Data Diving
According to the doctors and researchers who published the JAMA Network article, between August 2020 and April 2024, American hospitals were mandated to report weekly occupancy to the U.S. Department of Health and Human Services (HHS) as part of COVID-19 data tracking efforts. The intention of this mandate was to give the government an unprecedented insight into mean daily census and inpatient bed supply across nearly all hospitals nationwide.
The JAMA Network authors repurposed this HHS data to predict several possible hospital occupancy scenarios arising from an aging population over the next decade. By varying hospitalization rates and staffed hospital bed supply, they were able to come up with some eye-raising outcomes, which some would find potentially alarming.
Formula and Findings
The aging-adjusted annual number of hospitalizations were calculated by multiplying U.S. Census Bureau population projectionsfor 2025 to 2035 by an age-adjusted hospitalization rate from the 2019 to 2020 National Inpatient Sample. These future hospitalizations were used to calculate future hospital census. Hospital occupancy for each year between 2025 and 2035 was calculated by dividing mean daily census by staffed hospital bed supply.
The mean U.S. hospital occupancy was 63.9 percent (range was 63 to 66 percent) from 2009 to 2019 compared with 75.3 percent (ranging from 72 to 79 percent) in the year following the end of the COVID-19 public health emergency (PHE), i.e., May 2023 to April 2024. The number of staffed hospital beds declined from a pre-pandemic steady state of 802,000 (2009-2019 mean) to a post-PHE steady state of 674,000. Nevertheless, the mean daily census steady state remained at approximately 510,000. There was substantial state-to-state variation in the post-PHE hospital occupancy steady state, according to the group’s findings.
A Picture Emerges
Here are the implications of the numbers: without changes in the hospitalization rate or staffed hospital bed supply, total annual hospitalizations were projected to increase from 36,174,000 in 2025 to 40,177,000 in 2035 based on the expected growth in the aging population. This would correspond to a national hospital occupancy of approximately 85 percent by 2032 for adult beds and by 2035 for adult and pediatric beds combined. To put it another way, the U.S. has achieved a new post-pandemic hospital occupancy rate that is 11 percentage points higher than prior to the pandemic. This persistently elevated occupancy appears to be driven by a 16-percent reduction in the number of staffed US hospital beds rather than by a change in the number of hospitalizations. Let’s face it, there have been a number of hospital closures of late, including many rural facilities; and these closures are putting a strain on the capacity of those hospitals that remain open.
Health experts in developed countries generally hold that a national hospital occupancy rate of 85 percent constitutes a hospital bed shortage. The JAMA Network authors’ findings show that the U.S. could reach this precarious threshold as soon as 2032, with some states being at much higher risk than others. Of course, an increase in the staffed hospital bed supply by 10 percent, a reduction in the hospitalization rate by 10 percent or some combination of the two would offset the aging-associated increase in hospitalizations over the next decade; but how likely is this to happen?
Finally the authors of the JAMA Network article suggest that, in order to avoid the potential increase in excess mortality thought to be associated with a national hospital bed shortage, “future research should investigate the determinants of recent reductions in the staffed hospital bed supply (e.g., tight healthcare labor markets, hospital closures), and explore frameworks to improve national health system resilience (e.g., distributing resources according to geographic demand, innovative models such as next-day clinics to reduce avoidable hospitalizations).”
Hospital and health system leaders have a new hot potato on their plate; there’s no getting around it. Hopefully, with planning, innovation and perhaps a little help from new technologies (such as artificial intelligence), most facilities will be in good shape to cope with a capacity crowd that seems to be on its way.