Hospital Financial Health and Occupancy After the COVID Pandemic

Monday, March 23, 2026

9:00 AM - 10:00 AM Central Time

Location: Connections Central - RST 12

Roxana R. Amirahmadi, M.D. (she/her/hers)

National Institutes of Health Clinical Center, Maryland

Disclosure(s): No relevant financial relationship(s) to disclose.
AM

Alex Mancera, MSBT

Data Scientist
National Institutes of Health Clinical Center

Disclosure information not submitted.
GD

Guoqing Diao, MS, PhD

Professor
Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University

Disclosure information not submitted.
MW

Morgan Walker, MD

Senior Fellow
National Institutes of Health Clinical Center

Disclosure information not submitted.
Maniraj Neupane, MD, PhD

Bryan Health, Nebraska

Disclosure(s): No relevant financial relationship(s) to disclose.
SW

Sarah Warner, MPH

Senior Epidemiologist
National Institute of Health

Disclosure information not submitted.
SL

Shanshan Liu, Ph.D.

Statistician
George Washington University

Disclosure information not submitted.
SS

Sadia Sarzynski, MD

Staff Clinician
National Institutes of Health Clinical Center

Disclosure information not submitted.
Sameer Kadri, MD, MS

National Institutes of Health Clinical Center

Disclosure information not submitted.

Introduction: Hospitals without an ICU tend to be smaller, rural, and critical access with many having closed or approaching bankruptcy. Yet, over half of all US counties only have and rely heavily on non-ICU hospitals. We investigated the relationship between hospitals’ financial health and their ability to flex occupancy after the pandemic (a surrogate marker of operational efficiency) and whether lacking an ICU (a surrogate marker of high vulnerability) impacts this relationship.

Methods: We analyzed US short-term acute care, critical access and children's hospitals by merging financial data from RAND (FY 2017–2022), weekly post-pandemic occupancy from HHS (May–Dec 2022), and pre-pandemic occupancy and hospital characteristics from AHA annual survey databases, respectively. Linear regression tested the association of long-term financial health [pre-pandemic (FY17-19 average) operating margin (OM)] and liquidity [days cash on hand (DCOH)] with change in weekly post-pandemic occupancy from prepandemic baselines. Urbanicity, time period, bed capacity, workforce FTEs, primary service type, ED presence, health system affiliation, state, teaching status, and social vulnerability index were included in risk adjustment. Effect modification by presence of ICU(s) was tested using an interaction term.

Results: Across 2319 assessable hospitals, 800 had no ICU, 712 had a single ICU and 807 had multiple ICUs. Higher pre-pandemic OM was linearly associated with pre-to-post-pandemic occupancy increase for non-ICU hospitals (estimate: 0.36%, 95% CI: 0.0042–0.68% per %OM), but not for single-ICU (0.013, CI: -0.14–0.16) or multi-ICU (0.0052, CI: -0.091–0.10) hospitals. Similarly, higher FY22 OM was also incrementally associated with pre-to-post-pandemic occupancy increase in non-ICU hospitals (0.024, CI: 0.011–0.037), but not in single-ICU (-0.035, CI: -0.099–0.029) or multi-ICU (0.10, CI: -0.0019–0.20) hospitals. No association was found between pre-pandemic or FY22 DCOH and pre-to-post-pandemic occupancy change regardless of whether ICUs were present.

Conclusions: For US hospitals that lack critical care support and yet serve a large and unique population, better long-term financial health appears crucial to their ability to flex occupancy rates in current times.