Variables Influencing Radiology Volume Recovery During the Next Phase of the Coronavirus Disease 2019 (COVID-19) Pandemic

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has reduced radiology volumes across the country as providers have decreased elective care to minimize the spread of infection and free up health care delivery system capacity. After the stay-at-home order was issued in our county, imaging volumes at our institution decreased to approximately 46% of baseline volumes, similar to the experience of other radiology practices. Given the substantial differences in severity and timing of the disease in different geographic regions, estimating resumption of radiology volumes will be one of the next major challenges for radiology practices. We hypothesize that there are six major variables that will likely predict radiology volumes: (1) severity of disease in the local region, including potential subsequent "waves" of infection; (2) lifting of government social distancing restrictions; (3) patient concern regarding risk of leaving home and entering imaging facilities; (4) management of pent-up demand for imaging delayed during the acute phase of the pandemic, including institutional capacity; (5) impact of the economic downturn on health insurance and ability to pay for imaging; and (6) radiology practice profile reflecting amount of elective imaging performed, including type of patients seen by the radiology practice such as emergency, inpatient, outpatient mix and subspecialty types. We encourage radiology practice leaders to use these and other relevant variables to plan for the coming weeks and to work collaboratively with local health system and governmental leaders to help ensure that needed patient care is restored as quickly as the environment will safely permit.

Keywords: COVID-19; utilization; volumes.

Fig 1

Newly reported coronavirus disease 2019 (COVID-19) cases every 5 days in United States across a sample of illustrative states. (Based on data from CDC [5]).

Fig 2

Imaging volumes as a percentage of baseline volumes. Inpatient, outpatient, emergency department (ED), and total volumes at a single institution are depicted. Active deferral of elective examinations began on March 17, 2020. Resumption of examination scheduling began April 27, 2020.

Fig 3

Weekly imaging volumes from January to April 2020. Volumes are shown by radiology subspecialty in (A) and by modality in (B). County stay-at-home orders were issued in week 11. The governor announced plans for resuming delayed medical care in week 16. Our practice resumed normal scheduling of patients beginning week 17. CV = cardiovascular; Fluoro = fluoroscopy; IR = interventional radiology; Mammo = mammography; MSK = musculoskeletal; Neuro = neuro-imaging; NIR = neuro-interventional radiology; Nuc Med = nuclear medicine; US = ultrasound.

Fig 4

Illustration of how key variables may affect imaging volumes. For each variable, two scenarios are presented: a low-impact scenario (associated with higher imaging volumes, in blue) and a high-impact scenario (associated with lower imaging volumes, in red). (See Table 2 for further explanation.) (A) Effect of severity of disease in the local region, (B) effect of lifting of government social distancing restrictions, (C) effects of patient concern, (D) management of pent-up demand for imaging, (E) impact of the economic downturn, and (F) effect of the radiology practice profile.