Kaufman Hall: Hospital volumes remain below 2019 levels as care shifts to outpatient settings

By Robert King / October 18, 2022

Patient volumes continue to remain below pre-pandemic levels for hospitals and health systems this year as COVID-19 likely accelerated a shift to outpatient settings, a new report finds.

Consulting firm Kaufman Hall released its "2022 Healthcare Performance Improvement" report (PDF), which outlines the barriers hospitals and health systems face in a rough year financially. Another key obstacle continues to be workforce shortages, as more and more facilities shift resources to retain staff. 

“Healthcare leaders must navigate short-term challenges that continue to pressure revenue and expenses, while also adapting organizational strategy to match larger transformations in the way care is delivered,” said Kaufman Hall Managing Director Lance Robinson in a statement on the report. 

Kaufman conducted a survey of 86 hospital and health system leaders across the nation to discuss performance improvement and cost containment efforts at their facilities. A key finding of the survey is that patient volumes have shown little improvement in 2022 compared to last year. 

“Oncology is the only service line that showed significant improvement over last year’s survey, with 40% of respondents saying that oncology volumes were at 100% of pre-pandemic levels (compared with 35% of respondents in 2021),” the report said. 

However, several specialties such as orthopedics, cardiology and neurosurgery continue to struggle to return to 2019 levels. 

For example, only 30% of orthopedic service lines were at 100% or greater of pre-pandemic levels this year, compared with 38% for radiology and 20% for neurology. Only 26% of cardiology volumes returned to pre-pandemic levels, while the emergency department and pediatric volumes remained largely unchanged from 2021. 

Some respondents pegged the issue toward an accelerating shift to outpatient settings. 

“Even though hospitals effectively managed COVID-19 patients to prevent transmission of the virus, the public perceived hospitals as high-risk settings,” the report said. “People did not come in for screenings—mammography and colonoscopy screenings, for example, were down significantly.”

Newer technology and alternative treatments have also reduced the number of cases that need surgical procedures, another likely key driver, Kaufman said.

Another key issue has been retaining enough staff to ensure hospitals are running full steam. Kaufman found that 66% of respondents say staffing shortages have required their organization to run at less than full capacity.

Hospitals and health systems have faced a lingering staffing crunch that forced facilities to rely on pricey contract labor to shore up capacity problems. The shortages and inflation have pushed salaries up across the board, leading to another drag on revenues, Kaufman said. The survey showed that 67% of respondents saw hikes of more than 10% for their clinical staff. 

“Approximately one-third of respondents saw wage increases for clinical staff top 15% or more,” the report said.

A bright spot for hospitals is that the rate of contract labor use is declining. It showed that 44% of facilities report use of contract labor declining, compared with 29% that say it is holding steady and 27% that reported labor use is on the rise. 

In response to the crisis, hospitals and health systems have put renewed energy behind new retainment and recruitment strategies, with varying degrees of success. 

The most popular strategy was to simply raise wages, with 98% of respondents reportedly doing that. Another 84% relied on signing bonuses to help get new staff. 

Other strategies were more structural, such as introducing more flexible work schedules and higher overtime. Some facilities, for instance, are even looking into automation and artificial intelligence to take on burdensome administrative tasks. 

But some respondents cautioned that such schedule flexibility could come with a negative impact for bedside nursing.

“We have seen an increase in nurses leaving because [remote work] opportunities are not available to them,” a respondent told Kaufman.