Reversing the 60 percent decline in ambulatory care visits won't be easy.

Restarting regular care: Nine ways to get patients back to the office

May 13, 2020
Reversing the 60 percent decline in ambulatory care visits won't be easy.
President and CEO

Let me start with the observation that it just may be as hard to restart the parts of the healthcare system that are not focused on COVID-19 patients as it will be to revive the restaurant industry.

In the weeks since COVID-19 was deemed a global pandemic, healthcare utilization has declined precipitously. A Commonwealth Fund study found “the number of visits to ambulatory practices declined nearly 60 percent in mid-March and has remained low through mid-April.” Some notable figures from the chart below, which shows the decline from the baseline week of March 1 to April 5, are:

  • Pediatric visits are down 62 percent
  • Adult primary care declined 49 percent
  • Oncology has decreased 47 percent


Decline in visit from baselines to the week of April 5thSource: Ateev Mehrotra et al., “What Impact Has COVID-19 Had on Outpatient Visits?,” To the Point (blog), Commonwealth Fund, Apr. 23, 2020.


A survey of 1,000 independent pediatricians found dramatically lower vaccination levels in the past month. “The administration of measles, mumps and rubella shots dropped by 50 percent; diphtheria and whooping cough shots by 42 percent; and HPV vaccines by 73 percent.

Dramatically lower vaccination rates

While delaying preventive care may be a reasonable choice for patients to make during a pandemic, especially if the disruptions are short-lived, there’s even evidence suggesting people are avoiding emergency care too. An early April survey of nine major hospitals showed the number of severe heart attacks being treated in hospitals had declined by nearly 40 percent since the onset of the pandemic. The Boston Globe reported hospitals in the Boston area and across the country are seeing a precipitous drop in emergency room cases – by 40 percent or more.

At the same time, more people report concerns about the cost of healthcare.

In a survey conducted by PwC’s Health Research Institute during the first week, 78 percent of consumers said they would skip at least one medical visit such as maintenance visit for a chronic illness or a recommended lab test due to cost concerns. As unemployment tops 30 million and people lose employer-sponsored health insurance coverage, we expect health cost concerns to increase.

Nine Ways to Resume Patient Care

In light of the challenges I’ve outlined, I offer nine considerations as physician practices resume post-pandemic patient care.

  • Anticipate and acknowledge patient fears.

    Many patients remain fearful about returning to the doctor’s office for routine medical care and preventive screenings. Consider sending a reassuring letter or email to all patients outlining the steps your practice is taking to ensure as much social distancing as possible. For example, some practices plan to schedule immune-compromised patients for early-morning appointments and determine a limit to the number of people in the waiting room at any one time.
  • Make room for the emotional well-being of patients.

    Some patients are experiencing loss, grief, anxiety, depression and other mental health symptoms as a result of the emotional and/or financial toll COVID-19 has taken on them and their loved ones. Identify community or health plan resources to make available to impacted patients.
  • Use identification and stratification analytics (id and strat).

    It’s critical for practices to identify the patients with the greatest risk and the most significant gaps in care, even more so for physicians practicing population health in value-based care relationships. For example, diabetic retinopathy is an eye condition that can cause vision loss and blindness in people who have diabetes. There are no early symptoms, which is why eye exams are critical and are part of the HEDIS® quality measures for diabetics.
  • Use an analytic model to determine patients at highest risk for severe COVID-19 impacts.

    Early research has suggested that people with comorbidities like diabetes, hypertension and heart disease are at higher risk for COVID-19 complications and hospitalizations. Companies like Geneia have created analytics models to determine the population of patients at highest risk. Practices can benefit from using this kind of information to triage and prioritize patient outreach and engagement.
  • Use technology to monitor at-risk patients.

    Telehealth and remote patient monitoring allow practices to monitor and manage patients at greatest risk, and to do so in the safest possible manner from the comfort of their home. Clinicians respond to monitoring alerts and take action to prevent emergent situations from becoming emergencies and hospital visits.
  • Prioritize patient outreach.

    Use a care management solution and a clinical team to outreach to patients to begin bringing them back into the medical office, based on clinical priority.
  • Engage patients.

    Use motivational interviewing to help engage patients. Use education to reassure patients about the precautions being taken to protect their health, e.g. cleaning techniques and mask requirements for patients and staff.
  • Determine which visits need to be in-person.

    Work to schedule appointments for gap closures that require face-to-face visits such as cervical cancer screenings for women ages 21-64 and HbA1c testing for diabetics. Schedule elective surgeries based risk profile and id and strat.
  • Leverage resources to address social determinants of health.

    Research suggests medical care accounts for only 10-20 percent of health outcomes while the other 80-90 percent are attributed to social determinants of health (SDoH) such as financial security, loneliness, affordable housing and transportation. During the pandemic, 61 percent of patients report they have been adversely impacted by SDoH, and I suspect that number may increase in the coming weeks and months. Physician practices are advised to leverage community and health plan resources to help mitigate unmet social needs.

If your practice needs help resuming patient care, Geneia can help. Email me at