/ en Wed, 30 Apr 2025 01:00:57 -0500 Thu, 24 Apr 25 15:20:59 -0500 /news/headline/2025-04-24-study-finds-driving-covid-19-raises-crash-risk-25 <p>A <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC11978055/" target="_blank">study</a> published April 8 by the Public Library of Science’s Journal of Global Public Health found that driving while infected with COVID-19 raises the risk of an accident by 25%. The study analyzed public health and transportation data from seven states from 2020-2023. The results showed a significant association between acute COVID-19 infections and an increase in vehicle crashes.</p> Thu, 24 Apr 2025 15:20:59 -0500 Novel Coronavirus (SARS-CoV-2/COVID-19) /news/headline/2025-01-21-cdc-flu-activity-remains-high-covid-19-increasing-while-rsv-peaks <p>Respiratory illness activity remains high across the country, according to the <a href="https://www.cdc.gov/respiratory-viruses/data/index.html">latest data</a> from the Centers for Disease Control and Prevention. Seasonal flu activity remains elevated, while cases of COVID-19 are increasing and respiratory syncytial virus activity has peaked. <br> <br>The agency said emergency department visits for the flu and RSV remain high, while COVID-19 hospitalizations are low. Flu and COVID-19 vaccinations are low among adults and children, although COVID-19 vaccine coverage among older adults has increased compared to the 2023-2024 season. RSV vaccine rates remain low among adults. </p> Tue, 21 Jan 2025 15:08:20 -0600 Novel Coronavirus (SARS-CoV-2/COVID-19) /news/headline/2025-01-13-osha-ends-efforts-establish-covid-19-safety-standard <p>The Occupational Safety and Health Administration Jan. 13 <a href="https://www.federalregister.gov/public-inspection/2025-00632/occupational-exposure-to-covid-19-in-healthcare-settings">announced</a> that it terminated efforts to establish a final COVID-19 safety standard to protect workers in health care settings. The agency said it halted its efforts due to the end of the COVID-19 public health emergency, adding that any ongoing risk of COVID-19 faced by health care workers would be better addressed in an OSHA rulemaking effort that addresses infectious diseases more broadly. <br><br>The AHA previously <a href="/news/headline/2022-04-27-aha-testifies-osha-hearing-covid-19-emergency-temporary-standard">urged</a> OSHA not to finalize the rule, saying it was unnecessary and would cause confusion.</p> Mon, 13 Jan 2025 17:06:44 -0600 Novel Coronavirus (SARS-CoV-2/COVID-19) /center/living-learning-network Fri, 13 Dec 2024 15:30:00 -0600 Novel Coronavirus (SARS-CoV-2/COVID-19) /news/headline/2024-12-10-certain-prep-act-liability-protections-covid-19-countermeasures-extended-through-2029 <p>The Department of Health and Human Services Dec. 10 <a href="https://www.federalregister.gov/public-inspection/2024-29108/declaration-under-the-public-readiness-and-emergency-preparedness-act-for-medical-countermeasures">amended</a> the Public Readiness and Emergency Preparedness Act declaration for COVID-19, extending liability protections for certain COVID-19 countermeasure activities through 2029. Among other changes, the protections apply to all medical countermeasure activities provided through a federal agreement, as well as to pharmacists, pharmacy interns and pharmacy technicians who administer COVID-19 and seasonal flu vaccines and COVID-19 tests. These protections apply regardless of a federal agreement or emergency declaration.</p> Tue, 10 Dec 2024 15:05:30 -0600 Novel Coronavirus (SARS-CoV-2/COVID-19) /news/headline/2024-10-10-study-first-wave-covid-19-increased-heart-attack-stroke-risk-3-years-later <p>The National Institutes of Health Oct. 10 released results of a <a href="https://www.nih.gov/news-events/news-releases/first-wave-covid-19-increased-risk-heart-attack-stroke-three-years-later">study</a> that found that infection from COVID-19 in the first wave of the pandemic appeared to significantly increase the risk of heart attack, stroke and death for up to three years for unvaccinated individuals. When infected, those individuals had double the risk for cardiovascular events, and people with severe cases had nearly four times the risk. The study also is the first to show that increased risk of heart attack and stroke in people with severe COVID-19 may have a genetic component involving blood type. It is unclear if the risk of cardiovascular disease is or may be persistent for people who have had severe COVID-19 from 2021 to the present, NIH said.</p> Thu, 10 Oct 2024 14:21:07 -0500 Novel Coronavirus (SARS-CoV-2/COVID-19) /news/chairpersons-file/2024-10-07-chair-file-best-defense-against-flu-and-covid-19 <p>Autumn is here, and that means cooler weather and also the start of flu season.</p><p>We know the best way to prevent influenza is to get a flu vaccine. The Centers for Disease Control and Prevention recommends that everyone age 6 months or older get vaccinated, with rare exceptions, to help reduce the risk of flu and avoid serious, flu-related illnesses, hospitalization and even death. All U.S. flu vaccines will be <a href="https://www.cdc.gov/flu/vaccine-types/trivalent.html?CDC_AAref_Val=https://www.cdc.gov/flu/prevent/trivalent.htm" target="_blank" title="Types of flue vaccines site">trivalent</a> for the 2024–2025 season, protecting against three different influenza viruses.   </p><p>The AHA is once again collaborating with national partners in leading the United Against the Flu campaign to encourage the public to get vaccinated. Visit <a href="/ahia/promoting-healthy-communities/united-against-flu" target="_blank" title="AHA United Against the Flu Website">AHA.org/flu</a> for helpful information and resources, including the CDC’s flu shot finder and promotional messaging. Beginning this month through mid-March, the AHA team will create monthly social media kits with shareable posts that your teams can use to spread the word across your organization’s social channels.</p><p>Flu is not our only nemesis as fall and winter weather sets in. COVID-19 and RSV also are prevalent. Staying up to date and protected against these viruses is important. So when people get vaccinated against the flu, the <a href="https://www.cdc.gov/flu/vaccines/coadministration.html?CDC_AAref_Val=https://www.cdc.gov/flu/prevent/coadministration.htm" target="_blank" title="CDC Flu Website">CDC encourages</a> getting other vaccinations  — like the COVID-19 or RSV vaccine — if the timing is right and their health provider recommends it.</p><p>The adage that “the best defense is a good offense” aptly describes getting vaccinated. Getting the flu, COVID-19 and other recommended vaccines helps protect ourselves, our loved ones and our communities. It’s a winning strategy for staying healthy.</p> Mon, 07 Oct 2024 11:06:15 -0500 Novel Coronavirus (SARS-CoV-2/COVID-19) /guidesreports/2024-05-01-2023-costs-caring <div class="container"><div class="row"><div class="col-md-8"><h2>The Financial Stability of America’s Hospitals and Health Systems Is at Risk as the Costs of Caring Continue to Rise</h2><h3>April 2023</h3></div><div class="col-md-4"><div><a class="btn btn-wide btn-primary" href="/system/files/media/file/2023/04/Cost-of-Caring-2023-The-Financial-Stability-of-Americas-Hospitals-and-Health-Systems-Is-at-Risk.pdf" target="_blank" title="Click here to download the Massive Growth in Expenses and Rising Inflation Fuel Continued Financial Challenges for America’s Hospitals and Health Systems report PDF.">Download the Report PDF</a></div><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2023/04/Cost-of-Caring-2023-The-Financial-Stability-of-Americas-Hospitals-and-Health-Systems-Is-at-Risk-One-Pager.pdf" target="_blank" title="Click here to download the Massive Growth in Expenses and Rising Inflation Fuel Continued Financial Challenges for America’s Hospitals and Health Systems one-page overview PDF.">Download One-Page Overview PDF</a></div></div></div><div class="row"><div class="col-md-8"><p>After three years of unprecedented challenges and caring for millions of patients, including over 6 million COVID-19 patients, America’s hospitals and health systems are facing a new existential challenge — sustained and significant increases in the costs required to care for patients and communities putting their financial stability at risk.