How much Medicare claims dropped at start of pandemic

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Most U.S. health systems saw a reduction in elective procedures in the spring of 2020, which resulted in significant reductions in Medicare claims, according to a study from healthcare business consulting firm Avalere.  

For the analysis, published Feb. 9, Avalere examined Medicare fee-for-service claim volumes for hospital inpatient, outpatient and physician services during the first six months of 2020 compared to the same period in 2019.

In April 2020, the researchers recorded a 51 percent decrease in outpatient claims. Professional claims were down 42 percent in the same month. They also found a larger decrease in claims for people who weren't eligible for both Medicare and Medicaid than those who were. Dual-eligible beneficiaries had 28 fewer claims in April 2020 than the year before. Meanwhile, the number of claims per nondual eligible Medicare beneficiaries was down 48 percent 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 said. "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."

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