COVID-19: We Don’t have Enough ICU Beds

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Original story posted on: March 23, 2020

The U.S. healthcare system is facing a critical shortage of supplies, including ICU beds.

With the rising concern over COVID-19, I decided to look at data to see what our current shortage of ICU beds could be, comparing census data in Medicare cost reports with U.S. Centers for Disease Control and Prevention (CDC) data and information from a press conference recently held by New York Governor Andrew Cuomo.

We pulled Medicare cost reports from the Healthcare Reporting and Information System (HCRIS). On a quarterly basis, the Centers for Medicare & Medicaid Services (CMS) publishes data files of the latest filed or audited Medicare cost reports for all hospitals in the United States.

Let’s start with the state of New York. Based on HCRIS, the state has 4,182 intensive, coronary, and burn unit beds: the kind of beds that would have life-saving ventilators to care for COVID-19-infected patients. Reducing the number of beds available for COVID-19 patients, hospitals were already using 2,721 beds for existing critically ill patients. That means that New York has around 1,461 ICU beds available for COVID-19 patients. 

According to Governor Cuomo’s remarks on March 22, New York currently has tested more than 61,000 people, and found that more than 15,000 were infected with the COVID-19 virus. Governor Cuomo went on to say that 20 percent of COVID-19 patients will require hospitalization. This means that more than 3,000 critically ill patients will almost immediately eclipse the number of available beds.

The city of New York shows just 653 intensive care beds. Adjusting for the 361 beds already in use, based on utilization, there are fewer than 300 intensive care beds available for COVID-19 patients. Considering that the bulk of COVID-19 patients in the state of New York have come from New York City we can see that there is already a crisis of epic proportions.   

Los Angeles is a similar story. California has a total number of reported beds of 8,114, based on data from HCRIS. On average, 4,662 of these beds are being used for existing patients. This means that just 3,452 beds are available for the added load from COVID-19 patients. California is the state with the largest population in the United States, and it is almost a statistical certainty that California will catch up with New York, if nothing stops the progression of the disease.

Los Angeles has 846 beds, based on reported data. Of these,528 beds are being used for services currently.  That means that just 318 beds are available for COVID-19 patients. This assumes a perfect storm, in that all beds available are used.

Chicago, also a huge population center, is even worse off. They have 152 reported ICU beds, of which 117 are being used for existing patients. This means that Chicago has only 35 ICU beds for the entire city to use for COVID-19 patients. When you add the fact that many inner-city hospitals are already financially challenged, you have a recipe for disaster.

Nationally, the numbers don’t get better. Of the approximately 80,000 ICU beds nationwide, only about 30,000 are currently available. Again, based on Governor Cuomo’s statistics, as many as 110,000 Americans will require hospital treatment. 

Governor Cuomo is hoping that by controlling the outbreak, we can “flatten the curve.”  This would mean stretching out the need for beds to cover a four- to nine-month period. This would ease the spike in demand for ICU beds, but extend the time that additional beds are needed. 

Medicare will also have to immediately provide relief regarding the regulation governing the reimbursement of indirect medical education, or IME, payments to teaching hospitals. IME payments are made based on the ratio of interns and residents to available bed days. If beds are expanded for COVID-19 patients, Congress will have to make sure the additional beds are not counted in the IME computations of teaching hospitals, or IME payments will plummet.

In my mind, the bigger issue is what to do with weak patients who can’t return home. Nursing homes can’t take these patients and risk infecting the elderly population already receiving long-term care. I am with Governor Cuomo: we need a national plan, and the clock is ticking.     

Programming Note: Listen to Timothy Powell’s live news reports every Tuesday on Talk Ten Tuesdays, 10-10:30 a.m. EST.

Timothy Powell, CPA

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of both the RACmonitor and ICD10monitor editorial boards and a national correspondent for both Monitor Mondays and Talk Ten Tuesdays.

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