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RANZCR: The COVID-19 Impact on Services and Practices in Clinical Radiology and Radiation Oncology
The Royal Australian and New Zealand College of Radiologists (RANZCR) Inside News June 2020
Concerns about the spread of COVID-19 in Australia escalated rapidly from mid-March following the establishment of the National Cabinet on 13 March and the introduction of a raft of preventative and containment measures across the country.
Social distancing directives, the cancellation of elective surgery and non-essential medical services, the expansion of telehealth consultations for GPs and arrangements with private hospitals to ensure capacity to respond to the possible surge in infected patients were evidence of the calm before the expected storm.
In New Zealand, a four-level alert level system was introduced on 21 March to manage the outbreak within the country. The alert level, initially set at level two, was quickly raised to level four, putting the country into a nationwide lockdown for at least four weeks from 11:59 pm on 25 March. All imaging services deemed non-urgent were deferred.
Severe disruption to clinical radiology and radiation oncology services
Clinical radiologists have reported significant drops in patient presentations in Australia and New Zealand. In Australia, while GP consultations remained steady throughout March, the proportion of teleconsultations increased dramatically.
Telehealth consultations were introduced in mid-March initially for patients or GPs required to selfisolate or for patients considered vulnerable and were expanded in stages to all patients from the end of March.
The take-up of telehealth consultations and a corresponding downturn in test referrals raised concerns that patients were putting off seeing their doctor or not having diagnostic tests due to fears of contracting COVID-19.
Radiation oncologists have also become concerned that cancer patients are either not attending their required consultations or discontinuing their treatment after making incorrect assumptions about the safety, availability or capacity of clinical services.
Statements from the government and the Australian Medical Association (AMA) in April urging people to continue to see their GP or specialist for chronic conditions, including cancer, are reported to have resulted in an upturn in the volume of radiology referrals.
The Medicare services data showed a downturn of 14 per cent in radiology service volumes in March 2020 over the same period of the previous year after adjustment for working days.
The decline in services suggests a downturn of some 30 per cent in volume in the second half of March when social distancing and other preventive measures were introduced. The downturn of 30 per cent decline has continued throughout April 2020. In May 2020, service volumes have shown signs of improvement compared to a corresponding decline in the previous month.
Radiation oncology services have been slightly lower than expected, especially treatment services which were down 0.4 per cent, but overall up by one per cent in March 2020 over March 2019 (working day adjusted). Major treatment services which account for 98 per cent of the total radiation oncology services, have shown signs of improvement, up by around 10 per cent in early May 2020 over the same period in the previous year.
Surviving the crisis
The ability of private radiology practices to survive the COVID-19 pandemic downturn in the long term is unclear. Regulatory frameworks, together with high equipment and facility costs and a specialised workforce, place it at higher risk than other areas of health care. Any loss of community-based practices is likely to disrupt and diminish the quality and availability of health care: this would be magnified in rural and remote areas where there may be only one practice.
In Australia, as with all businesses affected by the pandemic, radiology practices have access to a range of financial support packages provided by the Federal and State/Territory Governments and other relevant entities, and it is assumed they have also been making commercial decisions based on their individual circumstances.
The AMA has put together a comprehensive summary of some of the financial support packages available. This list also includes a link to a quick reference of Government business assistance measures provided by RSM Australia that has a summary of the key measures in one place, with detail of eligibility criteria, how each stimulus package works, and action needed to be taken to access these packages.
Most clinical radiology and radiation oncology services have remained open, although some have reduced operating hours, required staff to take leave, etc.
Clinics have had to employ stricter infection control measures and patient management protocols, including social distancing, to ensure the safety of patients and staff and to minimise the risk of transmission of the COVID-19 virus.
These additional necessary precautions have added to the service delivery costs due to greater use of more expensive PPE, increased time to prepare for scans and time required to clean and disinfect equipment.
Preparing for the ‘new normal’
It is expected that service volumes will gradually improve now that social distancing and lockdown restrictions are being eased, providing greater reassurance to patients about the risks to their health from the virus. However, more COVID-19 cases are expected, and it is likely there will be continued uncertainty for many months to come. It is impossible at this time to predict how long it will take before some semblance of ‘normality’ returns to imaging practices. The longer it takes, the larger the backlog of imaging studies. In New Zealand, the deferral of non-urgent imaging services has added to the extensive pre-pandemic waiting lists for radiology services.
There is no one single prescriptive strategy for managing both the return to normal activity and the expected backlogs. Imaging providers will need to weigh the costs and benefits of resuming full services in the new ‘normal’ and there will be different considerations in different locations.
Some of the more stringent COVID-19 related measures will need to stay in place for some time with practices expected to continue to be financially impacted as a result.
Impact on radiology services
The charts below show the estimated impact of the COVID-19 crisis on trends in radiology services and outlays in Australia. Comparable data for New Zealand are not available.
The 2019/2020 financial year impact on radiology service volume is estimated to be a decline of six per cent with a corresponding decline in Medicare outlays of three per cent. When expected growth in 2019/2020 is factored into these trends, it is estimated there will be some 2.5 million fewer imaging services than were anticipated in 2019/2020 and an estimated corresponding decline of some $350 million in Medicare outlays for imaging services.
For more information visit:
www.ama.com.au/financialimplications
www.rsm.global/australia/ coronavirus-resources#business
