COVID-19 Lowered Medicare Care Utilization Across Races, Services

February 18, 2021 - In the first six months of 2020, fee-for-service Medicare utilization dropped across categories of services, races, and dual eligibility statuses, a recent Avalere study confirmed.

Avalere researchers studied fee-for-service Medicare beneficiaries’ healthcare spending habits in the first six months of 2020 and compared these to corresponding data from the first six months of 2019. The researchers drew their sample from CMS Medicare Part A and Part B fee-for-service claims data.

The findings were well-aligned with previous studies. They documented a severe drop in care utilization in the first six months of 2020, with disparities in impact for many minorities as compared to white individuals and less of an impact on dual eligible persons than on non-dual eligible individuals.

In the first two months of 2020, prior to the pandemic, utilization had been higher in every service category that Avalere studied when compared to 2019 levels. Inpatient and physician—or professional—care utilization were higher by double-digit percentage points and outpatient care utilization was 7 percent higher in both January and February 2020.

During March, April, and May of 2020, however, healthcare utilization among Medicare fee-for-service beneficiaries plunged. As a high-risk population, seniors were particularly restricted in their ability to seek traditional healthcare during the first three months of the pandemic.

Outpatient care utilization, in particular, took a hit dropping 18 percent in March 2020 from March 2019 utilization, 51 percent in April 2020 compared to April 2019, and 32 percent in May 2020. Even in June, while other healthcare utilization measures were once again higher than the same month in 2019, outpatient utilization levels were still one percent lower.

Inpatient care was the least affected. In fact, inpatient care utilization continued to hover slightly above 2019 levels in March 2020, the month when the pandemic hit and other forms of care saw double-digit decreases.

While not as severe as outpatient care, physician care utilization also dove below 2019 levels, 13 percent in March, 42 percent in April, and 25 percent in May 2020.

Avalere compared the decline by race as well, looking at the differences between utilization among Black, Hispanic, White, and Asian Medicare beneficiaries.

Care utilization in the Black and Hispanic communities—which had been on the rise in January and February of 2020—did not experience as much of a drop in the subsequent months of 2020 as their White and Asian counterparts.

This statistic might make sense in light of a previous study that indicated that Black patients—not just in the Medicare population, but overall—were four times more likely than White patients to use the emergency department instead of telehealth.

Additionally, Black and Hispanic communities are contracting the coronavirus more frequently than White and Asian populations. Hispanic individuals are 2.5 more likely to test positive for coronavirus than White people and Black individuals are twice as likely to test positive.

Asian individuals, too, are twice as likely to test positive than White people, but still had lower care utilization rates according to Avalere.

However, the Avalere study emphasized that the Black and Hispanic communities did feel the impact of the pandemic on their access to care, with care utilization decreasing as much as 32 percent and 34 percent respectively in the month of April 2020.

Meanwhile, in the Asian and White communities, care utilization in April 2020 was nearly half as common as it had been in April 2019. Even in June 2020, care utilization in the Asian community was seven percent lower than it had been in the year prior.

The study also noted that non-dual eligible individuals experienced a steeper decline in care utilization than dual eligible individuals did, with dual eligible beneficiaries seeing a little more than half the percentage decline that non-dual eligibles witnessed in April 2020.

“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,” Avalere warned.

“In addition, decrease in service utilization could indicate that people missed out on preventive care and postponed care they may have needed to receive, which contributes to compounding concerns in management of chronic and acute care leading to pent up demand in future months in addition to potential healthcare costs associated with gaps in care.”