Hospitals should increase capacity in response to the coronavirus, former HHS secretary says

• Hospitals should prepare for an inpatient surge due to the novel coronavirus, says a former HHS secretary.
• Hospital options include moving private rooms back to semiprivate status.
• CMS is easing some hospital capacity rules, such as the bed limit on critical access hospitals.

Hospitals should start looking to increase their patient capacity in anticipation of a surge of coronavirus cases, a former federal healthcare leader said.

Mike Leavitt, a healthcare industry adviser and formerly the secretary of the U.S. Department of Health and Human Services under President George W. Bush, said hospitals should look ahead to next steps in the novel coronavirus crisis.

“For example, if the modeling is correct, during the peak of the pandemic, many hospitals will run out of capacity,” Leavitt said in a March 16 email interview. “Now is the time to begin developing plans for temporary capacity.”

His comments came the same day that Maryland Gov. Larry Hogan issued an executive order aimed at both slowing the spread of the virus and increasing the state’s hospital capacity from about 9,000 beds to about 15,000. Some of that increase would come from trying to reopen closed hospitals.

By these actions we’re going to stop the spread, we’re going to save lives and we’re going to bend the curve downward so we don’t have the spike that overloads our healthcare system and our emergency rooms and our hospitals, so we can’t provide the care,” Hogan said at a news conference.

Currently, the 5,198 community hospitals in the U.S. have 792,417 staffed beds, according to the latest data from the American Hospital Association.

Hospital options in response to the pandemic

Although most hospitals have an average acute-care daily census of 60% to 65% of capacity, that capacity can run as high as 95% during the flu season, which is winding down, said Chris Plance, an adviser with PA Consulting.

Hospitals could increase their staffed bed numbers to their full allotment of licensed allowed beds (about 950,000 nationwide) by shifting private rooms to semi-private status, Plance said in an interview.

However, most beds (75% to 80%) are medical/surgical beds and not intensive care unit beds that would be needed for treating acutely ill COVID-19 patients.

That leaves many hospital executives to decide whether to designate some combination or all of their beds for COVID-19 patients to avoid comingling COVID-19 patients with other patients. The transition to ICU beds may not require extensive lead time and should be based on whether local spread of the virus occurs, Plance said.

Some large health systems may decide to designate certain hospitals for treating COVID-19 patients just as many already do for some types of treatments.

Some hospitals have pursued emergency capacity by, for example, creating an emergency department triage tent in the parking lot, which can be done quickly. Although such outpatient settings are easier to establish because they are less regulated, regulatory restrictions do not allow advanced inpatient treatments in those settings, Plance said.

The details of how to bill for care in an emergency location also remain unclear.

Latest federal steps

Using authority from a March 13 executive order, CMS made policy changes that could help providers address physical capacity issues, including:

• Waiving the requirement that critical access hospitals (CAHs) limit the number of beds to 25
• Waiving the requirement that CAHs limit length of stay to 96 hours
• Allowing acute care hospitals to house inpatients in previously excluded distinct part units, where the distinct part unit’s beds are appropriate for acute inpatient care
• Directing Inpatient Prospective Payment System hospitals to bill for care and annotate a patient’s medical record to indicate the patient is an acute care inpatient being housed in the excluded unit because of capacity issues related to the disaster or emergency
• Allowing contractors to waive equipment replacement requirements, such as the face-to-face requirement