Outpatient Imaging Centers Lag Behind Main Hospitals in COVID-19 Volume Recovery

Not only did non-hospital based imaging centers experience the most significant drop in imaging volumes during the height of the COVID-19 pandemic, but these off-site facilities have also been the slowest to recover.

According to a study published Aug. 15 in Academic Radiology, a team of investigators from Massachusetts General Hospital and Harvard Medical School examined the fluctuation of imaging volumes at several locations. They found imaging volumes of all modalities dipped more at the non-hospital locations.

“Affiliated imaging center volume decreased to a greater degree than the main hospital campus and showed a slower rate of recovery,” they said. “The trend in imaging volume and recovery were temporally related to public health announcements and COVID-19 cases.”

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To identify the severity of these imaging trends, the team conducted a descriptive retrospective study, examining volume from Massachusetts General Hospital (main hospital) and its 26 affiliated imaging centers from Jan. 1, 2020, to May 21, 2020. They considered January 1 to March 10 as the pre-state of emergency period (pre-SOE), and March 24 to May 10 as the post-state of emergency period (post-SOE).

Overall, they determined the average weekly imaging volume post-SOE slipped by 54 percent at the main hospital compared to 64 percent at the affiliated imaging centers. And, they affiliated imaging centers had a tougher, slower time recouping volume.

Specifically, hospital-based CT, X-ray, and ultrasound levels dropped by 41 percent, 49 percent, and 53 percent, respectively, while levels at affiliated centers fell by 43 percent, 61 percent, and 60 percent, respectively. Mammography suffered the greatest decline at roughly 92 percent in both environments, followed by nuclear medicine – a 77-percent drop at the main hospital, and a 74-percent drop at affiliated centers.

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In terms of actual image study numbers, the average number of weekly studies in the main hospital fell from 10,855 to 5,028 during the state-of-emergency and from 10,163 to 3,709 at the affiliated centers.

But, as the number of new daily COVID-19 cases began to subside, the team said, the main hospital and its affiliates experienced a steady rise in volume – by May 21, the main hospital had recovered 70 percent of its volume. However, the affiliated centers had only recouped 66 percent.

There are several possible reasons why an affiliated center might recover more slowly, the team said:

• Patients and referring providers postponed elective imaging appointments due to ongoing pandemic concerns
• Referring providers delayed scheduling outpatient elective studies
• Slower re-opening of affiliated imaging centers compared to large urban hospitals
• Increase in high-acuity visit to the main hospital as a result of postponed or delayed medical care

The drop in volume has also had financial implications, they added. Without the revenue, imaging centers could be pushed to delay expansion plans or equipment purchases. They could be forced to delay new hires or institute staff furloughs or layoffs. The Massachusetts General Hospital system itself implemented temporary pay and benefit reductions, as well as wage freezes.

Ultimately, the team said, the analysis from this study and future investigative efforts that examine imaging data from different healthcare systems can be used to create generalizable prediction and economic recovery models that can support budgetary and resource allocation decisions institutions might face in future pandemics.