Where Have All the Patients Gone?

Hospitals and practices in the US are struggling. Many large and prominent health systems have reported large quarterly/yearly losses. While some of those losses are due to investments in the stock market, most are showing an operating loss due in part to a decrease in patient volumes. The question I have: Where have all the patients gone?

Mounting Losses

A quick scan of recent headlines reveals a grim picture for the financial performance of health systems:

Most experts agree that hospital and practice revenues will continue to underperform for the remainder of 2022 and into 2023. One of the contributing factors to these losses is lower patient volumes.

Lower Patient Volumes

When the COVID-19 pandemic hit in 2020, patient visits to hospitals and practices drastically declined. Between the lockdowns, job losses, fear of contracting COVID-19, and not wanting to be a burden on a stretch system – patients stayed away from healthcare providers. When the vaccines became widely available and society opened back up, there was an expectation that patients would return. Some experts even predicted a post COVID-19 surge due to pent-up demand.

So far, that has not been the case.

According to the latest report from Strata Decision Technology, patient volumes in September 2022 were rising compared to July 2022, but still below the same month in 2021.

What is causing patients from seeking care?

Potential Reasons for Not Seeking Care

There are a lot of theories on why patients are not returning to healthcare. Here are some of mine:

  • Loss of insurance coverage
  • Higher cost of care due to higher deductible
  • Lack of access to care
  • Fear of contracting COVID-19
  • Fear of surprise medical bills
  • Not feeling “sick enough” to seek care
  • Distrust of healthcare

We’ve covered access to care and the erosion of trust in prior HCLDR Tweetchats, but we have not discussed the other reasons. In particular, I’m very interested to know what the HCLDR community thinks of patients avoiding care due to “not feeling sick enough”. Has the pandemic reset the acceptable level of “sick”…meaning if we don’t need a ventilator maybe we shouldn’t go to the ER? Is that maybe a good thing? Or are we going to be heading for an influx of patients who are more severely ill over the next several years because they did not come in early enough?

Personally, I do not see patient volumes rebounding until the economy recovers later in 2023. With so much economic uncertainty, I believe people who see themselves as “well enough” will continue to forgo care rather than take on the financial burden of medical bills. This means that at some point down the road, we will have people who are more acutely ill seeking care…and I do not believe the healthcare system is prepared for that influx.

Join the next HCLDR tweetchat on Tuesday October 11th at 8:30pm ET (for your local time click here) when we will be discussing the following questions:

  • Q1 Why do you think patient volumes are lower than expected? Is there a factor that stands out to you?
  • Q2 How can healthcare organizations convince patients to come in rather than delay NECESSARY care?
  • Q3 What are the silver linings (ie: learnings) that we should take from these lower patient volumes and financial losses at healthcare organizations?
  • Q4 What will need to change if healthcare organizations and physician practices are faced with patients who are more ill than they are used to seeing?


King, Robert. “Mayo Clinic posts $227M net loss for Q1 as labor expenses shoot up”, Fierce Healthcare, 20 May 2022, https://www.fiercehealthcare.com/providers/mayo-clinic-posts-227m-operating-loss-first-quarter-labor-expenses-shoot, accessed 9 October 2022

Kelly, Susan. “CommonSpirit posts $1.3B full-year operating loss”, Healthcare Dive, 26 September 2022, https://www.healthcaredive.com/news/commonspirit-earnings-loss-expenses/632614/, accessed 9 October 2022

Muoio, Dave. “Cleveland Clinic reports $283M loss, deferred care and high expenses in Q1 2022”, Fierce Healthcare, 26 May 2022, https://www.fiercehealthcare.com/providers/cleveland-clinic-reports-283m-loss-deferred-care-and-high-expenses-q1-2022, accessed 9 October 2022

Landi, Heather. “Ascension posts $884M loss in Q1 as hospitals hit with COVID surges, higher expenses”, Fierce Healthcare, 3 May 2022, https://www.fiercehealthcare.com/providers/ascension-posts-884m-loss-early-2022-hospitals-hit-covid-surges-higher-expenses, accessed 9 October 2022

“Hospital revenues and volumes are falling again”, Advisory Board, 16 June 2022, https://www.advisory.com/daily-briefing/2022/06/16/hospital-revenue, accessed 9 October 2022

“The National Patient and Procedure Volume Tracker™”, StrataSphere, September 2022, https://www.stratadecision.com/national-patient-and-procedure-volume-tracker/, accessed 9 October 2022

“Report: Hospital volumes, revenues plunge in April, offsetting previous gains”, AHA, 31 May 2022, https://www.aha.org/news/headline/2022-05-31-report-hospital-volumes-revenues-plunge-april-offsetting-previous-gains, accessed 9 October 2022

Image Credit

Photo by Maria Tyutina: https://www.pexels.com/photo/pink-and-blue-stadium-chairs-752036/

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