</p><p><strong>A confluence of several factors from historic inflation driving up the cost of medical supplies and equipment, to critical workforce shortages forcing hospitals to rely heavily on more expensive contract labor, led to 2022 being the most financially challenging year for hospitals since the pandemic began. Moreover, sustained demand for hospital care with patients coming to the hospital sicker and staying longer has exacerbated these challenges.</strong></p><p id="figure1"><img src="/sites/default/files/inline-images/Figure-1-Cumulative-Hospital-Expense-Growth-Is-More-Than-Double.png" data-entity-uuid="9a61fc19-9117-48c7-836b-f68e4825502a" data-entity-type="file" alt="Figure 1. Cumulative Hospital Expense Growth Is More Than Double the Cumulative Increases in Medicare IPPS Reimbursement, 2019–2022. Hospital Expense Growth: 17.5%. Medicare IPPS Reimbursement: 7.5%. Source: FY 2020–2022 IPPS Final Rule." width="50%" height="50%" class="align-right">These challenges have been particularly financially devastating for hospitals and health systems because they come on top of two years of battling the COVID-19 pandemic. Hospitals and health systems have been on the front lines delivering care to patients, acting as de facto public health agencies, and incurring significant increases in costs from a range of inputs, including labor, drugs, supplies and administrative activities associated with burdensome billing and insurance tasks. In addition, as many individuals deferred care during the pandemic, hospitals saw a dramatic rise in patient acuity. At the same time, workforce shortages across the health care continuum have left hospitals unable to discharge patients to other care settings (e.g., skilled nursing facilities) creating patient bottlenecks with hospital beds occupied without any reimbursement.</p><p>These unfortunate realities have resulted in a 17.5% increase in overall hospital expenses between 2019 and 2022, according to data from Syntellis Performance Solutions, a health care data and consulting firm. Further exacerbating the situation is the fact that the staggering expense increases have been met with woefully inadequate increases in government reimbursement. Specifically, hospital expense increases between 2019 and 2022 are more than double the increases in Medicare reimbursement for inpatient care during that same time (See <a href="#figure1">Figure 1</a>). Because of this, margins have remained consistently negative, according to Kaufman Hall’s Operating Margin Index throughout 2022 (See <a href="#figure2">Figure 2</a>). In fact, over half of hospitals ended 2022 operating at a financial loss — an unsustainable situation for any organization in any sector, let alone hospitals. So far, that trend has continued into 2023 with negative median operating margins in January and February. According to a recent analysis, the first quarter of 2023 saw the highest number of bond defaults among hospitals in over a decade.<a href="#fn1"><sup>1</sup></a> This also is one of the primary reasons that some hospitals, especially rural hospitals, have been forced to close their doors. Between 2010 and 2022, 143 rural hospitals closed — 19 of which occurred in 2020 alone.<a href="#fn2"><sup>2</sup></a><sup>,</sup><a href="#fn3"><sup>3</sup></a> Finally, despite these cost increases, hospital prices have grown modestly. In fact, in 2022, growth in general inflation (8%) was more than double the growth in hospital prices (2.9%).</p><p>This report will examine the magnitude of cost increases over the last year, and the impact these increases have had on the financial stability of the hospital field.</p><p id="figure2"><img src="/sites/default/files/inline-images/Figure-2-Kaufman-Hall-Operating-Index-YTD-by-Month.png" data-entity-uuid="55165081-b4eb-4e04-8a1c-50d909ff2763" data-entity-type="file" alt="Figure 2. Kaufman Hall Operating Index YTD by Month. January 2022: -3.4%. February 2022: -3.6%. March 2022: -2.1%. April 2022: -2.4%. May 2022: -1.9%. June 2022: -0.7%. July 2022: -1.1%. August 2022: -0.6%. September 2022: -0.4%. October 2022: -0.6%. November 2022: -0.6%. December 2022: -0.6%. January 2023: -0.8%. February 2023: -1.1%." width="1288" height="592"></p><h2>Labor Expenses</h2><div class="row"><div class="col-md-5"><p>Beginning in early 2022, the hospital field's existing workforce shortages were exacerbated with increased patient demand for hospital care due to a combination of sustained COVID-19 surges, a new virulent disease affecting primarily pediatric patients called respiratory syncytial virus (RSV), and deferred care from the early days of the pandemic. To quickly meet this demand, hospitals were increasingly forced to turn to health care staffing agencies to fill necessary gaps, especially for bedside nursing and other critical allied health professionals such as respiratory and imaging technicians.</p></div><div class="col-md-7"><blockquote><h4>Labor has been really the primary driver of our increased expenses. We've seen a 17% increase in our nursing costs, for instance, during COVID, mainly because of many nurses leaving the field and the workforce. <em>— President and CEO of a health system in the Northeast</em></h4></blockquote></div></div><p>A recent <a href="https://www.syntellis.com/sites/default/files/2023-03/AHA Q2_Feb 2023.pdf" target="_blank" title="Syntellis Hospital Vitals: Financial and Operational Trends — Workforce Pressures Take Their Toll in 2022">report by Syntellis Performance Solutions</a> found that full-time equivalents (FTEs) for hospital contract employees jumped 138.5%. This reliance on temporary contract labor came at a significant expense to hospitals, as health care staffing agencies took advantage of the situation and increased their rates to record high levels. The same report found that the rate hospitals were charged for contract employees increased 56.8% in 2022 compared to pre-pandemic levels. It is for this reason that hospitals’ contract labor expenses increased a staggering 257.9% in 2022 relative to 2019 levels (See <a href="#figure3">Figure 3</a>).</p><p advantage contract figure firms hospital id="figure3><img alt=" labor of shortages take workforce> </p><p>The explosive growth in contract labor expenses in large part fueled the 20.8% increase in overall hospital labor expenses during the same time period. Even after accounting for the fact that patient acuity (as measured by the case mix index) has increased during this period, labor expenses per patient increased 24.7%. <strong>These increases are particularly challenging, because labor on average accounts for about half of a hospital's budget.</strong></p><h2>Non-Labor Expenses</h2><p>The historic rise in inflation has been particularly challenging for hospitals and health systems as it has sparked a significant increase in non-labor expenses. As prices for essential goods such as food and clothing have seen significant price growth, so too have the prices for essential goods for hospitals such as drugs and medical supplies.