The Decline in Non-COVID-19 Hospitalizations Is Financially Affecting Hospitals

New data from the Kaiser Family Foundation and Epic Health Research Network show while there was a rise in the number of COVID-19 cases in fall 2020, there was a decline in non-COVID-19 hospital admissions during that time period.

“These new data provide additional information to help assess the economic impact of the COVID-19 pandemic on hospitals and insurers and also adds to our understanding of the extend to which people are continuing to delay or forgo care nearly one year into the pandemic,” Tyler Heist and colleagues wrote.

The investigators analyzed trends in total hospital admissions and then separately analyzed non-COVID-19 admissions overall and by patient region, age, and sex. They calculated actual admissions as a share of total predicted admissions in 2020 based on trends from past years.

The analysis was based on electronic health record data from Epic Health Research Network and included all inpatient hospital admission volume from Dec. 31, 2017 to Dec. 5, 2020 and involved patients who were discharge or died as of Jan. 13, 2021. The data were aggregated and pooled weekly from 34 healthcare organizations across the U.S, of which, the states represented 73% of COVID-19 cases as of Jan. 21, 2021 and 76.7% of the U.S. population.

Heist and the team found total hospital admissions dropped to 69.2% of predicted admissions during the lowest point in the year (week ending April 4) before rising and staying at or above 90% since June 2020. Since the week ending Dec. 5, 2020, total admissions were at 94.2% of what was predicted. There was a decrease in hospital admissions from March 8 to Dec. 5, 2020, which represented 8.5% of the total expected admissions for all of 2020.

As COVID-19 cases rose in November 2020, non-related hospitalizations began declining and were about 80% of predicted hospitalizations by the end of the month, suggesting people may be delaying or completely skipping care due to the pandemic. The more recent decline in non-COVID-19-related admissions has been steepest in the Midwest and West since December. Admissions in those regions were at roughly 76% of predicted levels at the end of November when cases of COVID-19 were surging in those regions.

The drop in admissions was unanticipated by health systems and could have impacted each one financially in different ways. Recent study findings demonstrated the median hospital had enough cash on hand to pay its operating expenses for 53 days in 2018, but the 25th percentile hospital only had enough cash on hand for eight days. Smaller hospitals, public hospitals, and rural hospitals are considered the most likely to face financial challenges due to revenue loss from COVID-19. Some hospitals may be at risk of closing or merging if they cannot make up for the declines in revenue caused by admission decline.