COVID-19 Provider Relief Funding and Future Allocation Considerations

Summary

The Coronavirus Aid, Relief, and Economic Security (CARES) Act appropriated $100 billion for the Public Health and Social Services Emergency Fund—known as the Provider Relief Fund (PRF)—and subsequent legislation appropriated an additional $75 billion through the Paycheck Protection Program and Health Care Enhancement Act.

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The purpose of the PRF is to support hospitals and other healthcare providers in the national response to the COVID-19 pandemic. As of August 24, 2020, over $120 billion of these funds have been allocated and nearly $75 billion in provider payments have been made.

The purpose of this analysis was to learn more about the PRF payments to acute care hospitals. Understanding the distribution of relief funding to date can help inform future funding allocations to providers most in need, including acute care hospitals in areas with the highest COVID-19 case rates and safety-net providers.

Approach and Key Findings

Avalere examined PRF payments to acute care hospitals to learn more about receipt of funding by hospital characteristics (e.g., ownership and bed size) and by characteristics of counties in which hospitals are located (e.g., COVID-19 impact and socioeconomic factors).

Avalere identified 1,605 hospitals (49% of acute care hospitals) receiving provider relief payments. The mean payment to acute care hospitals receiving PRF payments was $15.3 million and the median was $6.7 million. PRF payment amount per hospital bed, rather than total payment amount, was examined to account for differences in hospital size.

The findings highlight areas where greater financial assistance may be important to support acute care hospitals experiencing or at risk for experiencing significant COVID-19 impact. For example, close to one-third of hospitals receiving a PRF payment and located in counties with the highest COVID-19 cases per population received among the lowest PRF payments per bed. The findings also indicate that a higher proportion of hospitals serving larger non-Hispanic Black and Hispanic populations received among the lowest PRF payments relative to hospitals located in areas serving smaller non-White populations (Table 1).

Table 1. PRF Payments to Acute Care Hospitals by Hospital and Population Characteristics
Characteristic	n (row)	<$25,000 per bed n=376	$25,000–$49,999 per bed n=412	$50,00–$99,999 per bed n=362	>$100,000 per bed n=455
Profit Status
Not-for-profit	998	19%	28%	22%	30%
Proprietary	338	42%	26%	20%	12%
Public	269	15%	15%	26%	45%
Beds
<100 beds	585	18%	15%	24%	42%
100–499 beds	879	11%	34%	28%	27%
>500 beds	141	23%	26%	23%	28%
Medicaid Ratio
<15%	427	26%	28%	26%	21%
15%–24%	621	21%	28%	23%	28%
>25%	557	24%	21%	20%	35%
Census Division
East North Central	292	29%	31%	21%	18%
East South Central	134	17%	31%	28%	24%
Middle Atlantic	189	16%	10%	31%	43%
Mountain	102	29%	26%	12%	32%
New England	81	12%	31%	21%	36%
Pacific	152	21%	30%	24%	26%
South Atlantic	157	24%	16%	32%	28%
West North Central	246	17%	34%	17%	32%
West South Central	252	34%	22%	19%	25%
COVID Cases (per 100,000 population)
<500	248	15%	15%	31%	39%
500–999	390	20%	32%	23%	26%
1000–1499	299	25%	36%	18%	20%
1500–1999	282	26%	25%	24%	24%
>2000	386	29%	19%	19%	33%
COVID Mortality (per 100,000 population)
0	455	17%	11%	28%	43%
<25	397	30%	41%	17%	13%
25–74	482	26%	31%	24%	20%
>75	271	20%	18%	20%	42%
Race
Non-Hispanic Black
<5%	582	19%	21%	24%	36%
5%–14%	530	26%	29%	23%	22%
>14%	493	26%	27%	21%	26%
Hispanic
<5%	535	20%	21%	27%	32%
5%–14%	525	22%	32%	21%	25%
>14%	545	28%	24%	20%	28%
Note: Percentages shown here are row percentages. For example, 29% of hospitals in counties with more than 2000 COVID cases per 100,000 received less than $25,000 per bed in provider relief funding. Shading reflects percentage values. Light blue is <16%, medium blue is 16–30%, and dark blue is >30%.

Implications for Acute Care Hospitals and Future Provider Relief Funding

The findings largely confirm the receipt of PRF payments as intended. However, the results also highlight the importance of continued support for acute care hospitals and safety-net providers serving communities with high COVID-19 impact as well as for communities at risk for COVID-19 impact as providers prepare for future COVID-19 surges. Future funding allocation may consider prioritizing the following criteria based on the findings presented in this analysis to ensure access to care and treatment for COVID-19.

Continued Focus on High Impact Areas

Many acute care hospitals located in areas with significant COVID-19 impact may not be receiving resources that could help meet community need. While acute care hospitals receiving PRF payments in early surge areas received among the highest levels of funding per bed, hospitals in more recent surge areas received lower levels of payment, highlighting potential lags in distribution of funds to impacted areas, the need to monitor high impact criteria, and the need to facilitate distribution of resources in anticipation of surges.

Continued Focus on At-Risk Communities

PRF allocations to date have included a focus on Medicaid population and safety-net providers. However, as the pandemic has continued, the disproportionate impact of COVID-19 on vulnerable populations has become more evident. The CDC has reported that COVID-19 infection rates are 2.8 times higher in Hispanic and Latino populations and 2.6 time higher for Black and African-American people. Similarly, the CDC has reported increased rates of hospitalization among Hispanic and Latino (4.6 times higher) and Black or African-American people (4.7 time higher). Considering more targeted funding to acute care hospitals treating at-risk populations identified by demographic and socioeconomic factors may help ensure that resources and treatment are available to communities at risk of COVID-19 case surges.

Methodology

The primary data source for this analysis was the Department of Health and Human Services PRF data set. Records for payments to acute care hospitals were identified based on keyword analysis of the provider name (e.g., hospital, medical center, health system). Records were merged to short-term acute care hospitals in the 50 states and DC from the FY 2020 Final Rule Impact File by name and city using text matching algorithms in SAS followed by manual review. Through this process, Avalere was able to identify PRF payments to 1,605 acute care hospitals.

Hospital characteristics—including bed size, ownership status, geographic location, teaching hospital status, and Medicaid ratio—were obtained from the Provider Specific File and the Impact File. County-level demographic and socioeconomic characteristics were added to the analytic file from the County Health Rankings data from Robert Wood Johnson Foundation. Data on county-level COVID-19 cases and deaths were obtained from the Centers for Disease Control and Prevention.

Funding for this research was provided by Gilead Sciences. Avalere retained full editorial control.

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