<a href="#fn4"><sup>4</sup></a> A report by Kaufman Hall estimated that non-labor expenses alone would result in a one-year expense increase of $49 billion for hospitals and health systems.<a href="#fn5"><sup>5</sup></a><sup>,</sup><a href="#fn6"><sup>6</sup></a> In fact, since 2019, non-labor expenses have increased 16.6% on a per patient basis. Below, we focus on three areas of non-labor expenses that have seen tremendous cost growth:</p><ol type="I"><li><a href="#drugexpenses">Drug Expenses</a></li><li><a href="#medicalsupplies">Medical Supplies and Equipment Expenses</a></li><li><a href="#othernonlaborexpenses">Other Non-Labor Expenses such as Purchased Services Expenses</a></li></ol><h3 id="drugexpenses">I. Drug Expenses</h3><p>As hospitals and health systems faced an increasingly challenging environment due to pandemic surges as well as workforce shortages, drug companies took the opportunity to significantly raise the prices of existing drugs as well as introduce new drugs at record prices.<a href="#fn7"><sup>7</sup></a> High drug prices affect both patients directly and hospitals, especially when purchasing provider-administered drugs. In fact, for the first time in history, the median price of a new drug exceeded $200,000 — a staggering figure that implies a double-digit year-over-year price growth (See <a href="#figure4">Figure 4</a>).<a href="#fn8"><sup>8</sup></a><sup>,</sup><a href="#fn9"><sup>9</sup></a> To further contextualize these launch prices, the median new drug launch price is more than quadruple the average price of a new car and more than triple the median annual household salary ($70,784) in the United States, illustrating how unaffordable these drugs are for both providers and their patients.<a href="#fn10"><sup>10</sup></a></p><p id="figure4"><img src="/sites/default/files/inline-images/Figure-4-Launch-Prices-of-Novel-Drugs-Approved-by-FDA-Since-July-2022.png" data-entity-uuid="f7940fa1-700f-4c22-b888-d69553c830fd" data-entity-type="file" alt="Figure 4. Launch Prices of Novel Drugs Approved by FDA Since July 2022. Hemgenix: $3,500,000. Skysone: $3,000,000. Zynteglo: $2,800,000. Xenpozyme: $780,000. Rezlidhia: $386,400. Tecvayli: $375,00. Krazati: $237,000. Lylgobi: $210,006. Tzield: $193,900. Lunsumlo: $180,000. Relyvrio: $158,000. Elahere: $130,500. Sotyktu: $75,000. Briumvi: $59,000. Sunlenca: $42,250. Imjudo: $39,000. Rolvedon: $27,000. $222,003: Median price of new drug. $70,784: Median household income. $45,094: Average cost of new car. Source: Reuters survey of companies that received FDA approval for new drugs in the second half of 2022. Each bottle represents $100,000 in cost. Median household income from Census Bureau for 2021. Average price of new care from Kelley Blue Book new-vehicle average transaction price in September 2022." width="1292" height="792"></p><p>In addition, a report by the Assistant Secretary for Planning & Evaluation (ASPE) at the Department of Health and Human Services (HHS) found that drug companies increased drug prices for 1,216 drugs — many used to treat chronic conditions like cancer and rheumatoid arthritis — by more than the rate of inflation, which was 8.5% between 2021 and 2022. In fact, the average price increase for these drugs was 31.6%, with some drugs experiencing price increases as much as 500%.<a href="#fn11"><sup>11</sup></a> Moreover, recent drug shortages, specifically for certain drugs used to treat cancer, have also fueled further expense growth. It is estimated that drug shortages alone cost hospitals nearly $360 million a year.<a href="#fn12"><sup>12</sup></a></p><div class="row"><div class="col-md-4"><p>Therefore, it is no surprise, that as hospitals face the reality of operating on negative margins, drug companies are enjoying record revenues and profits. For example, some drug companies are experiencing over 200% revenue growth.<a href="#fn13"><sup>13</sup></a></p></div><div class="col-md-8"><blockquote><h4>"In the last year, we've seen double digit increases in pharmaceuticals and medical supplies. Our utility costs are up and certainly our labor costs are up." <em>— CEO of a health system in the South</em></h4></blockquote></div></div><p>For these reasons, high drug prices have been a primary driver of skyrocketing drug costs for hospitals. According to data from Syntellis Performance Solutions, hospital drug expenses per patient have increased 19.7% between 2019 and 2022. Even after accounting for the fact that patients were on average sicker (as measured by the case mix index) in 2022 than in 2019, drug expenses per patient were up over 18%. This suggests that the growth in hospital drug expenses is not primarily due to sicker patients requiring more drugs, rather it is a result of drug companies’ deliberate decisions to increase the prices of their products.</p><h3 id="medicalsupplies">II. Medical Supplies and Equipment</h3><div class="row"><div class="col-md-6"><p>While the demand for patient care has risen, so has the need for medical supplies necessary to deliver patient care and personal protective equipment (PPE) necessary to ensure the safety of both hospital staff and patients. Hospitals rely on a global supply chain for access to these supplies and equipment, and entities across the supply chain have experienced inflationary cost increases. Ongoing supply chain disruptions have led to higher manufacturing costs, packaging costs, and shipping costs, which translate into higher prices for hospitals.<a href="#fn14"><sup>14</sup></a> In fact, the National Academies recently released a report highlighting the ongoing challenges that supply chain disruptions place on providers needing to access medical supplies.<a href="#fn15"><sup>15</sup></a></p></div><div class="col-md-6"><blockquote><h4>"But in other industries like we see in our area, manufacturing, retail, hospitality, you can decide not to fill that order. You can decide to shut your restaurant down for a day. We can't do that in health care." <em>— President and CEO of a health system in the Midwest</em></h4></blockquote></div></div><p>As a direct result, hospital supply expenses per patient increased 18.5% between 2019 and 2022, outpacing increases in inflation by nearly 30%. Particularly alarming is the growth in supply costs needed for care in the emergency department — often the first level of care provided in the hospital. Hospital expenses for emergency services supplies experienced a nearly 33% increase between 2019 and 2022. These include equipment such as ventilators, respirators and other sophisticated equipment that are critical to keeping patients alive in the emergency department. As patient acuity has increased dramatically during this period, the need for these equipment to care for more complex patients also has increased.<a href="#fn16"><sup>16</sup></a> More specifically, as patients stay in the hospital longer requiring more intensive care, the amount of supplies and the type of supplies required to care for those patients become more expensive.<a href="#fn17"><sup>17</sup></a></p><h3 id="othernonlaborexpenses">III. Other Non-Labor Expenses</h3><p id="figure5"><img src="/sites/default/files/inline-images/Figure-5-Percent-Change-in-Selected-Expenses-Per-Patient-between-2019-and-2022.png" data-entity-uuid="7e28c68b-ee01-4134-b00f-d6ff74896077" data-entity-type="file" alt="Figure 5. % Change in Selected Expenses Per Patient between 2019 and 2022. Laboratory Services: 27.1%. Emergency Services: 31.9%." width="50%" height="50%" class="align-right">In addition to hospitals’ costs for drugs and medical supplies and equipment, costs for other areas that help support patient care such as purchased service expenses also have risen precipitously. This, in part, has driven clinical costs higher, making clinical services such as emergency and lab services more expensive to administer.