Over-Capacity Challenges Loom Large as US COVID-19 Hospitalizations Projected to Reach 4.8M

Over the past two weeks, home health providers and industry advocates have expressed serious concern about over-capacity issues the COVID-19 pandemic may cause.

Recently leaked information from an American Hospital Association (AHA) webinar suggests those concerns are well-founded.

While the home health industry hasn’t been drastically disrupted by COVID-19 so far, that may change in coming weeks. If the virus continues to spread as projected, more Americans — especially the oldest and frailest — will inevitably be sent to the hospital, likely needing home health services following disarchage.


Broadly, the disease burden is expected to be 10 times more severe than the typical flu season.

During an AHA webinar, a University of Nebraska Medical Center professor provided his “best guess” as to how COVID-19 — also known as the coronavirus — will impact hospitals across the country. Moving forward, hospitals should expect 4.8 million hospitalizations associated with COVID-19, in addition to 96 million cases overall in the U.S.

The University of Nebraska Medical Center professor also estimated there would be about 480,000 deaths, according to Business Insider, which first reported on the leaked information. Those hundreds of thousands of fatalities and millions of hospitalizations would undoubtedly push the U.S. health care system to its limit.


The best guess did not include a specific time frame.

The American Hospital Association told Business Insider that the professor’s analysis is his own — and that the information should not be attributed to AHA.

If the estimate of 4.8 million hospitalizations is even close to accurate, though, that could create a huge surge in demand for in-home care, particularly if hospital physicians overtly avoid facility-based care.

In 2017, about 3.4 million individuals used the home health benefit, according to a June 2019 report from the Medicare Payment Advisory Commission (MedPAC). Those individuals accounted for roughly 6.3 million episodes of care.

Although home health care has steadily trended toward becoming a pre-acute service, providers still receive a sizable portion of their referrals from hospitals and other post-acute care (PAC) settings.

Of the 6.3 million episodes overall in 2017, 2.2 million came from hospitals or PAC settings.

Of course, patients discharged from hospitals make up one piece of the over-capacity puzzle.

Even if hospital admissions don’t skyrocket in coming weeks, home health providers may still see an uptick in demand from community-based, homebound individuals who need extra support.

“[Providers] are preparing for a potential upsurge in patients, as individuals at high risk of contracting the virus — as well as those exhibiting signs of the infection — seek care,” National Association for Home Care & Hospice (NAHC) President William A. Dombi said this week in a video to the organization’s members.

In a Wednesday letter to the Centers for Medicare & Medicaid Services (CMS), NAHC urged policymakers to establish a direct connection between hospitals and home health agencies to help streamline the discharge process. NAHC similarly called for a series of other regulatory measures.

Long-time industry veteran Raj Kaushal — a former chief clinical officer for a large home health provider — discussed over-capacity concerns in a recent interview with Home Health Care News.

“[Home health providers] will face that unfortunate opportunity, but what the limiting factor usually is in those situations is capacity,” Kaushal said. “Capacity because of the limitation of supplies and also manpower.”

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