Coronavirus disease 2019 (COVID-19) caused unprecedented patient volume in hospitals and critical care units. While addressing the high patient volume, providers also had to determine patient-specific disease severity and assign each patient to one of five potential treatment plans. Though nursing shortages have occurred before, the shortage that occurred during the pandemic not only compromised quality of care but also contributed to increased hospital expenses as healthcare systems turned to travel nurses to fill staffing gaps. Hospitalized COVID-19 patients often possessed comorbidities, which correlated to more intense treatment plans as well as an increased cost of treatment. COVID-19 hospitalizations cost approximately $41,611 in 2020, which was a stark increase from the average hospitalization cost ($11,700) for a non-COVID-19 patient in 2016. The payer demographics during this pandemic included many Medicare and Medicaid patients. Hospitals were provided less compensation for services provided given the lower reimbursement rates on Medicare and Medicaid as compared to private insurance. This led to an increased cost of care (20.1% higher total hospital expenses per patient) and an increased complexity of care. This financial pressure was further imposed due to providing care largely to a population with low reimbursement rates during a time of nursing shortages. Government interventions in the form of the Coronavirus Aid, Relief, and Economic Security (CARES) Act and Paycheck Protection Program (PPP) loans were commissioned given the financial and operational pressures of the time. Though these interventions kept many hospitals from declaring bankruptcy, the funds were disproportionately directed towards hospitals with high volumes of private insurance patients. It was concluded that despite the federal funding, the financial and operating pressures were not adequately alleviated.
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