</p><p>Purchased service expenses, which are expenses hospitals incur to create operational efficiencies such as information technology (IT), environmental services and facilities, and food and nutrition services increased 18% between 2019 and 2022. With increased patient demand and inflationary pressures, hospitals have been forced to incur additional purchased service costs as they renew and renegotiate their purchased service contracts. For example, as the cost of food has gone up over the last year, hospitals’ food services costs have grown. Specifically, food and nutrition service expenses per patient grew over 15% between 2019 and 2022.</p><p>Hospitals also have incurred increased costs in particular clinical areas. This is due to a combination of increased patient demand after many patients delayed or avoided care during the pandemic and inflationary cost growth for supplies and equipment needed to provide care. Specifically, compared to 2019 levels, laboratory service expenses per patient were up 27.1% in 2022 and emergency service expenses per patient were up 31.9%.</p><p>With hospitals bearing cost growth in many areas, they have been forced to cut costs elsewhere to stay financially afloat, and in the case of many rural hospitals, simply keep the doors open.</p><h2>Expenses from Burdensome Insurer Policies</h2><p>Notwithstanding labor and non-labor expense increases, commercial health insurer policies like unnecessary prior authorization requirements and improper claim denials continue to add significant burden for hospital staff — diverting staff time from caring for patients and contributing to clinician burnout. These practices add substantial administrative costs to the health care system by slowing down the provision of care, requiring providers to purchase additional IT tools to manage insurer requirements and necessitating the hiring of additional staff solely to manage administrative paperwork.</p><p>Administrative costs constitute as much as 31% of total health care spending — 82% of which can be attributed to billing and insurance.<a href="#fn18"><sup>18</sup></a> In a <a href="/infographics/2022-11-01-survey-commercial-health-insurance-practices-delay-care-increase-costs-infographic">recent survey fielded by the AHA</a>, 84% of hospitals reported the cost of complying with insurer policies is increasing, with 95% reporting increases in time spent seeking prior authorization approval.<a href="#fn19"><sup>19</sup></a> Even though more than half of all prior authorization denials are overturned, commercial health insurers continue to flood hospitals with prior authorization denials to the detriment of both patients and providers. This is especially egregious when prior authorization is required for widely available lifesaving medications with clear clinical indications for use, such as insulin, where the service or treatment protocol are neither new nor have a history of unwarranted variation in utilization. The AHA report also found that 50% of hospitals and health systems have more than $100 million in accounts receivables for claims that are older than six months, which impact hospitals’ cash flow and ability to weather the avalanche of cost increases they have faced. Shockingly, seven in 10 hospitals reported having an outstanding claim from 2016 or older. In addition, 35% of hospitals reported $50 million or more in foregone payments because of denied claims.</p><p id="figure6"><img src="/sites/default/files/inline-images/Figure-6-Reported-Change-in-Insurer-Required-Administrative-Tasks-for-Medical-Services.png" data-entity-uuid="f9d044f0-06a9-496f-ad07-f9354e07cb20" data-entity-type="file" alt="Figure 6. Reported Change in Insurer-Required Adminsitrative Tasks for Medical Services. Increased: 74%. No Change: 13%. Decreased: 2%. Didn't Know: 11%." width="50%" height="50%" class="align-right">A recent survey conducted by Morning Consult on behalf of the AHA found that nearly three-fourths of nurses reported increases in insurer-required administrative tasks for medical services over the last five years. Nearly 9 in 10 nurses reported insurer administrative burden had negatively impacted patient clinical outcomes (See <a href="#figure6">Figure 6</a> on next page).</p><p>Confronted by ever-growing costs, hospitals have been limited in how they can respond to the administrative burden levied by commercial health plans. Over the course of the last several years many hospitals, looking for operational efficiencies to combat rising costs, have been driven to trim down their administrative workforce.<a href="#fn20"><sup>20</sup></a> However, with a narrowing menu of options for hospitals to choose from in responding to insurer administrative expenses, 78% of hospitals report their experience with commercial health insurers is getting worse.</p><h2>Outlook for the Rest of 2023</h2><p>As the public health emergency comes to end on May 11, a number of important waivers and flexibilities also will come to an end immediately, or will sunset at the end of this year.<a href="#fn21"><sup>21</sup></a> The downstream effects of this will be wide-ranging as hospitals will be faced with a set of additional challenges. For example, with the end of the public health emergency, the continuous Medicaid enrollment provision will no longer be in effect starting April 1 meaning that states can begin dis-enrolling current Medicaid beneficiaries from the program that do not meet the state’s Medicaid enrollment criteria. According to the Kaiser Family Foundation, as many as 14 million current Medicaid beneficiaries could lose coverage over the next year.<a href="#fn22"><sup>22</sup></a> Undoubtedly, these coverage losses will drive higher rates of uninsured and underinsured individuals, raising hospitals’ uncompensated care costs and potentially negatively impacting disproportionate share payments as well as 340B program eligibility, both of which allow hospitals to offset some of the expense increases as well as furnish programs and services critical to patients. Further, the ending of regulatory relief through the 20% Medicare inpatient prospective payment system add-on payment for beneficiaries diagnosed with COVID-19 to offset the cost of highly complex care for these patients, will certainly add financial pressure to an already fragile situation for hospitals and health systems.</p><p>The combination of the impacts on hospitals of the ending public health emergency as well as continued expense growth has created an uncertain future for hospitals and health systems. A study by McKinsey on the impact of inflation and other cost pressures for the health care system projected that there would be $98 billion in additional costs between 2022 and 2023 alone, representing an astounding $248 billion increase in costs relative to 2019.<a href="#fn23"><sup>23</sup></a> In fact, their projections suggest that non-labor costs alone could increase by $112 billion by 2027. Therefore, it is no surprise, that credit rating agencies have a negative outlook for the field. For example, Moody’s has projected a negative outlook for the hospital field for 2023 due in large part to inflationary cost pressures and persisting workforce challenges.