A new analysis from the Center for Improving Value in Health Care (CIVHC) shows elective procedures represent nearly 75% of all procedures performed and result in an average of over $200M per month in payments to Colorado hospitals, clinicians, ambulatory surgery centers and diagnostic procedure centers.
The analysis is based on claims in the Colorado All Payer Claims Database (CO APCD) which includes payments from Medicare, Medicaid, and the majority of commercial insurance plans with the exception of some self-insured employer plans. The results support efforts to understand the financial impact of Governor Polis’ March 2020 order for temporary cessation of elective procedures aimed at preserving personal protective equipment and allocating resources to prioritize essential health care procedures during the COVID-19 state of emergency.
Results show that free-standing providers are likely to have experienced the highest financial impact as elective procedures represent 91% of payments for all procedures delivered (both elective and non-elective) at Ambulatory Surgery Centers and diagnostic procedure centers. Inpatient hospital procedures were the least affected of the three categories evaluated, with 24% of payments identified as elective of all procedures. However, elective procedures represented 66% of hospital-based outpatient payments which poses a significant potential financial impact.
Procedures identified in the analysis as elective include inpatient and outpatient surgical operations and diagnostic procedures such as gastrointestinal endoscopies. Data was analyzed from January to June for 2018 and 2019 and is available by month to account for seasonality. Cost and utilization information for possibly elective procedures is also available which includes procedures that, depending on clinical circumstances, may or may not be considered elective.
Critical Access Hospitals (CAHs) were exempt from the Governor’s order and were analyzed separately.
Elective procedures at CAHs represented a small percentage (1.8%) of the total elective and possible elective claims across Colorado, but receive on average $4.7M per month for these procedures which could have resulted in financial hardship for small rural facilities if patients were reluctant to seek procedures during the order.
This is one of many elective service-related analyses that are possible with data from the CO APCD to help Colorado evaluate the impact of COVID-19. Additional COVID-19 analyses and resources are available at civhc.org, including Populations at Risk for Serious Illness. For more information contact us at info@civhc.org.