Throughout the COVID-19 pandemic, Michigan emergency department (ED) and primary care utilization significantly dropped, according to representatives of these facilities. This led to a decrease in care centers’ operating margins and worse health outcomes for patients all around the state.
At our 2022 Michigan State of Reform Health Policy Conference, a panel of three experts from different silos of health care delivery talked about the effect that COVID-19 had on hospitals and patients in the state who deferred important medical care.
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Speaking on the panel were Nina Abubakari, President and CEO of Advantage Health Centers, Darryl Elmouchi, President of BHSH/Spectrum Health West Michigan, and Christine Surdock, Plan President of Molina Healthcare of Michigan.
All three presenters shared data points showing the decline in services and important precautionary screenings given in the state.
Elmouchi said in late 2020, there was 42% less emergency care given in BHSH hospitals including 23% less ED visits for heart attacks.
“This not only had ramifications at the time, but will have lasting ramifications on the public’s health—and the health of health systems—over the coming months and years,” Elmouchi said.
BHSH hospitals were greatly affected in the recent omicron wave as well. Elmouchi said over 2,000 elective surgeries were canceled in just the omicron wave, leading to more deferred care and folks not getting the treatment they need.
Abubakari spoke about her experience at Advantage, a federally qualified health center (FQHC) in Detroit. At Advantage, she saw higher numbers of positive COVID-19 rates accompanied with 43% less in-person visits. Though the center transitioned to telehealth care, not all patients had access to the necessary technology to receive virtual care.
Advantage saw a significant downturn in utilization for dental services, cervical cancer screenings, counseling, depression screenings and follow-up, controlling for high blood pressure, treatment for diabetics, HIV screenings and diagnoses, among others.
“As you can imagine, with the reduction of patients that we saw and our inability to provide telehealth effectively and efficiently, the care we were giving was not as robust, well-rounded, and certainly not as integrated as we once were able to give,” Abubakari said. “That certainly had an effect on our ability to provide quality care to our patients.”
Surdock spoke specifically about Molina’s Medicaid members and how they were impacted by COVID-19. In the two years of the pandemic, their members have seen an 8% decrease in breast cancer screenings, 20% decrease in Well-child visits within a child’s first 15 months, a 35% decline in child immunizations, and a 24% decline in lead screening for children.
The panelists then spoke more about how the pandemic has affected the health of hospitals, health systems, FQHCs, and primary care providers. The pandemic has led to a decrease in revenue and morale in health care delivery spaces.
Elmouchi said the average hospital in early 2022 had a negative 3.5% to 4.5% operating margin. This is due to the reduced amount of more expensive services like elective surgeries.
“That’s going to have a dramatic impact on how we’re all able to care for people,” Elmouchi said.
Due to decreases in operating margins, many hospitals and health centers in the state had to close. Abubakari said 17% of health centers are temporarily closed and 33% of state community health centers are closed at least temporarily.
She said that though there has been lots of money from the federal and state government to supplement these losses in revenue for health centers, patient visits are still the number one driver in revenue.
“When you see that reduction in patients, you are also going to see a reduction in revenue as well,” Abubakari said.
The panelists also spoke on the increase in stress and workplace violence that health care professionals are experiencing.
Elmouchi highlighted that violence towards health care workers, especially due to enforcement of mask mandates in hospital and primary care settings, is threefold higher than before the pandemic.