<a href="#fn24"><sup>24</sup></a></p><h2>Conclusion</h2><p>Hospitals and health systems — and their teams — are committed to providing high-quality care to all patients in every community. This steadfast commitment to caring and advancing health has never been more apparent than during the last three years battling the greatest public health crisis in a century.</p><p>However, the costs of delivering on this commitment to care have grown tremendously. As the data in this report show, 2022 brought an unprecedented set of challenges for hospitals and health systems, which has left the field in a financially unsustainable situation. These challenges are continuing in 2023.</p><p>To address these challenges and ensure hospitals have the ability to continue taking care of the sick and injured, as well as keeping people and communities healthy, congressional support and action are necessary. Among other actions, Congress should:</p><ul><li>enact policies that bolster hospitals and health systems’ efforts to support today’s workforce and ensure a future pipeline of professionals to mitigate longstanding workforce challenges and meet the nation’s increasing demands for care;</li><li>reject efforts to cut any Medicare or Medicaid payments to hospitals and health systems. Medicare and Medicaid significantly underpay the costs of providing care and further cuts could reduce access to care for patients and communities;</li><li>establish a temporary per diem payment to address a backlog in hospital patient discharges due to workforce shortages;</li><li>urge the Centers for Medicare & Medicaid Services to use its “special exceptions and adjustments” authority to make a retrospective adjustment to account for the difference between the market basket update that was implemented for fiscal year (FY) 2022 and what the market basket is currently projected to be for FY 2022; and</li><li>create a special statutory designation and provide additional support for metropolitan anchor hospitals that serve historically marginalized communities.</li></ul><p>As the hospital field maintains its commitment to care in the face of significant challenges, policymakers must step up and help protect the health and well-being of our nation by ensuring America has strong hospitals and health systems.</p><h2>Sources</h2><ol><li id="fn1"><a href="www.beckershospitalreview.com/finance/hospitals-see-most-1st-quarter-defaults-since-2011.html#:~:text=Bonds%20of%20eight%20hospitals%20lapsed,2022%2C%20according%20to%20the%20report." target="_blank">www.beckershospitalreview.com/finance/hospitals-see-most-1st-quarter-defaults-since-2011.html#:~:text=Bonds%20of%20eight%20hospitals%20lapsed,2022%2C%20according%20to%20the%20report.</a></li><li id="fn2"><a href="/2022-09-07-rural-hospital-closures-threaten-access" target="_blank">/2022-09-07-rural-hospital-closures-threaten-access</a></li><li id="fn3"><a href="https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/" target="_blank">https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/</a></li><li id="fn4"><a href="https://www.mckinsey.com/industries/healthcare/our-insights/the-gathering-storm-the-transformative-impact-of-inflation-on-the-healthcare-sector" target="_blank">https://www.mckinsey.com/industries/healthcare/our-insights/the-gathering-storm-the-transformative-impact-of-inflation-on-the-healthcare-sector</a></li><li id="fn5"><a href="/guidesreports/2022-09-15-current-state-hospital-finances-fall-2022-update" target="_blank">/guidesreports/2022-09-15-current-state-hospital-finances-fall-2022-update</a></li><li id="fn6"><a href="/system/files/media/file/2022/09/The-Current-State-of-Hospital-Finances-Fall-2022-Update-KaufmanHall.pdf" target="_blank">/system/files/media/file/2022/09/The-Current-State-of-Hospital-Finances-Fall-2022-Update-KaufmanHall.pdf</a></li><li id="fn7"><a href="/fact-sheets/2022-12-05-workforce-shortages-delay-patient-discharges-and-exacerbate-providers-severe-financial-challenges" target="_blank">/fact-sheets/2022-12-05-workforce-shortages-delay-patient-discharges-and-exacerbate-providers-severe-financial-challenges</a></li><li id="fn8"><a href="https://www.reuters.com/business/healthcare-pharmaceuticals/us-new-drug-price-exceeds-200000-median-2022-2023-01-05/#:~:text=The%20median%20annual%20price%20of,2022%2C%20the%20median%20was%20%24222%2C003." target="_blank">https://www.reuters.com/business/healthcare-pharmaceuticals/us-new-drug-price-exceeds-200000-median-2022-2023-01-05/#:~:text=The%20median%20annual%20price%20of,2022%2C%20the%20median%20was%20%24222%2C003.</a></li><li id="fn9"><a href="https://jamanetwork.com/journals/jama/article-abstract/2792986" target="_blank">https://jamanetwork.com/journals/jama/article-abstract/2792986</a></li><li id="fn10"><a href="https://www.census.gov/library/publications/2022/demo/p60-276.html#:~:text=Highlights,and%20Table%20A%2D1)." target="_blank">https://www.census.gov/library/publications/2022/demo/p60-276.html#:~:text=Highlights,and%20Table%20A%2D1).</a></li><li id="fn11"><a href="https://aspe.hhs.gov/index.php/reports/prescription-drug-price-increases" target="_blank">https://aspe.hhs.gov/index.php/reports/prescription-drug-price-increases</a></li><li id="fn12"><a href="https://www.axios.com/2023/03/21/drug-shortages-upend-cancer-treatments" target="_blank">https://www.axios.com/2023/03/21/drug-shortages-upend-cancer-treatments</a></li><li id="fn13"><a href="https://newsroom.vizientinc.com/en-US/releases/new-vizient-survey-finds-drug-shortages-cost-hospitals-just-under-360m-annually-in-labor-expenses" target="_blank">https://newsroom.vizientinc.com/en-US/releases/new-vizient-survey-finds-drug-shortages-cost-hospitals-just-under-360m-annually-in-labor-expenses</a></li><li href="https://www.beckershospitalreview.com/hospital-management-administration/supply-chain-issues-are-here-to-stay-health-leaders-share-predictions-strategies.html" target="_blank"><a href="https://www.beckershospitalreview.com/hospital-management-administration/supply-chain-issues-are-here-to-stay-health-leaders-share-predictions-strategies.html" target="_blank">https://www.beckershospitalreview.com/hospital-management-administration/supply-chain-issues-are-here-to-stay-health-leaders-share-predictions-strategies.html</a></li><li id="fn15"><a href="https://nap.nationalacademies.org/catalog/26420/building-resilience-into-the-nations-medical-product-supply-chains" target="_blank">https://nap.nationalacademies.org/catalog/26420/building-resilience-into-the-nations-medical-product-supply-chains</a></li><li id="fn16"><a href="/system/files/media/file/2022/08/pandemic-driven-deferred-care-has-led-to-increased-patient-acuity-in-americas-hospitals.pdf" target="_blank">/system/files/media/file/2022/08/pandemic-driven-deferred-care-has-led-to-increased-patient-acuity-in-americas-hospitals.pdf</a></li><li id="fn17"><a href="https://www.healthleadersmedia.com/finance/3-questions-kaufman-halls-erik-swanson-healthcare-finance-2023" target="_blank">https://www.healthleadersmedia.com/finance/3-questions-kaufman-halls-erik-swanson-healthcare-finance-2023</a></li><li id="fn18"><a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2022.00241" target="_blank">https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2022.00241</a></li><li id="fn19"><a href="/infographics/2022-11-01-survey-commercial-health-insurance-practices-delay-care-increase-costs-infographic" target="_blank">/infographics/2022-11-01-survey-commercial-health-insurance-practices-delay-care-increase-costs-infographic</a></li><li id="fn20"><a href="https://www.beckershospitalreview.com/strategy/penn-medicine-eliminates-administrative-jobs-in-cost-cutting-move" target="_blank">https://www.beckershospitalreview.com/strategy/penn-medicine-eliminates-administrative-jobs-in-cost-cutting-move</a></li><li id="fn21"><a