uptake in December was the most prevalent for behavioral health and endocrinology while visits for podiatry, orthopaedics and surgery remained very low.

Orthopaedic and cardiology visits were down for the cumulative study period by 16% and 20%, respectively, compared to the baseline of March 1-7, 2020, according to the report. The data is in line with fourth-quarter and full-year procedure trends highlighted by medtechs in recent earnings calls.

Johnson & Johnson, Stryker and Zimmer, all of which have large orthopaedic portfolios, saw hip and knee procedures take a hit due to elective declines throughout last year, with elective procedures dropping again in the fourth quarter after volumes increased throughout the second and third quarters from the significant lows of March and April.

Stryker's hips and knees business declined year over year by 8.3% and 10.2%, respectively in 2020; similarly, Zimmer’s hips business declined by 9.4% and knees declined by 15%. J&J’s overall orthopaedics business dropped by 3.7% on a reported basis, fueled by a 12.5% decline for knee procedures.

Edwards Lifesciences, which specializes in cardiac procedures, reported a similar trend and impact. The company’s transcatheter aortic valve replacement business, which largely makes up Edwards' revenue, had a mid-single-digit sales decline in the U.S. in 2020.

CEO Michael Mussallem said that while a slowdown in the fourth quarter was expected, the end result was tougher than expected. One cause of the slowdown, according to the CEO, was a decline in referrals from treatment centers as patients stayed out of healthcare facilities.

Due to fourth-quarter procedure declines spilling into the first quarter and possibly the second, top medtech executives are looking to the second half of 2021 for a meaningful rebound.