The Early Impact of the COVID-19 Pandemic on Hospital Finances.
The Early Impact of the COVID-19 Pandemic on Hospital Finances.
复制标题
COVID-19 大流行对医院财务的早期影响。
DOI：
10.1097/jhm-d-22-00037
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Young,Gary
中科院分区：
文献类型：
--
作者：
Rhodes,JordanH;Santos,Tatiane;Young,Gary
方法：我们使用的数据来自医疗保险和医疗补助服务中心医疗费用报告信息系统。研究样本包括所有接受医疗保险付款的普通急症护理和危重病医院。主要结果包括营业利润率，净患者收入，运营费用和无偿护理费用。我们测试了2019年至2020年医院财务结果的平均变化。我们还测试了按医院特征分层的样本中财务结果的变化：所有权类型（投资者拥有，非营利和公共），医疗补助不成比例的份额医院状态，农村状态，县未保险率四分位数和医疗补助扩张状态。主要发现：我们的样本由4，059家医院（8，118个观察结果）组成的平衡小组组成，数据跨越2019年和2020年。在所有医院样本中，营业利润率在2019年至2020年期间平均下降了5.3个百分点，相当于比2019年下降了130%。在这些利润率下降的基础上，净患者收入平均下降了3.2%，而运营费用则增加了1.5%。我们观察到，尽管疫情导致大量工作岗位流失，但无偿护理费用没有变化。当按医院特征对分析进行分层时，观察到所有权类型之间存在差异。值得注意的是，投资者拥有的设施在财务上受到的影响小于非营利性和公立医院。虽然安全网和农村医院一般表现不差于他们的非安全网和nonrural同行，位于医疗补助扩张状态的医院经历了急剧下降的营业利润率相对于位于nonexpansion states的医院，由更大的相对下降患者reviews.Practical Applications：我们观察到的营业利润率下降可以归因于供应链问题，持续的劳动力短缺，并暂停选择性服务。《平价医疗法案》对医疗保险市场的改革可能有助于使医院免受无偿医疗费用增加的影响。在疫情不断变化的背景下，了解医院的财务表现至关重要，以便采取措施应对进一步的财务困境，最终可能导致医院整合加剧、关闭医院和降低护理质量。我们的研究结果强调，需要有针对性的反应，是针对潜在的医院特点。临时和有针对性地提高住院和门诊服务价格，有助于抵消非紧急护理延迟带来的收入损失。其他政策可以解决持续的劳动力挑战和供应链问题。
Methods:We used data from the Centers for Medicare & Medicaid Services Healthcare Cost Report Information System. The study sample included all general acute care and critical access hospitals that receive Medicare payments. The primary outcomes included operating margins, net patient revenues, operating expenses, and uncompensated care costs. We tested for average changes from 2019 to 2020 in hospitals' financial outcomes. We also tested for changes in financial outcomes across samples stratified by hospital characteristics: ownership type (investor-owned, nonprofit, and public), Medicaid disproportionate share hospital status, rural status, county uninsured rate quartile, and Medicaid expansion status.Principal Findings:Our sample consisted of a balanced panel of 4,059 hospitals (8,118 observations) with data spanning 2019 and 2020. Across the full sample of hospitals, operating margins declined by an average of 5.3 percentage points between 2019 and 2020, equating to a 130% reduction from 2019 levels. Underlying these margin declines, net patient revenues declined by 3.2% on average, while operating expenses increased by 1.5%. We observed no changes in uncompensated care costs despite the large number of job losses that accompanied the pandemic. When stratifying the analysis by hospital characteristics, differences were observed across ownership types. Notably, investor-owned facilities were less affected financially than nonprofit and public hospitals. Although safety-net and rural hospitals generally fared no worse than their non-safety-net and nonrural counterparts, hospitals located in Medicaid expansion states experienced steeper declines in operating margins relative to hospitals located in nonexpansion states, driven by larger relative declines in patient revenues.Practical Applications:The operating margin declines we observed can be attributed to supply-chain issues, persistent labor shortages, and suspension of elective services. The Affordable Care Act reforms in health insurance markets likely helped to insulate hospitals from increases in uncompensated care costs. In the shifting context of the pandemic, it is important to understand hospitals' financial performance so that measures can be taken to address further financial distress that may eventually lead to increased consolidation, hospital closures, and lower quality of care. Our findings stress the need for targeted responses that are tailored to underlying hospital characteristics. Temporary and targeted increases in inpatient and outpatient service prices can help offset revenue losses from the deferment of nonurgent care. Other policies can address the ongoing workforce challenges and supply-chain issues.