href="/special-bulletin/2023-02-07-public-health-emergency-end-may-11" target="_blank">/special-bulletin/2023-02-07-public-health-emergency-end-may-11</a></li><li id="fn22"><a href="https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/" target="_blank">https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/</a></li><li id="fn23"><a href="https://www.mckinsey.com/industries/healthcare/our-insights/the-gathering-storm-the-transformative-impact-of-inflation-on-the-healthcare-sector" target="_blank">https://www.mckinsey.com/industries/healthcare/our-insights/the-gathering-storm-the-transformative-impact-of-inflation-on-the-healthcare-sector</a></li><li id="fn24"><a href="https://www.moodys.com/research/Moodys-2021-outlook-for-US-not-for-profit-and-public--PBM_1256579" target="_blank">https://www.moodys.com/research/Moodys-2021-outlook-for-US-not-for-profit-and-public--PBM_1256579</a></li></ol></div><div class="col-md-4"><div><a class="btn btn-wide btn-primary" href="/system/files/media/file/2023/04/Cost-of-Caring-Toolkit.docx" target="_blank" title="Click here to download the Cost of Caring Social Media Content Toolkit DOCX.">Download the Social Media Content Toolkit</a></div><div><a class="btn btn-wide btn-primary" href="/press-releases/2023-04-20-new-aha-report-finds-financial-challenges-mount-hospitals-health-systems-putting-access-care-risk" target="_blank" title="Click here to see the New AHA Report Finds Financial Challenges Mount for Hospitals & Health Systems Putting Access to Care at Risk press release.">View the Press Release</a></div><hr><p><a href="/system/files/media/file/2023/04/Cost-of-Caring-2023-The-Financial-Stability-of-Americas-Hospitals-and-Health-Systems-Is-at-Risk.pdf" target="_blank" title="Click here to download The Financial Stability of America’s Hospitals and Health Systems Is at Risk as the Costs of Caring Continue to Rise PDF."><img src="/sites/default/files/inline-images/Page-1-Cost-of-Caring-2023-The-Financial-Stability-of-Americas-Hospitals-and-Health-Systems-Is-at-Risk.png" data-entity-uuid="d9830e92-be7e-4c72-98e3-d183d3e07ade" data-entity-type="file" alt="The Financial Stability of America’s Hospitals and Health Systems Is at Risk as the Costs of Caring Continue to Rise page 1." width="695" height="900"></a></p><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/guidesreports/2023-04-20-2022-costs-caring" target="_blank">View the 2022 Cost of Caring Report</a></div><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/guidesreports/2021-10-25-2021-cost-caring" target="_blank">View the 2021 Cost of Caring Report</a></div></div></div></div> Wed, 01 May 2024 08:59:39 -0500 Novel Coronavirus (SARS-CoV-2/COVID-19) /guidesreports/2024-04-04-assessing-impact-covid-19-rural-hospitals <div class="container"><div class="row"><div class="col-md-8"><div class="panel module-typeC"><div class="panel-heading"><h2 class="panel-title"><span>Key Findings</span></h2></div><div class="panel-body"><ul class="red"><li class="red">Approximately half (48%) of rural hospitals consistently experienced negative operating margins from patient services prior to and during the COVID-19 pandemic.</li><li class="red">A small minority (12%) of rural hospitals consistently experienced positive operating margins prior to and during the COVID-19 pandemic.</li><li class="red">The COVID-19 provider relief funds benefited all rural hospitals, however rural hospitals with negative total margins had the greatest benefit, with overall increases to profitability.</li><li class="red">In 2021, COVID-19 provider relief funds masked long-standing financial challenges experienced by many rural hospitals.</li><li class="red">System membership may provide benefits to rural hospitals in terms of supporting operations and navigating regulatory and financial challenges during the COVID-19 pandemic.</li></ul></div></div> ul.red { list-style: none; } ul.red li.red::before { content: "\2022"; color: #9d2235; font-weight: bold; display: inline-block; width: 1em; margin-left: -1em; } <h2>Purpose</h2><p>The purpose of this research is to examine the impact of the COVID-19 pandemic on rural hospital financial performance. The results of this study will provide rural hospital leaders a better understanding of the impact of the COVID-19 pandemic on rural hospital operational and financial performance. Results will also assist policy makers seeking to understand the impact of provider relief funds on rural hospital financial performance.</p><h2>Background</h2><p>The COVID-19 pandemic created financial and operating challenges for hospitals across the country. These challenges may have been particularly severe for rural hospitals since, prior to COVID-19, rural hospitals were already struggling with shrinking margins, declining volumes, workforce challenges and other barriers to providing care. The COVID-19 pandemic caused a rapid series of changes for rural hospitals, with the potential to cause drastic swings in the ways rural hospitals provide care to their communities. Moreover, the effects of these changes are likely to shift over time since the intensity of revenue pressures (like limits on elective surgeries) and expense pressures (like unusually high staffing costs) changed throughout the course of the pandemic. The availability of financial aid varied throughout the course of the pandemic as well. Most provider relief funds and other financial support were available to hospitals between 2020 and 2021 and have not continued beyond that time. COVID-19’s effects are also unlikely uniform given the variation in rural hospitals’ revenue sources (i.e., the degree to which they depend on revenues from patient care, investment returns or special COVID-19 pandemic funding), variation in prior financial performance and other determinants. Rural hospital financial performance is multifaceted and is influenced by both hospital and community characteristics. Hospital characteristics such as ownership, size and system affiliation may be important determinants of financial performance. System membership in particular may benefit rural hospitals in a variety of ways, by supporting rural hospitals in maintaining efficient operations and by helping rural hospitals navigate the particular regulatory and financial challenges that COVID-19 posed.</p><h2>Data and Methods</h2><p>This study used hospital-level data from 2017 to 2022. Data were obtained from the Medicare Hospital Cost Reports, the AHA Annual Survey, the Area Health Resource File, the Center for Disease Control and Prevention and the Kaiser Family Foundation. Data were merged using a unique hospital provider ID and a year identifier. Hospitals differed in the annual start and end dates of their reporting years. Some hospitals’ start and end dates aligned with the calendar year while other hospitals used a different fiscal year. We recorded hospital financial observations based on cost reporting year of the hospital’s data. For instance, hospital data appearing on the 2020 cost report file were recorded as 2020, even if the hospital’s reporting year ran from March 1, 2020, to Feb. 28, 2021.</p><p>Rural hospitals were defined as acute care general hospitals located in non-metropolitan counties (micropolitan and non-care-based counties) and Eligible Census Tracts in Metropolitan Counties. The sample consisted of 2,246 rural hospitals (12,256 rural hospital years). Rural hospitals with profitability margins in less than the 1st percentile and greater than the 99th percentile were excluded from the analysis and rural hospitals with reporting periods of less than 360 days were also excluded from the analysis.