Where have all of our emergency room patients gone? 

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Having a sound revenue cycle plan in place to protect revenues is a must!

***This article was written by one of EPM’s advertising partners as a promotional supplement.***

When COVID-19 first struck, EDs quickly prepared for the influx of round-the-clock visitors to the emergency department by redesigning makeshift ICUs and repurposing various hospital units to accommodate new virus patients.


What many emergency docs could not prepare for, however, was the stark decline in the number of cases coming in for other “normal” emergencies. DuvaSawko, a company specializing in EM billing and management solutions, has seen a 45-50% drop in emergency patient visits since COVID-19 became prevalent at the beginning of the year.

These visits — headaches, back pain, chest pains, abdominal pain and other very common reasons for ER visits — aren’t occurring in many hospitals, and even the cardiac and stroke units have been oddly quiet.

The reduction in ED visits isn’t limited to particular subsets of the nation; they are happening across the United States. A recent study by JAMA Internal Medicine of 24 emergency departments showed the percent of patients’ volume during the pandemic decreased by 41.5% and 63.5% in Colorado and New York, respectively. ED visits decreased by more than 40% across all the health care systems.


Studies to investigate the phenomenon have concluded with a medley of possibilities. Some physicians have speculated that there actually are fewer heart attacks and strokes occurring because people have been staying home more. They claim that the decline results from people working from home offices and staying more relaxed, not eating out at unhealthy restaurants, and not being exposed to external pollutants.

Other experts maintain it’s more harmful to your body to be staying home with the stress of isolation, higher consumption of fatty, sodium-ridden processed foods and lack of exercise. For these reasons, some experts say they would expect higher rates of emergency room visits. But most will agree that the steep decline comes down to fear.

Patients with potentially dangerous symptoms are staying at home for fear of contracting the virus in a location that may seemingly be a hotspot. These individuals dismiss their serious chest pain symptoms, severe headaches and abdominal pain for that fear of exposure. Patients who do come in with severe acute symptoms are waiting longer to visit, often staying at home until they feel it is imperative to seek help.

For some, this delay is life-threatening, and their outlooks may not be so positive. As healthcare providers, we worry that this mortality rate from ignored health issues may end up more significant than that of the virus itself in less-affected regions.


In addition to the fear of virus contraction, individuals choosing not to seek emergency care may also feel other anxieties that prevent them from reaching out. Patients with symptoms may avoid the hospital due to concerns about extended wait times due to overloaded EDs.

They may also worry about the unavailability of staff and resources to tend their needs. Some may even feel a sense of civic responsibility to avoid monopolizing the resources that other, more critical COVID-19 patients may require.

Many patients’ fears may also stem from their heightened risk of complications from COVID-19. The same individuals showing symptoms of a life-threatening diagnosis are often the same patients who have been warned since the start of the pandemic about their high risk of complications if they were to contract the virus. Many cardiologists find it understandable for them to be concerned that they may be heading to a potential virus hotspot for urgent care.

However, it’s essential to help them recognize that their outlook could be far grimmer by not seeking medical help in a heart attack or stroke situation than it would be by contracting the virus. This delay in seeking prompt care has led some groups, such as CardioSmart.org, to begin outreach programs that raise awareness and encourage patients not to ignore symptoms.

But how do we, as medical professionals, cope with this loss of revenue from the decline in ED visits? It’s especially critical during this time that your revenue cycle is being properly managed, and potential money isn’t slipping through the cracks.

DuvaSawko was founded by emergency department physicians and helps ED practices identify missing revenue, increase efficiencies, mitigate compliance risk, and collect every dollar possible.

With the industry’s fastest collection rates, averaging a 30% increase in revenue for clients, DuvaSawko is a great way to ensure you’re getting the most money possible during this uncertain time and has mastered the art of maximizing collections for emergency medicine groups.

So, where does this leave us for the future of our EDs? For the 2020-2021 influenza season, the CDC predicts it’s likely that flu viruses and the virus that causes COVID-19 will be spreading simultaneously. Health experts say it’s even possible to have the flu and COVID-19 at the same time, though they have yet to determine how probable this may be. With the seasonal flu symptoms having many parallels to the new coronavirus, we will likely find our EDs becoming more inundated with those seeking medical care and requiring testing for both flu and COVID-19.

We project there will be a return to where we once were with patient numbers and even possible growth by the second quarter of 2021. The one component all Emergency Medicine groups have to take into consideration as these numbers begin to rise is the reduced level of reimbursement they’re experiencing due to the downturn in volume.

DuvaSawko is one of the few billing and coding companies that is founded and operated by emergency medicine physicians, giving them a distinct advantage over other companies in the industry.

Overall, there will soon be an uptick in patients needing testing and treatment with the upcoming flu season, especially to rule out COVID-19. We will also see those patients who have formerly chosen to delay obtaining medical care as minor symptoms they previously ignored may now require more immediate emergency treatment. We anticipate an increase in visits later this year, with a close return to “normal” patient numbers mid next year.

It is crucial now, more than ever, to streamline your practice’s revenue collection efforts to secure the most funds possible. For more information on DuvaSawko’s billing and coding solutions, dedicated account managers and proprietary software solution, visit www.DuvaSawko.com.


FOUNDER/EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than 30 years, working exclusively night shifts for the past 20 years in emergency departments across the country. During that period, he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and the founder of Plaster Publishing.

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