OIG: Pandemic forced hospitals into ‘survival mode’

A new report from the HHS’ Office of Inspector General lays bare the varied challenges hospitals faced in the past year — and continue to face. These range from challenges in healthcare delivery to staffing shortages to shaky finances.

Hospitals and health systems have spent a year fighting a deadly pandemic with, at times, little to no resources. This has had a devastating effect on the healthcare industry. Now, a new government report is attempting to take stock of the year gone by and the ongoing challenges facing hospitals.

Released by the Department of Health and Human Services’ Office of Inspector General, the report details how responding to the Covid-19 crisis has affected healthcare organizations’ capacity to care for patients, staff and their communities. The report is based on a survey of 320 hospitals nationwide conducted by the OIG between Feb. 22-26.

“Nearly one year into the pandemic, hospitals reported that operating in ‘survival mode’ for an extended period of time has created new and different problems,” the report states.

There are five key areas the report covers:

1. Healthcare delivery
The Covid-19 pandemic put a severe strain on hospital capacity, and even a year after the first coronavirus cases hit, many are struggling with capacity issues. At the time of the survey, 40 hospitals had over 90% inpatient occupancy and 56 had over 90% of their intensive care unit beds occupied.

Some hospitals even reported that they operated at over 100% capacity during surges of Covid-19 cases, according to the report.

All hospitals were hit hard during the pandemic, but rural facilities experienced the worst of it. Capacity was a particularly intractable problem for these hospitals. Among survey respondents, 67 hospitals served rural communities, and 28 of them operated fewer than 15 inpatient beds.

Another key issue was the suspension of elective surgeries and other services during the pandemic to conserve resources. Many hospitals experienced reduced patient volume, and now administrators are worried about the exacerbated care needs of people who avoided hospitals, the report states.

A well-documented issue amid the pandemic has been the worsening of existing health disparities. Forty-one hospitals that responded to the survey were located in counties where 20% or more of the population had household incomes below the federal poverty level, and 113 hospitals reported serving communities with a higher social vulnerability score than the national average, according to the Centers for Disease Control and Prevention’s Social Vulnerability Index.

These hospitals reported challenges in treating patients with certain underlying conditions that disproportionately affect people of color — such as heart and lung ailments — including the fact that they lack the advanced capacity or resources needed to care for large numbers of vulnerable patients, the report states.

2. Staffing
Staffing challenges hobbled hospitals amid the pandemic, and even at the time of the survey, 38 reported to the HHS that they faced a critical staffing shortage.

This staffing shortage resulted in caregivers being forced to balance multiple clinical and administrative responsibilities, and being reassigned from their normal duties to care for Covid-19 patients, the report states.

Nursing, in particular, saw huge turnover. This has left hospitals concerned that care quality suffered. Several administrators reported that staffing shortages forced them to assign substantially more patients than usual to each staff member.

3. Vaccinations
Though the availability of vaccines heralded the beginning of the end of the public health crisis, being tasked with administering doses has exacerbated the financial and staffing challenges facing hospitals, according to the report.

Some hospitals said they needed to divert clinical staff away from patient care to administer vaccines. At one hospital, it took 25 staff members working an eight-hour shift to distribute 600 vaccines, an administrator reported.

Further, the costs associated with vaccine administration, like equipment for storing vaccines and other supplies, have strained hospital finances.

But moves have been made to address the cost issue. Since the survey was conducted, the Centers for Medicare & Medicaid Services increased the Medicare payment amount for administering the Covid-19 vaccine in a bid to support providers.

4. Supplies
Early on in the pandemic, extreme supply shortages left hospitals scrambling to care for patients as well as their own staff. Though supplies eventually became easier to obtain, many hospitals still say they lack dependable supply chains for personal protective equipment.

The least dependable is the availability of surgical gloves and N95 masks, with 19 hospitals saying they reported to HHS that they could not order and obtain the masks in the week before the survey was conducted.

There is also an added challenge of identifying reputable vendors, hospitals said.

5. Finances
The evolving costs of battling the Covid-19 pandemic, and concurrent revenue losses from moves like suspending elective care, has left hospital finances in shambles. One administrator said their hospital was operating at a 25% reduction in revenue due to lower patient volumes.

In particular, hospitals serving disproportionately under-and uninsured populations and rural communities report concerns about financial instability.

Further, hospitals are concerned about repaying the financial assistance they received during the course of the pandemic.

HHS will use these frontline perspectives as it leads policymaking “to help solve these foundational challenges,” the report states.

Photo credit; Maria Stavreva, Getty Images