Care Disruption During COVID-19: a National Survey of Hospital Leaders

Abstract

Background The COVID-19 pandemic caused massive disruption in usual care delivery patterns in hospitals across the USA, and highlighted long-standing inequities in health care delivery and outcomes. Its effect on hospital operations, and whether the magnitude of the effect differed for hospitals serving historically marginalized populations, is unknown. Objective To investigate the perspectives of hospital leaders on the effects of COVID-19 on their facilities’ operations and patient outcomes. Methods A survey was administered via print and electronic means to hospital leaders at 588 randomly sampled acute-care hospitals participating in Medicare’s Inpatient Prospective Payment System, fielded from November 2020 to June 2021. Summary statistics were tabulated, and responses were adjusted for sampling strategy and non-response. Results There were 203 responses to the survey (41.6%), with 20.7% of respondents representing safety-net hospitals and 19.7% representing high-minority hospitals. Over three-quarters of hospitals reported COVID testing shortages, about two-thirds reported staffing shortages, and 78.8% repurposed hospital spaces to intensive care units, with a slightly higher proportion of high-minority hospitals reporting these effects. About half of respondents felt that non-COVID inpatients received worsened quality or outcomes during peak COVID surges, and almost two-thirds reported worsened quality or outcomes for outpatient non-COVID patients as well, with few differences by hospital safety-net or minority status. Over 80% of hospitals participated in alternative payment models prior to COVID, and a third of these reported decreasing these efforts due to the pandemic, with no differences between safety-net and high-minority hospitals. Conclusions COVID-19 significantly disrupted the operations of hospitals across the USA, with hospitals serving patients in poverty and racial and ethnic minorities reporting relatively similar care disruption as non-safety-net and lower-minority hospitals. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-08002-5.

Outcomes Among Patients Hospitalized With Non–COVID-19 Conditions Before and During the COVID-19 Pandemic in Alberta and Ontario, Canada

“…However, we found that outcomes were relatively stable across surge index strata for patients hospitalized during the pandemic for non–COVID-19 medical conditions. This finding is contrary to the commonly held belief, even in a survey of hospital administrators, that inpatients without COVID-19 received poorer quality of care and experienced worse outcomes during COVID-19 surges . Our findings suggest that the Canadian health care system may have, for the most part, weathered the storm during the pandemic or at least may have been used to running at near capacity even before the pandemic.…”

The COVID-19 pandemic did not negatively impact frequency or continuity of outpatient care in Alberta, Canada

“…Our finding that care and prescribing patterns were also very similar after pandemic onset compared to the prior year in patients without ACSC also provides some reassurance that although earlier studies reported marked reductions in outpatient visits in the first few months of the pandemic 4,5 , this had largely recovered by the end of the first year, at least in our province. Our findings also call into question the commonly-held assumption expressed by two thirds of healthcare policy makers and administrators 14 and one third of elderly Americans 15 in recently published surveys that access to outpatient care for non-COVID conditions deteriorated after onset of the pandemic. Interestingly, we found that provider continuity actually improved for both those with or without ACSC during the pandemic, likely reflecting the fact that virtual care is easier to implement with patients already known to physicians rather than for new patients.…”

“…However, as we don't have any data on the content of each outpatient encounter, we are unable to address the question of whether quality and outcomes of outpatient care deteriorated after pandemic onset, two other concerns raised in the surveys of elderly Americans and healthcare administrators 14,15 . Further research is needed to investigate whether the shift towards virtual outpatient care has negatively impacted screening for and detection of new conditions (such as diabetes, atrial fibrillation, or cancer).…”

Health Equity Adjustment and Hospital Performance in the Medicare Value-Based Purchasing Program

“…The true impact will depend on actual hospital performance and proportion of dual-eligible inpatient stays in FY 2026. Nonetheless, our analysis used the most recent performance data available before the COVID-19 pandemic, which resulted in the suspension of the HVBP program and other value-based payment programs . Second, our estimation of hospital-level HVBP payment adjustments relied on standardized operating amounts for hospitals designated as meaningful electronic health record users.…”

“…Nonetheless, our analysis used the most recent performance data available before the COVID-19 pandemic, which resulted in the suspension of the HVBP program and other value-based payment programs. 44 Second, our estimation of hospitallevel HVBP payment adjustments relied on standardized operating amounts for hospitals designated as meaningful electronic health record users. However, national data have shown that almost all acute care hospitals have achieved meaningful electronic health record use, with even higher rates among hospitals participating in the HVBP program.…”