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How hospital capacity varies dramatically across the country

Healthcare Dive analyzed data to paint a picture of hospital capacity, pinpointing areas with a higher ratio of people to beds and signaling where there is a risk for capacity issues.

March 30, 2020

Fewer hospital beds in select regions make them especially vulnerable to the novel coronavirus as it’s expected to spread from big city hot spots to other areas of the country.

As the U.S. has become the next epicenter of the outbreak, hospitals are preparing for the worst. The pathogen threatens to overwhelm their facilities and resources, especially if mitigation efforts fail to blunt a surge of COVID-19 patients.

The latest figures from the Johns Hopkins Coronavirus Resource Center report more than 143,000 confirmed cases in the U.S. and more than 2,500 deaths as of Monday.

The New York City metro area has the most beds compared to the rest of the country. Still, that is not enough capacity to meet the crushing demand.

To illustrate hospital capacity across the country, Healthcare Dive sought to compare bed counts to population, and found population size isn’t always indicative of the number of beds available.

Population size is not always indicative of bed capacity in the top 20 metro areas

Below are the 20 most populated metro areas in the U.S., sorted by population. As you move down the chart, population size decreases, but bed counts do not always. Areas like D.C. and Seattle have fewer beds relative to population size, while Miami and Philadelphia have more beds relative to population.

Some areas like Washington, D.C., have relatively fewer beds compared to their population, while others like Miami, Philadelphia and St. Louis have more beds relative to the number of people in the region.

Some hospitals are turning to hotels and tents, and Vice President Mike Pence has said he’s working with the Department of Defense to get field hospitals and other options online.

Still, researchers cautioned there is a long way to go to meet projected demands. If America’s healthcare system was able to free up half of its beds by discharging patients, the country would still need three times as many beds, Ashish Jha, director of the Harvard Global Health Institute, told reporters during a call on Tuesday. That projection assumes 40% of Americans get infected over the next six months.

“What we know right now is that capacity to manage patients varies dramatically from community to community,” Jha said.

Areas with the highest ratio of people per bed

To paint a picture of hospital capacity across the country, Healthcare Dive used CMS cost reports and population data to calculate the ratio of people per bed in metropolitan areas and regions. In other words, how many residents are there for a single bed? It’s a way to pinpoint areas with a higher ratio of people to beds, signaling areas potentially at risk for capacity issues.

Healthcare Dive analyzed specific geographic areas, in this case metropolitan CBSAs, or core-based statistical areas, which are geographic areas that consist of an urban center of 50,000 people or more.

In the U.S., about 42% of the more than 143,000 cases are concentrated in New York, overwhelming available resources. Still, case counts are swelling in areas outside of New York including Chicago, Detroit and New Orleans. Indicating the outbreak is likely to be widespread in America.

Healthcare Dive found the Bloomsburg-Berwick, Pennsylvania, area has the lowest ratio in the nation with 86 people for each bed. Most areas have much higher ratios, the median being around 400 people per bed when comparing CBSAs. The metro area of New York City sits in the middle with 405 people per bed.

Bloomsburg-Berwick, PA

1 bed

Greeley, CO

1 bed

The Greeley, Colorado area has the nation’s highest ratio of people per bed, according to the data. About 60 miles northeast of Denver and with a population of more than 314,000, there are 1,397 people for every one hospital bed in the Greeley area.

The CMS data shows a total of 225 hospital beds in the Greeley area, operated by Banner Health’s North Colorado Medical Center.

However, a new 50-bed hospital opened recently and was not included in the most recent cost reports. It is operated by UCHealth.

Still, while those numbers may seem grim, Colorado’s hospital leaders cautioned that the state can and is working to tap into additional resources, citing freestanding emergency rooms and ambulatory surgical centers.

It’s imperative to look beyond just one locale or one hospital and consider the resources of the state as a whole, Colorado’s hospital leaders told Healthcare Dive.

Colorado has a total of 10,293 hospital beds (12,558 licensed beds) and at least 973 ICU beds, the Colorado Hospital Association said.

“It’s going to take the whole system for us to get through this,” Julie Lonborg, senior vice president at the Colorado Hospital Association, told Healthcare Dive.

