Here’s How Far Medicare Claims Dropped Last Spring Due To COVID-19

COVID-19 caused a massive 51% drop in outpatient Medicare fee-for-service claims last April compared to 2019 as the pandemic reached full swing, according to a new analysis.

The analysis, released Tuesday from consulting firm Avalere Health, sought to explore the impact of the pandemic on healthcare utilization from March through May. The pandemic caused doctors’ offices to close and hospitals to shutter elective procedures to preserve capacity to fight the virus.

“The impact of delayed or avoided care on the health status of Medicare beneficiaries will need to be examined over the following months and years as there could be lasting effects even as the pandemic recedes,” the analysis said.

Avalere found the greatest drop in claims for Medicare fee-for-service occurred in April. The biggest decline was the 51% drop of outpatient claims compared with 2019, compared with a 42% drop for inpatient fee-for-service claims and a 23% drop for professional and physician service claims.

The consulting firm looked at a random sample of Medicare Part A and B fee-for-service claims between January and June 2019 and the same time frame last year.

The declines started to occur in March, when lockdowns began to spread across the country. Outpatient claims declined by 18% that month and inpatient claims by 13%.

Increases also weren’t as pronounced in May, when states started to ease lockdowns and shelter-in-place orders. Outpatient claims declined by 32% in May 2020 compared with 2019, and inpatient by 25%.

Claims also started to rise slowly in June as inpatient rose by 3% compared to 2019 and professional/physician services by 4%. However, outpatient claims continued to decline and were down 1% that month.

Patient volumes have seesawed for hospitals across 2020. While volumes rebounded in the summer, some systems have had to pause elective procedures again in the fall and winter as COVID-19 has surged again.

Avalere also looked at healthcare use changes among dual-eligible Medicare and Medicaid beneficiaries.

“While duals and non-duals looked similar in terms of their utilization rates in January and February of 2020 compared to the same months of 2019, the groups deviate in the spring,” the analysis said.

The number of claims per non-dual-eligible Medicare beneficiary fell 48% in 2020 compared to April 2019, but only fell 28% among dual-eligibles that same month.

The claims seemed to rebound in June as they increased by 4% for duals and 3% for non-duals compared to the same month in 2019.

Avalere noted that the decrease in healthcare use could indicate that people missed out on preventive and postponed care which could complicate “management of chronic and acute care leading to pent up demand in future months.”


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