COVID-19 Surges Led to Fluctuating Occupancy Rates at Hospitals

COVID-19 surges in 2020 led to increased occupancy in inpatient settings and intensive care units (ICUs) and declining surgical occupancy rates, creating unstable financial conditions for hospitals, a study published in JAMA Health Forum found.

Researchers used data from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project State Inpatient Databases from 2019 and 2020 for 45 states to determine how occupancy fluctuations due to COVID-19 impacted hospitals.

The study evaluated inpatient occupancy at 3,960 hospitals in 45 states (393,580 hospital-weeks) and ICU occupancy at 2,703 hospitals in 33 states (268,416 hospital-weeks).

Instances with low COVID-19 admission rates (less than one weekly admission per 100 beds) or relatively low rates (between one and four weekly admissions per 100 beds) accounted for nearly two-thirds of hospital-weeks in 2020. Periods with relatively high (between 10 and 14 weekly admissions) or high (15 or more weekly admissions) admission rates accounted for less than one-fifth of hospital-weeks.

Most periods of high COVID-19 admissions lasted less than a month. In the first half of the pandemic, periods with low COVID-19 admissions were common at 30.5 percent of hospital-weeks, while periods with high COVID-19 admissions were not at 6.1 percent of hospital-weeks. In the second half of the year, a smaller share of hospital-weeks had low COVID-19 admissions at 12.3 percent, while 9.2 percent of hospital-weeks had high COVID-19 admission rates.

During weeks with low COVID-19 admissions, inpatient occupancy declined by 9.3 percentage points per 100 beds (12.7 percent) relative to the mean. The decrease was more pronounced in the first half of 2020 (11.6 percentage points) compared to the second half (5.2 percentage points).

The percentage-point decrease in admissions was 10.3 in other metropolitan counties, 9.2 in large urban counties, and 5.6 in rural counties.

During weeks with high COVID-19 admissions, inpatient occupancy grew by 5.8 percentage points per 100 beds (7.9 percent). The increase was steeper in the second half of the year at 9.1 percentage points or 12.6 percent. Inpatient occupancy increased by 4.5 percentage points (5.8 percent) in large metropolitan hospitals and 10.0 percentage points (27.4 percent) in rural hospitals.

Similarly, ICU occupancy decreased by 5.4 percent during weeks with low COVID-19 admissions and increased by 67.8 percent during weeks with high COVID-19 admissions.

Other service lines, including maternal, mental health and substance use disorders, injury, and surgical service lines, saw different occupancy changes during the pandemic. The most significant decreases in occupancy occurred during weeks with high COVID-19 admissions, ranging from a 1.1 percentage point decrease for maternal patients to 8.5 percentage points for surgical patients.

During weeks with low COVID-19 admissions in the first half of 2020, occupancy decreases ranged from 0.6 percentage points for maternal patients to 3.7 percentage points for surgical patients. In the second half of the year, surgical occupancy decreases ranged from 1.2 percentage points during weeks with low COVID-19 admissions to 2.3 percentage points in weeks with high COVID-19 admissions.

The significant increases in ICU occupancy likely strained ICU staff, which may have reduced care quality and increased in-hospital mortality, researchers said. The decrease in occupancy for surgeries, injuries, and deliveries likely reflected patients deferring care, which may have also contributed to increased mortality.

Additionally, low occupancy rates led to financial losses for hospitals, including reduced operating margins, net patient revenues, and net operating income outside of COVID-19 relief funds. Fluctuating occupancy rates also created challenges, as these changes led to increased reliance on travel nursing, which is more expensive for hospitals.