HHS' Office of Inspector General released a report April 6 that details the challenges hospitals are confronting due to COVID-19, how they are responding, and what they are asking of the government to better meet their needs during the coronavirus crisis.
The OIG conducted brief telephone interviews March 23-27 with administrators from 323 hospitals across 46 states, the District of Columbia and Puerto Rico, which were part of a random sample. Hospital administrators shared the following challenges their organizations face in response to COVID-19, as well as how they would like the government to respond:
1. Challenge: Severe shortages of testing supplies and extended waits for results. Hospitals reported frequently waiting seven days or longer for test results, which results in a number of "rule-out" cases that strain existing challenges with staffing, bed availability and shortages of personal protective equipment. According to one hospital, 24 hours is typically considered a long turnaround time for virus testing.
Hospitals' ask: Hospitals expressed a need for greater coordination from the federal government around testing kits and supplies to provide "equitable distribution of supplies throughout the country," according to the report. Hospitals also asked for the government to provide testing kits, take steps to ensure that supply chains can provide hospitals with a sufficient supply of tests, and expedite results by allowing more entities to produce and conduct tests.
2. Challenge: Widespread shortages of PPE. Hospital administrators reported higher than normal use of PPE contributed to shortages, as well as a disrupted supply chain. One administrator said their hospital's purchaser reported delays of three to six months for key supplies, including N95 masks. At the time of their interview, some hospital administrators noted that they had not received supplies from the federal stockpile, or that the supplies they had received were insufficient in quantity or quality. Several hospitals reported sharp price increases for supplies, including one administrator who cited a mask that previously cost 50 cents is now $6.
Some hospitals have turned to nontraditional sources of medical equipment and supplies, such as online retailers, home supply stores, paint stores, auto body shops and beauty salons. Staff have even assembled their own equipment from office supplies. Hospitals have also implemented conservation strategies, including reusing PPE (which is typically intended for single use) and limiting provider-patient interactions. As one administrator told the OIG: "We are throwing all of our PPE best practices out the window."
Hospitals' ask: Hospitals asked for the government's support in obtaining a range of supplies and equipment, noting that they were in competition with other providers for limited supplies. Government intervention and coordination, they said, could help reconcile this problem. They also want the government to loosen restrictions around the transfer or gifting of equipment and supplies.
3. Challenge: Difficulty maintaining adequate staffing and supporting staff. Hospitals cited need for specialized staff, concerns that staff exposure to the virus will exacerbate shortages and overwork, and concerns about the emotional toll that staff face.
Some administrators said their hospitals were training certain medical staff, like anesthesiologists, hospitalists and nurses, to help care for patients on ventilators. Those with partnerships with large health systems also said they can deploy medical staff to other hospitals in the system that may be experiencing a shortage. Hospitals are also offering support to staff, including child care, grocery services, hotel accommodations and mental health services.
Hospitals' ask: Hospitals want the government to enable reassignment of licensed professionals and realignment of duties within the hospital and throughout their healthcare networks; provide flexibility with respect to licensed professionals practicing across state lines; and provide relief from regulations that restrict the practice of contracted staff or physicians based on business relationships.
4. Challenge: Decreased revenue, increased costs and gaps in reimbursement. Hospitals have essentially stopped elective procedures and many other services, which accounts for a substantial portion of hospitals' revenue. At the same time, costs have increased as hospitals prepare for a potential surge of patients by purchasing extra equipment, remodeling rooms for negative pressure, or setting up drive-thru clinics and tents. Furthering this problem is gaps in reimbursement, such as reimbursement for telehealth services that doesn't cover the hospitals' costs. Hospitals also reported difficulty in getting reimbursed for treating patients in nontraditional spaces due to a lack of qualifying billing codes for care in these locations.
Hospitals' ask: Hospitals of all types reported need for financial assistance, with some expressing need for assistance in a matter of weeks to avoid insolvency. Hospitals told the OIG they want the government to expedite Medicare payments by dropping the 14-day wait period and to offer loans and grants. [Editor's note: CMS has adjusted Medicare payment policies to expedite payment and extend 100 percent reimbursement for six months, among other changes, which are detailed here.]
5. Challenge: Changing and/or inconsistent guidance from authorities. Hospitals said fluctuating guidance from officials and agencies at the federal, state and local level has contributed to confusion, fear and distrust among staff and the public. One administrator pointed to CDC guidance on the use of face masks, which differed from the guidance issued at the state level. "It's difficult when a doctor or nurse shows you legitimate information from legitimate sources and they're contradictory," one administrator told the OIG.
Hospitals' ask: Hospitals said the federal government could play a central role in messaging and communications to mitigate what they perceive as conflicting or inconsistent guidance across levels of government. Specifically, hospitals want the government to provide evidence-based guidance, reliable predictive models and data, and a single place to find information they need.