COVID-19: Hospitals’ response to the pandemic challenged by shortages of tests, PPE, staff and beds, says OIG

Crystal Yednak Senior Manager, Health Research Institute, PwC US April 10, 2020

Hospital administrators said testing challenges are hampering their ability to treat COVID-19 patients, conserve short supplies of personal protective equipment (PPE) and protect staff from exposure to the virus, according to a survey of 323 hospitals conducted by the HHS Office of Inspector General (OIG) between March 23 and 27.

Seventy-six percent of the hospitals surveyed reported treating one or more patients with suspected or confirmed COVID-19 cases. Providers reported that severe shortages of testing supplies were thwarting their abilities to properly monitor patients and staff for the virus in order to prevent the spread.

With labs overwhelmed, hospitals told investigators that they were waiting seven days or longer for results, which meant keeping patients in much-needed beds longer than they may have needed to be.

At one hospital, it was assumed that between 20% and 25% of staff had COVID-19, but because they didn’t have quick test results, staff members suspected of infection were kept out of the rotation, exacerbating staffing issues.

PPE remained an urgent concern as hospitals reported turning to paint supply companies, online retailers and other nontraditional sources. Masks that originally cost 50 cents were reported to have increased to $6 apiece.

In addition, hospitals said they were scrambling for basics such as IV poles, infrared no-touch thermometers, linens, disinfectant and toilet paper as well as other critical equipment such as ventilators.

Many hospitals told investigators that post-acute-care facilities were requiring negative COVID-19 tests before taking patients from hospitals, which was creating extra challenges for their already shrinking bed capacity. With test result turnarounds reaching seven days, patients were lingering in the hospitals unnecessarily, according to the report.

Amid these concerns, hospitals said they were dealing with sometimes extreme financial pressures of having to spend money to buy supplies and add beds and staff, while they cleared schedules of non-COVID, nonemergency appointments. One hospital administrator reported that specialty clinic volume was down 80%; primary care volume had decreased by 50%.

Hospitals asked for consistent guidance from federal, state and local authorities to help provide clarity to the public and to the staff. “It’s difficult when a doctor or nurse shows you legitimate information from legitimate sources and they’re contradictory,” one hospital administrator was quoted as saying.

Respondents also called for government intervention and coordination to help address the supply problems for testing, PPE and ventilators.

HRI impact analysis

The inspector general indicated that the report was not an official review of HHS performance, but a survey to share how hospitals are responding and inform future public health efforts.

But it served as an official record of what hospitals and doctors have been reporting across social media and in television interviews as they plead for the supplies they need to protect patients and their staff.

CMS has already taken steps to address some of the concerns raised in the OIG report, such as easing rules on practicing across state lines and establishing surge facilities in alternative settings.

The report shares ways hospitals have responded to the dearth of supplies, from 3D-printing masks, substituting sandwich bags for thermometer covers and asking the community for any PPE they have or can make. But as many hot spots head into their predicted peak weeks, the concerns around tests, PPE and ventilators remain urgent.

As for the financial crunch providers are feeling, the $2.2 trillion CARES Act provides for Medicare accelerated payments and a chance to defer payment of the employer share of the payroll tax along with billions of dollars in funding meant to aid hospitals facing financial hardship.

Already, however, lawmakers this week were discussing another round of aid, some of which could go to hospitals grappling with the human toll of the pandemic and the ensuing financial crisis.

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Trine K. Tsouderos

HRI Regulatory Center Leader, PwC US

Tel: +1 (312) 241 3824

Crystal Yednak

Senior Manager, Health Research Institute, PwC US

Erin McCallister

Senior Manager, Health Research Institute, PwC US

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