Hospitals are struggling with a new set of problems because they have been operating in "survival mode" for the past year, according to a report from HHS' Office of Inspector General released on Tuesday.
Not only has the COVID-19 pandemic worsened longstanding challenges in healthcare delivery, access and health outcomes, it has also created new issues as health systems try to restart routine hospital care. Hospitals reported that they continue to suffer from staffing shortages that affect patient care and that exhaustion and trauma have taken a toll on staff's mental health, HHS OIG said. They're also dealing with various problems related to vaccine distribution and vaccine hesitancy among their staff and communities.
"Many hospitals reported experiencing financial instability because of increased expenses associated with responding to a pandemic and lower revenues from decreased use of other hospital services. Hospitals indicated that many of the challenges were more severe for rural hospitals," the report said.
Those findings echo a recent analysis funded by the American Hospital Association that found nearly 40% of hospitals would operate in the red in 2021 under the best-case scenario. About half of hospitals would lose money on their operations in the worst-case scenario.
"For rural hospitals, the most optimistic scenario would result in median margins that are 38% down from pre-pandemic baselines, with the most pessimistic scenario resulting in a 100% decline from baselines," AHA said in a statement.
Hospitals told HHS OIG that they need government support to better understand how to prevent and treat the virus and safe ways to discharge patients with COVID-19. They also need help filling gaps in hospital staffing, especially for nurses and some specialties. Hospitals need more financial relief, too, especially those in rural and underserved communities.
Widespread vaccinations to reduce the spread of COVID-19 would help address all those problems, HHS OIG said.
Providers told the agency they're worried that COVID-19 patients with longer-term effects will need complex specialty care. Hospitals reported seeing patients with serious post-COVID conditions, such as pulmonary issues, pneumonia, heart problems and blood clots, HHS OIG said.
"One hospital described 'a tsunami of people going forward' who they predicted would experience long-term effects from COVID-19," the report said.
HHS OIG based its report on a late February survey of 320 hospital administrators from 45 states, the District of Columbia and Puerto Rico.