There are only one or two hospitals in almost all of the 10 regions with the highest ratio of people per bed. Rounding out the top 10 areas with the highest ratio of people per bed following Greeley, include Albany, Oregon; Gettysburg, Pennsylvania; Merced, California; California-Lexington Park, Maryland; Bremerton-Silverdale, Washington; Lawrence, Kansas; Monroe, Michigan; Provo-Orem, Utah; and Ogden-Clearfield, Utah.

Metros at risk of capacity shortages

Below are the 10 metro areas with the highest people-per-bed ratio.

The data shows the total bed capacity in a region, but does not take into account the patients currently occupying those beds. However, in an effort to free up existing beds, many hospitals have halted elective surgeries, including in Greeley to free up resources and staff to be able to respond to a potential surge.

“UCHealth Greeley Hospital is caring for a large number of patients at this time, and by working together as a large system, UCHealth is able to redirect patients and admissions to other facilities to help even out our capacities at this and other hospitals,” Kelly Tracer, a spokesperson for the hospital, told Healthcare Dive.

In fact, many hospitals plan to lean on the larger systems they’re a part of to shuffle resources to respond to the pandemic.

In Gettysburg, Pennsylvania, there are 76 hospital beds and 1,353 people per hospital bed. WellSpan Health, which operates Gettysburg Hospital, said it plans to coordinate its response by using its eight other hospitals in different areas and some 200 locations.

“We are taking a comprehensive approach to this issue, developing a network of more than 10 outdoor testing locations across our five-county region and temporarily repurposing several of our outpatient medical practices to care locations dedicated solely for the treatment of patients who are suspected or confirmed to have COVID-19 and have non-emergency medical needs,” according to a statement WellSpan Health provided Healthcare Dive.

Other locations with the highest people per bed ratio are converting existing space into dedicated areas to treat COVID-19 patients to prepare for a crush of patients, including in Lawrence, Kansas, with 893 people for every bed.

Lawrence Memorial Hospital in Lawrence, Kansas, about 40 miles west of Kansas City, is prepared to up its capacity to 205, LMH said in a statement. The hospital reported 136 beds to CMS but said it is licensed for 174.

“At any given time we have upwards of 100 patients,” Traci Hoopingarner, vice president of clinical care and chief nursing officer for LMH Health, said in a statement.

As New York continues to grapple with mounting cases, leaders are issuing dire warnings to the rest of the country.

“New York is the canary in the coal mine. What happens to New York is going to wind up happening in California and Washington state and Illinois. It’s just a matter of time,” New York Gov. Andrew Cuomo said.

Below is an interactive table of hospital bed availability in different metros across the country. Search for your metro area to find the corresponding hospital capacity.

Bed availability in other metro areas

Below is a table of 262 metropolitan CBSAs, along with each CBSA’s people-per-bed ratio and number of beds available per 1,000 people.

Methodology

For this story, Healthcare Dive compared hospital bed counts to the population of several metropolitan statistical areas.

The hospital bed counts data and population data were both provided by Publicaccountability.org, a project of the Investigative Reporting Workshop at American University. The hospital bed counts data was extracted from the most recently filed CMS cost reports received in 2017 or later. The population data comes from the Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States: April 1, 2010 to July 1, 2018 from the 2018 Population Estimates. For more information about the two datasets, see the public repository.

This data was then grouped by CBSAs (or core-based statistical areas) and further subsetted to only include metropolitan statistical areas. A metropolitan statistical area is a U.S. geographic area, defined by the Office of Management and Budget, consisting of an urban center of 50,000 people or more and the adjacent counties that are socioeconomically tied to that urban center.

Hospital types and definition of beds

The hospital bed counts dataset includes acute care, critical access and children’s hospitals. (Psychiatric hospitals are not included.)

The bed count used in our analysis aggregates several types of beds: adult/pediatric acute care beds, intensive care beds, coronary care beds, intensive care units, surgical ICU beds, subprovider inpatient psychiatric beds, subprovider inpatient rehabilitation beds, subprovider inpatient other beds, skilled nursing beds, nursing facility beds, other longterm beds, hospice beds, and other specialty beds.

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