The Kaiser Family Foundation (KFF) reported that 48% of U.S. adults surveyed had postponed medical care due to the COVID-19 pandemic. In good news, more than two-thirds of those who delayed care expected to get the care they have delayed over the next three months. "This is encouraging given one of the key concerns to normalized growth for med-tech is the willingness of patients to go to a health care facility," said Wells Fargo Equity Research Senior Analyst Larry Biegelsen.

The KFF survey quantified the high rate of delayed care caused by many states halting all elective procedures in March and April to prepare to treat patients with COVID-19 and fear on the part of patients that kept them from seeing healthcare providers who remained open through this spring.

“I was surprised that almost half had someone in the family who delayed care and also surprised in the confidence people had that they would get that care fairly soon,” KFF Vice President Liz Hamel, lead author of the report, told BioWorld. “It’s somewhat telling that everyone expected they would get care in the next three months. That indicates some significant level of pent-up demand.”

The survey found a very low rate of visits lost or delayed into next year, with just 1% of the 1,189 surveyed saying that they would not get the delayed care at all and 2% expecting to wait more than one year to get the care.

“The coming months will tell if people feel comfortable” returning to medical settings, Hamel said. The survey indicated that health care appointments would be among the first activities people expected to resume, with 82% saying they already were or would go to a dental or medical appointment in person in the next three months. That compared to just 53% planning to eat in person at a restaurant and 19% expecting to attend a concert or sporting event over the same time period.

Appointments and procedures rebounding

Medical appointments began ticking upward in late April. By the week ending May 1, total patient visits had risen from pandemic lows across nearly all specialties except endocrinology based on Iqvia’s BrandImpact data. Oncology, pain, and cardiology were down only about 10% from their pre-pandemic highs at the beginning of May.

By mid-month, Wells Fargo Equity Research reported that cardiology was down just 5% and oncology was down only 3% from pre-pandemic levels. Telehealth visits accounted for the majority of visits for some specialties, with every specialty except oncology conducting at least 35% of early May visits remotely.

“We view this data as a leading indicator of procedure volume given that a patient needs to see a physician before scheduling a procedure,” noted Biegelsen.

As important for a return to elective procedures as patient willingness to see a physician is availability of space for procedures. Cowen Equity Research calculated the number of “unencumbered days” available for elective surgeries in April, May, and June as states opened up.

Cowen’s Joshua Jennings and colleagues estimated that eight states will have at least 75% of their regular 65-day total for the three-month period available. Those states were Hawaii, Georgia, Idaho, South Carolina, West Virginia, Texas, California, and North Dakota. The national average was 44 days in the second quarter.

Notably, more than half the states (26) had no elective surgery days available in April, while 42 states had at least 20 or 22 days available in May. The analysts anticipated no restrictions in June.

The Cowen team recognized that availability was just one part of the equation that has suppressed elective surgeries, noting “non-essential procedure volumes have declined even in instances where no restrictions exist for elective surgeries. Thus, counting unencumbered days has only limited value in assessing potential elective procedure volumes.”

As predicted with the increase in health care visits and lifting of restrictions, a rise in elective procedures from the lows of mid-April continued into May. Orthopedic and ophthalmology, specifically cataract surgery, demonstrated particularly strong recoveries, with hernia procedures picking up rapidly as well. That bodes well for many med-tech companies, including Alcon AG, Glaukus Corp, Medtronic plc, Johnson & Johnson, Globus Medical Inc., Nuvasive Inc., Zimmer Biomet Holdings Inc., and others, according to Biegelsen.

The increases seen to date validate expectations of 623 physicians surveyed by Wells Fargo Equity Research in late April/early May. The physicians reported that the percentage of procedures postponed had declined compared to the late March/early April period, 75% vs. 83%. They expected that it would take about three and a half months for procedures to return to their pre-pandemic levels.

That “supports the view that med-tech growth in the U.S. could be back to normal by Q4 2020 (assuming a second COVID-19 wave in the fall is not disruptive),” according to Biegelsen and his colleagues.

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