Assessing the Impact of Unemployment on Anesthesia Practices
May 26, 2020 Each week, we are all updated on the growing ranks of the nation's unemployed. State lockdowns have resulted in some unimaginable unemployment numbers in every state. As of May 21, another 2.4 million workers were added to the jobless rolls, bringing the total to 38.6 million—and this number represents just the individuals who were actually able to file. Some states have reported such a volume of unemployment claims that many people were not even able to complete the process. As traumatic as it is to lose a job, typically this involves loss of insurance as well. COBRA may be an option for some, but it is usually prohibitively expensive, and so an ever-increasing number of Americans are simply going without. Tracking Percentage of Uninsured Patients One of the metrics most practices track is their percentage of self-pay or uninsured patients. While the percentages can vary considerably from one practice to another based on location and type of practice, the overall ABC/Medac client average for the first 10 weeks of the year (January 1 through March 15, the onset of the coronavirus lockdown) was 2 percent. As the table below indicates, the percentage of Medicaid and uninsured patients increased through week four. As the table also indicates, this increase corresponded to a drop in the Medicare percentage by week. As one might have anticipated, a significant percentage of seniors decided not to have their surgical procedures because of their risk status for COVID-19.
A review of actual case volumes sheds some interesting light on these trends. If we compare the average cases by week for the first ten weeks of the year to the seven weeks of the coronavirus, we find that Medicare case volumes dropped 74 percent and non-Medicare volumes, excluding self-pay patients, dropped by 70 percent. Self-pay volume by contrast only dropped by 50 percent. How should we interpret this? Many of these cases are non-scheduled emergencies. In other words, these patients needed care urgently even though they did not have insurance. While it is true that many of these patients have not and will not pay their anesthesia bills, the overall impact on the practice is minimal and does not appear to be getting any worse.
It should also be noted, as we have mentioned in a previous e-alert, that if patients with no insurance are confirmed COVID-19 patients, there is a special program that will provide payment to the anesthesia provider at Medicare rates.
There are many aspects of the coronavirus that continue to cause concern for all of us, such as the rising number of people testing positive and the number of people dying. The impact of state lockdowns and the inability to schedule surgical cases have clearly been major challenges to all of our clients. While unemployment will be a serious issue for so many Americans, for the time-being at least it will not be an issue that greatly impacts our clients' collections.
An Uncertain Future
There has been much discussion of the potential impact of pent-up demand for surgical time. Thus far, a significant percentage of patients who were supposed to have non-emergent procedures, such as endoscopies, are opting to wait. It is impossible to tell how long the fear of contracting the virus will impact surgical volumes. Some cases may become more critical with time, and the patients may have lost their insurance in the meantime. This is an unknown we will just have to monitor over time.
In the meantime, if you would like a more detailed assessment of the impact of self-pay patients on your practice, feel free to contact your account executive or email us at info@anesthesiallc.com.