Pandemic-deferred care fueled patient acuity increases and higher hospital spending, AHA says

As patients delayed or avoided care during the COVID-19 pandemic, hospital patients are now experiencing more severe disease, in many cases requiring longer hospitalizations and more intensive treatments.

Patient acuity has increased over the past two years, driving increases in hospitals’ spending and underscoring the need for additional support from Congress, the American Hospital Association (AHA) wrote this week in a new report.

Citing data from Kaufman Hall’s monthly industry reports, the hospital lobbyist’s report pointed to a 9.9% average length of stay (ALOS) increase from 2019 to 2021 that has so far continued to inch upward in 2022.

Centers for Medicare & Medicaid Services data indicate a 10% increase in average length of stay and a 7% increase in case mix index (CMI) from 2019 to 2021 within the Medicare fee-for-service population, the AHA wrote. Excluding those hospitalized for COVID-19, ALOS and CMI remained 6% and 5% higher, respectively.

Acuity also grew among patients receiving several hospital-based procedures or conditions, according to data from healthcare software and analytics firm Strata Decision Technology cited in the report.

Appendectomy CMI rose 15% from 2019 to May 2022 while mastectomy CMI and hysterectomy CMI rose 11.1% and 7%, respectively, across the same periods, according to the firm’s data. Further, ALOS from 2019 to 2021 rose as much as 89% among those hospitalized for rheumatoid arthritis, 64% for neuroblastoma and adrenal cancer patients and 16% for prostate cancer patients.

AHA wrote that the increases are “likely” a result of consumers’ delayed or avoided care and cited journal studies showing a decline in various cancer screenings in 2021 and, separately, that each month of delayed cancer care comes with a 10% increase in mortality.

“Elective procedures tend to be medically necessary and are broadly defined as any procedure that can be scheduled in advance,” AHA wrote. “These can include procedures such as hernia repair, appendectomies and mastectomies—which, if prolonged, can lead to patients getting much sicker and requiring more intensive care.”

The other side of sicker patients is more complex and costly care, the industry group continued. Alongside well-documented increases in hospital labor expenses, AHA pointed to GoodRx data indicating a 21% price increase for the rheumatoid arthritis drug Humira between 2019 and 2021 that, compounded with the aforementioned 89% ALOS increase, further dragged hospitals’ spending over the course of the pandemic.

AHA made it clear it's looking to lawmakers for relief from these expenses and other factors such as inflation. The industry group capped off its report with a list of requests to legislators:

  • Ending cuts to Medicare payments to providers
  • Extending or cementing waivers supporting patient care efficiency and access
  • Extending health coverage subsidies
  • Cracking down on commercial payers’ “improper business practices” such as “burdensome administrative hurdles” that “take caregivers away from the bedside”

“The data are clear—patient acuity in hospitals has risen significantly since the start of the pandemic, presenting hospitals with a unique set of challenges that demands immediate attention and additional support from Congress,” the AHA wrote. “Hospitals need additional federal support and resources to ensure their caregivers can continue doing what they do best—taking care of patients and advancing the health of their communities.”