</p><p>We identified four measures of operating margin which differed according to the revenue types included in each. These measures were:</p><ul><li>Patient care margin, which only includes revenues from patient care activities.</li><li>Operating margin, which includes revenue from patient care activities as well as other operating revenue (e.g., gift shop, cafeteria, tuition).</li><li>Total margin, which includes all operating sources of revenue plus investment returns, donations and non-COVID-19 related government appropriations.</li><li>Total margin with public health emergency (PHE) funds, includes all sources of revenue and PHE funds.</li></ul><p>To understand the variation in hospitals’ financial performance, we created three groups of hospitals based on their financial strength as measured by patient care margins from 2017- 2022. These groups include:</p><ul><li>Hospitals with positive margins in each year of the study period.</li><li>Hospitals with negative margins in each year of the study period.</li><li>Hospitals with a mix of positive and negative margins during the study period.</li></ul><h2>Results</h2><h3>Profitability Trends from 2017-2022: 2021 Was a Positive Outlier for Most Rural Hospitals</h3><p><img src="/sites/default/files/inline-images/Figure-1-Rural-Hospital-Profitability.png" data-entity-uuid="3fdebece-d832-4cd6-8969-7eb6952c7b72" data-entity-type="file" alt="Figure 1: Rural Hospital Profitable." width="732" height="502" class="align-left"></p><p>Figure 1 shows mean hospital margins for the three years prior to the COVID-19 pandemic through 2022. Prior to the pandemic, the cost of providing care to rural patients exceeded reimbursement rates, resulting in negative patient care margins. However, rural hospitals lost money on patient care, but relied on other sources of income, including donations, non-COVID-19 government appropriations, and revenue from cafeteria and gift shop sales, to earn small, positive total margins on average. In 2020, hospital total, operating and patient care margins declined. Hospital financial margins in 2021 saw increases in all measures. However, these were followed by steep declines in 2022 as all margin measures fell below pre-pandemic levels.</p><p>In addition to the variation from year to year, hospital financial performance showed notable variation from the average levels shown in Figure 1. To investigate this variation, we divided hospitals into three groups based on their patient care margins over the course of the study period. These groups included a “positive margin” group of hospitals whose patient care margins were positive in each year of the study period, a “negative margin” group of hospitals whose patient care margins were negative in each year of the study period, and a “mixed” group whose patient care margins were positive in some years and negative in others. Notably, 48% of the organizations in our sample (1,078 hospitals) had negative margins from patient care every year. Forty-percent of the sample (907 hospitals) had a mix of positive and negative margins throughout the study period. Only 12% of our sample of rural hospitals (261 organizations) had positive patient care margins each year of the sample.</p><p><img src="/sites/default/files/inline-images/Figure-2-Patient-Care-Margin_0.png" data-entity-uuid="5077e501-7cfb-45dc-8b57-f8fa8f08143c" data-entity-type="file" alt="Figure 2: Patient Care Margin." width="1047" height="735" class="align-left"></p><p>Figure 2 presents the performance of each group of hospitals by year. The operating margins from patient services for both the persistent negative margin group and the group with mixed performance were consistently negative. Interestingly, even though the group with mixed performance contained hospitals with positive margins in some years and negative margins in others. The frequency and magnitude of the negative margins in this group were large enough to give the group as a whole a negative average operating margin from patient services in all years of the sample. A small number of rural hospitals experienced positive operating margins from patient services.</p><h3>Characteristics of Hospitals with Consistent Positive Margins from Patient Care</h3><p>Our analysis identified several ways that hospitals with persistent positive margins differed from hospitals in the mixed and negative margin groups (Table 1). Hospitals in the positive margin group had a smaller share of discharges coming from Medicare and Medicaid patients. Hospitals in the positive margin group were also more likely to be affiliated with systems — 83% of hospitals in the positive margin group were system members compared to 60% and 37% of the mixed and negative margin groups respectively. Finally, positive margin hospitals were more likely to be for-profit, have a larger average bed size, have lower average length of stay and have lower operating expenses.</p> h2 { color: #003087; } h3 { color: #9d2235; } table, th, td { border: black 1px solid; } th { empty-cells: hide; } td.cellcenter { text-align: center; vertical-align: bottom; } <h3>Table 1: Rural Hospital Characteristics by Financial Performance Group</h3><table><thead><tr><th> </th><th>Always negative patient care margins</th><th>Mixed patient care margins</th><th>Always positive patient care margins</th></tr></thead><tbody><tr><td>Percent of sample</td><td class="cellcenter">48%</td><td class="cellcenter">40%</td><td class="cellcenter">12%</td></tr><tr><td>Percent <strong>Medicare</strong> discharges</td><td class="cellcenter">50.5%</td><td class="cellcenter">45.2%</td><td class="cellcenter">40.3%</td></tr><tr><td>Percent <strong>Medicaid discharges</strong></td><td class="cellcenter">9.1%</td><td class="cellcenter">9.3%</td><td class="cellcenter">8.6%</td></tr><tr><td>Percent of group hospitals <strong>affiliated with a system</strong></td><td class="cellcenter">36.6%</td><td class="cellcenter">60.3%</td><td class="cellcenter">82.8%</td></tr><tr><td>Percent of group hospitals with <strong>for-profit ownership</strong></td><td class="cellcenter">6.1%</td><td class="cellcenter">10.1%</td><td class="cellcenter">23.8%</td></tr><tr><td>Mean <strong>bed size</strong></td><td class="cellcenter">39.6</td><td class="cellcenter">46.2</td><td class="cellcenter">63.5</td></tr><tr><td>Average length of stay (days)</td><td class="cellcenter">15.0</td><td class="cellcenter">18.5</td><td class="cellcenter">7.1</td></tr><tr><td>Mean operating expense per inpatient day</td><td class="cellcenter">$14,424</td><td class="cellcenter">$21,581</td><td class="cellcenter">$13,098</td></tr></tbody></table><h3>COVID-19 Relief Funds Contributed to Positive Margins in Many, but Not All, Rural Hospitals</h3><p><img src="/sites/default/files/inline-images/Figure-3-Percent-of-Rural-Hospitals-with-Negative-Total-Margins-with-and-without-COVID-funds.png" data-entity-uuid="d73932fb-6157-47a3-9c6a-9ebfd681d994" data-entity-type="file" alt="Figure 3: Percent of Rural Hospitals with Negative Total Margins (with and without COVID funds." width="733" height="538" class="align-left"></p><p>Figure 3 shows the percent of rural hospitals in our sample with negative total margins, annually, from 2017-2022. The bars represent the percent of hospitals with negative total margins, both with and without COVID-19 relief funds.