Massachusetts Chapter of the American College of Surgeons

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Projecting the Financial Impact of COVID-19 Elective Surgery Cancellations on the Nationís Hospitals
Sourav Bose1,2, Serena Dasani3,4, Sanford Roberts4,5, Chris Wirtalla4, Ronald P. DeMatteo, MD5, Gerard M. Doherty, MD1, Rachel Kelz2,4,5
1Department of Surgery, Brigham and Women's Hospital, Boston, MA, 2Leonard Davis Institute of Health Economics, Philadelphia, PA, 3Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Womenís Hospital, Boston, MA, 4Center for Surgery and Health Economics, Philadelphia, PA, 5University of Pennsylvania Health System, Philadelphia, PA

Background: COVID-19 resulted in a three-month cessation of elective surgeryóa substantial driver of hospital revenueóand placed patients at risk and hospitals under financial stress. The resumption of procedures requires strategic considerations that account for ongoing demand as well as the backlog of patients who were unable to undergo surgery. We sought to quantify the financial impact of elective surgery cancellations during the pandemic, simulate hospitalsí recovery times, and understand the implications of the CARES Act on hospital solvency.
Methods: Elective cases were abstracted from the Nationwide Inpatient Sample (2016-2017). Time series were utilized to forecast March-May 2020 revenues and demand. Sensitivity analyses were conducted to calculate the time to clear backlog cases. Variables included pre-COVID capacity utilization, post-COVID starting utilization, and utilization growth rate. Subset analyses were performed by hospital region and teaching status.
Results: National revenue loss due to elective surgery cessation was estimated to be .3 billion. Recovery to market equilibrium was conserved across strata and influenced by pre- and post-COVID capacity utilization. Median recovery time was 12-22 months. Lower pre-COVID utilization was associated with fewer months to recovery. The benefit of a greater post-COVID monthly growth rate was diminished if post-COVID starting utilization rates were higher than baseline pre-COVID utilization rates.
Conclusion: Strategies to mitigate the predicted revenue loss due to elective surgery cessation will vary with hospital-specific supply-demand equilibrium. The CARES Act may inadequately buffer losses observed by rural and urban non-teaching hospitals, increase these institutionsí financial risk, and exacerbate care disparities.


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