Association Between COVID-19 Relief Funds and Hospital Characteristics in the US

Abstract

Importance: In response to financial stress created by the reduction in care during the COVID-19 pandemic, hospitals received financial assistance through the Coronavirus Aid, Relief, and Economic Security (CARES) Act program. To date, the allocation of CARES Act funding is not well understood.

Objective: To examine the disbursement of the High-Impact Distribution CARES Act funds and the association between financial assistance and hospital-level financial resources prior to the COVID-19 pandemic.

Design setting and participants: This cross-sectional analysis of US-based hospitals and health systems assesses the hospital characteristics associated with CARES Act funding with linear regression models using linked hospital and health system-level information on CARES Act funding with hospital characteristics from Hospital Cost Report data.

Exposures: Hospital and health system CARES Act financial assistance.

Main outcomes and measures: Hospital and health system affiliation, status, and financial health prior to the COVID-19 pandemic. Data analysis took place from December 2020 through June 2021.

Results: The analysis included 952 hospital-level entities with an average payment of $33.6 million, most of which was received during the first payment round. Wide ranges existed in CARES Act funding, with 24% of matched hospitals receiving less than $5 million in funding and 8% receiving more than $50 million. Academic-affiliated hospitals, hospitals with higher pre-COVID-19 assets and hospitals with higher COVID-19 cases received higher levels of funding, while critical access hospitals received lower levels of financial assistance. A 10% increase in hospital assets, endowment size, and COVID-19 cases was associated with 1.4% (95% CI, 0.8% to 2.0%; P = .003), 0.2% (95% CI, 0.1% to 0.3%; P < .001), and 3.5% (95% CI, 2.8% to 4.2%; P < .001) increases in CARES Act funding, respectively.

Conclusions and relevance: In this cross-sectional study of US hospitals and health systems, findings suggest that High-Impact Distribution CARES Act funds may have disproportionately gone to hospitals that were in a stronger financial situation prior to the pandemic compared with those that were not, but funds also went disproportionately to those that eventually had the most cases.

Figure 1.. Distribution of CARES Act Funding

Authors’ analysis of matched Coronavirus Aid, Relief, and Economic Security (CARES) Act data.

Figure 2.. Distribution of Log-Transformed CARES Act Funding and Hospital Assets

A, Total hospital assets; B, Hospital endowment funds. Authors’ analysis of matched Coronavirus Aid, Relief, and Economic Security (CARES) Act and Centers for Medicare & Medicaid Services Hospital Cost Report data. The dot weighting reflects total discharge equivalents for each hospital. The blue line is the regression line between the 2 variables. For A, the slope is 0.61; for B, 0.42.

Figure 3.. Association Between CARES Act Funding and Hospital Characteristics

Analysis of matched Coronavirus Aid, Relief, and Economic Security (CARES) Act, Centers for Medicare & Medicaid Services Hospital Cost Report, and COVID-19 case data. Commercial revenue share (coefficient: −0.6; 95% CI, −1.1 to −0.1; P = .16); Medicaid revenue shares (1.0; 0.4 to 1.7; P < .001); log investment income (−0.0008; −0.0074 to 0.0058; P = .81); log total assets (0.1; 0.08 to 0.20; P < .001); log endowment (0.02; 0.01 to 0.03; P < .001); nonprofit status (0.13; 0.03 to 0.23; P = .01); critical access hospital (−0.40; −0.61 to −0.19; P < .001); teaching hospital (0.4; 0.3 to 0.5; P < .001); log total discharge equivalents (0.15; 0.05 to 0.24; P = .01); log total COVID-19 cases (0.35; 0.28 to 0.42; P < .001).