</p><p>Prior to the pandemic, COVID-19 relief funds were clearly unavailable, so the two bars are equal. However, it is notable that even in the pre-pandemic period, between 35% and 40% of rural hospitals had negative total margins. During the pandemic, COVID-19 relief funds were successful in providing financial support to help hospitals cope with declining volumes and other financial challenges. For instance, in 2020, excluding relief funds, 41% of rural hospitals would have reported negative total margins. However, 26% of rural hospitals incurred losses after accounting for the supplemental COVID-19 relief funds. Relief funds continued to supplement hospital financial margins through 2022.</p><h3>COVID-19 Relief Funds Caused the Largest Increases in Total Margin for Hospitals That Would Have Experienced Losses</h3><p>Table 2 presents the average total margins for rural hospitals with and without the COVID-19 relief funds from 2020-2022. The COVID-19 relief funds increased the total margin for all hospitals.</p><ul><li>For some rural hospitals with negative (-) total margins, COVID-19 relief funds resulted in margins that were still negative, but less so. These rural hospitals experienced 2.59% point increase after the inclusion of COVID-19 relief funds. Among these hospitals, the total margin increased from -10.44% to -7.85%.</li><li>For other rural hospitals with negative (-) total margins, COVID-19 relief funds fully covered the cost of providing care and resulted in positive (+) margins. Among these hospitals, total margin increased 12.42% points after the inclusion of COVID-19 relief funds. The total margin increased from -5.52% to 6.90%.</li><li>COVID-19 relief funds increased the margins of some hospitals that would have had positive margins without the relief funds. However, margin increases among this group were relatively small. This group of rural hospitals experienced a margin increase of 2.65% points after the inclusion of the COVID-19 relief funds. Their total margin increased from 9.64 to 12.28%.</li></ul><h3><strong>Table 2.</strong> Average Total Margins for Rural Hospitals With and Without the COVID-19 Relief Funds (2020-2022)</h3><table><thead><tr><th> </th><th>Average total margins <em>without</em> COVID-19 PHE funds</th><th>Average total margins <em>with</em> COVID-19 PHE funds</th><th>Absolute change in total margin</th></tr></thead><tbody><tr><td rowspan="2">Negative Total Margin (-)</td><td class="cellcenter">-10.44%</td><td class="cellcenter">-7.85%</td><td class="cellcenter"><span>⇧</span> 2.59%</td></tr><tr><td class="cellcenter">-5.52%</td><td class="cellcenter">6.90%</td><td class="cellcenter"><span>⇧</span> 12.42%</td></tr><tr><td>Positive Total Margin (+)</td><td class="cellcenter">9.64%</td><td class="cellcenter">12.28%</td><td class="cellcenter"><span>⇧</span> 2.64%</td></tr></tbody></table><h2>Discussion</h2><p>At the outset of the pandemic, there was particular concern that hospitals would not have the financial resources needed to address the challenges posed by the COVID-19 pandemic. Our results show that the worst fears about hospital financial conditions were avoided, in part due to the rapid distribution of COVID-19 provider relief funds. The majority of these funds, and other forms of financial aid, were distributed to hospitals during 2020 and 2021 (though some fund distributions still impacted hospitals’ 2022 reporting years). As a result, the percentage of rural hospitals incurring losses was between 11 and 15 percentage points lower than it would have been between 2020 and 2022. Moreover, in 2020 and 2021, the percent of rural hospitals with negative margins dropped below pre-pandemic levels.</p><p>Unfortunately, these benefits did not accrue to all groups of rural hospitals during the pandemic period. Almost half of rural hospitals experienced negative margins from patient care both before the pandemic, in 2020, and in each year after. Moreover, total margins in 2022, the most recent year of data available, have declined. When provider relief funds are excluded from margins, the average total margin for all groups of hospitals is lower than it was in any year of our sample.</p><p>Our analysis of hospitals with persistent negative margins from patient care, persistent positive margins from patient care and mixed margins revealed that these groups differ in important ways. The hospitals that struggled financially during the study period had higher volumes of Medicare and Medicaid patients. They were also smaller and less likely to be affiliated with a hospital system. The fact that the most financially vulnerable rural hospitals share similar characteristics suggests that these providers may require unique strategies or policy interventions to remain financially viable.</p><p>Overall, our results suggest that relief funds provided much needed support to rural hospitals, and in addition to addressing the financial needs stemming from the COVID-19 pandemic, these funds were able to provide a measure of relief to many rural hospitals from long-standing financial pressures. However, these observations raise questions about how rural hospitals will cope financially as COVID-19 funding has ended but persistent financial challenges remain.</p><h2>Conclusion</h2><p>Provider relief funds were successful in preventing financial losses for many hospitals during the pandemic and, in some cases, contributed to positive hospital margins in 2021. However, as this funding declined in 2022, and hospitals faced persistent, and in some cases worsening, financial challenges, margins dropped. This decline is especially concerning for the large percentage of hospitals that struggled financially even prior to the pandemic. Rural hospitals that were part of hospital systems were perhaps able to mitigate the financial effects of the pandemic. Hospital systems may be able to provide aid to rural hospitals, navigate the operational and regulatory challenges that came with the COVID-19 pandemic and provide efficiencies in those operations.</p></div><div class="col-md-4"><a href="/system/files/media/file/2024/04/Assessing-the-Impact-of-COVID-19-on-Rural-Hospitals-report.pdf" target="_blank" title="Click here to download the Assessing the Impact of COVID-19 on Rural Hospitals report PDF."><img src="/sites/default/files/inline-images/Page-1-Assessing-the-Impact-of-COVID-19-on-Rural-Hospitals-report.png" data-entity-uuid="1d21e4b0-b522-462a-984a-192786ce9679" data-entity-type="file" alt="Assessing the Impact of COVID-19 on Rural Hospitals report page 1." width="695" height="900"></a></div></div></div> Thu, 04 Apr 2024 10:22:45 -0500 Novel Coronavirus (SARS-CoV-2/COVID-19) /news/headline/2024-03-04-fda-approves-combo-test-flu-covid-19-alerts-providers-medical-device-risks <p>The Food and Drug Administration recently granted <a href="https://www.fda.gov/news-events/press-announcements/fda-roundup-march-1-2024">emergency use authorization</a> for the first over-the-counter home antigen test to detect both flu and COVID-19. The OSOM Flu SARS-CoV-2 Combo Home Test is authorized for use to detect and differentiate influenza A and B and SARS-CoV-2 in nasal swab specimens from people aged 14 and older when conducted at least twice over three days with at least 48 hours between tests. <br><br>In other news, the FDA last week recommended health care providers monitor patients with the <a href="https://www.fda.gov/medical-devices/safety-communications/hintermann-series-h3-total-ankle-replacement-has-higher-expected-risk-device-failure-fda-safety">Hintermann Series H3 Total Ankle Replacement system</a> for potential device failure, and patients with certain implantable <a href="https://www.fda.gov/medical-devices/safety-communications/biozorb-markers-and-potential-risks-use-breast-tissue-fda-safety-communication">BioZorb breast tissue markers</a> for potential serious complications. </p> Mon, 04 Mar 2024 15:04:00 -0600 Novel Coronavirus (SARS-CoV-2/COVID-19)