Hospitals to See 10% Fewer Total Admissions Than Projected in 2020

Hospitals could see admissions fall 10 percent below projections for 2020 even though stays and other types of services have rebounded compared to earlier this year, a new report from Kaiser Family Foundation (KFF) shows.

The report created in collaboration with Epic Health Research Network analyzed Epic electronic medical records from 27 health care organizations, representing 162 hospitals in 21 states, to find that hospital admissions declined by nearly one-third this spring to gradually climb during the summer. Hospital admission levels rebounded to approximately 95 percent of their predicted level by July 11th.

More recently, however, total admissions declined slightly and were at about 90 percent of predicted levels by August 8th.

“If overall hospital admissions remain at or above 90 percent of predicted admissions, hospital revenues may stabilize at a somewhat sustainable level,” the report states. “However, if the coronavirus begins to spread more rapidly later in the fall and non-emergency procedures are once again delayed, it could have serious consequences both for hospitals’ financial stability and the health of patients.”

Smaller hospitals and those located in rural areas would particularly be affected financially.

“These hospitals may be more likely to close or merge if they do not have the financial resources to make up for declines in revenue caused by the declines in admissions shown in our data,” the report adds.

Hospitals have received emergency funding from the federal government, including $175 billion in grants through the Provider Relief Fund and a 20 percent boost to reimbursements for COVID-19 admissions.

The financial assistance should “soften the blow to their bottom lines significantly,” says Karyn Schwartz, a senior fellow at KFF and a co-author of the analysis. But much of the money was not targeted to safety-net hospitals, which operate on narrow margins outside of a pandemic, Schwartz points out in the report.

How much of a hit hospital revenue could take even with financial assistance from the government will hinge on the type of admissions that were missed and which payers reimbursed hospitals for those admissions, Schwartz states in the report.

When looking specifically at non-COVID-19 admissions, for example, people age 65 years and older had about half as many admissions in late March and April compared to what hosptials predicted in 2020. While the admissions level has increased somewhat, it stabilized at approximately 80 to 85 percent of the predicted level in late July and early August. Meanwhile, admissions for people under age 65 were at about 90 percent of predicted levels during the same period.

The slower return to pre-pandemic hospital use among older patients could result in hospital payer mix changes.

“While patients age 65 and older typically have Medicare, the majority of younger patients have private insurance, which typically reimburses at a higher rate than Medicare,” according to the report. “If hospitals experience an increase in the share of patients with private insurance, that could help mitigate some of the revenue declines they are likely to see from a drop in overall admissions.”

The report also found that hospitals in the Northeast – which saw the brunt of COVID-19 at the start of the year – experienced the steepest decline in non-COVID-19 admissions. Admissions decreased to a low of about 50 percent of predicted admissions by April 11th and have since increased to about 87 percent of predicted levels by August. Hospitals in the Midwest followed a similar patten but with less severe declines.

Meanwhile, hospitals in the South have not seen as much of a rebound since the number of COVID-19 cases increased in some Southern states during the summer. Hospitals in the West also did not experience as steep of a decline in admissions and have not experienced as large of a rebound. By early August, admissions levels were about 82 percent of predicted levels in the South and about 83 percent of predicted levels in the West.

Industry leaders hope to leverage this data in the future to understand the true impact COVID-19 had on care in the US.

“The data show which areas of the country experienced the steepest declines and where admissions came back to nearly pre-pandemic levels. In the future, we’ll be able to compare this data with patient outcomes to better understand which non-emergency care is most critical,” said Sam Butler, MD, vice president of clinical informatics at Epic and a co-author of the analysis.