Balancing revenue generation with capacity generation: Case distribution, financial impact and hospital capacity changes from cancelling or resuming elective surgeries in the US during COVID-19

Abstract

Background: To increase bed capacity and resources, hospitals have postponed elective surgeries, although the financial impact of this decision is unknown. We sought to report elective surgical case distribution, associated gross hospital earnings and regional hospital and intensive care unit (ICU) bed capacity as elective surgical cases are cancelled and then resumed under simulated trends of COVID-19 incidence. Methods: A retrospective, cohort analysis was performed using insurance claims from 161 million enrollees from the MarketScan database from January 1, 2008 to December 31, 2017. COVID-19 cases were calculated using a generalized Richards model. Centers for Disease Control (CDC) reports on the number of hospitalized and intensive care patients by age were used to estimate the number of cases seen in the ICU, the reduction in elective surgeries and the financial impact of this from historic claims data, using a denominator of all inpatient revenue and outpatient surgeries. Results: Assuming 5% infection prevalence, cancelling all elective procedures decreases ICU overcapacity from 340% to 270%, but these elective surgical cases contribute 78% (IQR 74, 80) (1.1 trillion (T) US dollars) to inpatient hospital plus outpatient surgical gross earnings per year. Musculoskeletal, circulatory and digestive category elective surgical cases compose 33% ($447B) of total revenue. Conclusions: Procedures involving the musculoskeletal, cardiovascular and digestive system account for the largest loss of hospital gross earnings when elective surgery is postponed. As hospital bed capacity increases following the COVID-19 pandemic, restoring volume of these elective cases will help maintain revenue.

The Economic Impact of COVID-19 Treatment at a Hospital-level: Investment and Financial Registers of Brazilian Hospitals

“…The decrease in occupation rates findings could be associated with the preventive strategy adopted of canceling or postponing elective surgeries and procedures. 12,13 However, specific analyses could not be done to confirm this hypothesis.…”

“…The total economic impact associated with the strategies assumed by the hospitals and health-care systems are unknown and difficult to estimate yet, but it can be divided in investments to prepare organizations to treat COVID-19 patients; 2 and decreases in revenue, due, for example, to canceling or postponing elective surgeries and procedures. 12,13 In Brazil, the impact of the pandemic has been devastating. Through February 23, 2021, there were over 10.3 million confirmed cases and approximately 250 000 reported deaths.…”

Impact of the SARS-CoV-2 pandemic on ophthalmic care in Germany

“…The results of the survey conducted by the commission for cross-sectoral ophthalmology of the German Ophthalmological Society (DOG) and the Professional Association of German Ophthalmologists (BVA) provide the first overall impression of the occasionally dramatic changes in ophthalmic care in Germany during the first weeks of the SARS-CoV-2 pandemic. This resulted in considerable restrictions on the performance of elective treatments and procedures worldwide and across disciplines due to the conversion of hospitals to deal with the expected care of COVID-19 patients and the provision of the largest possible intensive care bed capacities, as well as the implementation of social distancing and hygiene rules [1][2][3][4][5][6][7][8][9][10][11][12].…”

“…In the first months of 2020, the SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) pandemic led to massive restrictions in medical care worldwide and a drastic reduction in non-urgent outpatient and inpatient treatment [1][2][3][4][5][6][7][8][9][10][11][12]. Ophthalmology, a specialty with a high proportion of outpatient and planned surgical interventions for non-life-threatening indications, was particularly affected.…”

Auswirkungen der SARS-CoV-2-Pandemie auf die ophthalmologische Versorgung in Deutschland

“…Dieser Unterschied erklärt sich aus der meist äußerst konsequent umgesetzten Strategie der Krankenhäuser, auf die Herausforderungen der COVID-19-Pandemie mit einer Fokussierung auf die ausschließliche Versorgung von Notfällen und dringlichen Fällen zu reagieren und so kontinuierlich die zur Versorgung von COVID-19-Patienten erforderliche Kapazität an Intensiv- und Überwachungsbetten gewährleisten zu können [ 1 – 3 , 8 – 10 ]. Vor allem das stationäre Operieren wurde so zu einer knappen Ressource, was sich auch an der Reduzierung der Bettenkapazitäten zeigt.…”