The Second Act:
The Massachusetts
Health Care System Charts
a New Normal
In the final weeks of 2020, many in Massachusetts were feeling cautiously optimistic about what the New Year would mean for the COVID-19 pandemic.1,2
Vaccines—developed in record time and proven effective—were being rolled out to health care workers, long-term care residents, first responders, and other high-risk populations.3 At the same time, new treatments were coming online to treat the most severe COVID-19 cases.4,5
A weary world was eager to turn the page on COVID-19. However, in 2021 new challenges emerged for the health care system in the wake of the pandemic.
Utilization and the
continued strain on the
hospital system
The start of 2021 saw a sharp decline in COVID-19 hospitalizations. Patients who were admitted to the hospital with COVID-19 were less likely to need higher levels of care,6 credited in part to vaccines and advances in treatment.
Any relief this may have provided hospitals was offset by an increase in non-COVID hospitalizations and a resurgence of residents seeking health care services, after putting off or canceling care in 2020. Hospitalizations were nearly back to their pre-pandemic levels.
Utilization and the
continued strain on the
hospital system
The start of 2021 saw a sharp decline in COVID-19 hospitalizations. Patients who were admitted to the hospital with COVID-19 were less likely to need higher levels of care,6 credited in part to vaccines and advances in treatment.
Any relief this may have provided hospitals was offset by an increase in non-COVID hospitalizations and a resurgence of residents seeking health care services, after putting off or canceling care in 2020. Hospitalizations were nearly back to their pre-pandemic levels.
COVID-19 Hospitalizations
Utilization and the
continued strain on the
hospital system
The start of 2021 saw a sharp decline in COVID-19 hospitalizations. Patients who were admitted to the hospital with COVID-19 were less likely to need higher levels of care,6 credited in part to vaccines and advances in treatment.
Any relief this may have provided hospitals was offset by an increase in non-COVID hospitalizations and a resurgence of residents seeking health care services, after putting off or canceling care in 2020. Hospitalizations were nearly back to their pre-pandemic levels.
COVID-19 Hospitalizations
Utilization and the
continued strain on the
hospital system
The start of 2021 saw a sharp decline in COVID-19 hospitalizations. Patients who were admitted to the hospital with COVID-19 were less likely to need higher levels of care,6 credited in part to vaccines and advances in treatment.
Any relief this may have provided hospitals was offset by an increase in non-COVID hospitalizations and a resurgence of residents seeking health care services, after putting off or canceling care in 2020. Hospitalizations were nearly back to their pre-pandemic levels.
COVID-19 Hospitalizations
Utilization and the
continued strain on the
hospital system
The start of 2021 saw a sharp decline in COVID-19 hospitalizations. Patients who were admitted to the hospital with COVID-19 were less likely to need higher levels of care,6 credited in part to vaccines and advances in treatment.
Any relief this may have provided hospitals was offset by an increase in non-COVID hospitalizations and a resurgence of residents seeking health care services, after putting off or canceling care in 2020. Hospitalizations were nearly back to their pre-pandemic levels.
COVID-19 Hospitalizations
Utilization and the
continued strain on the
hospital system
But the patients who ended up at the hospital were sicker7 and had longer lengths of stay in the hospital due to a number of converging factors.
Average Length of Stay: Hospital Inpatients
Utilization and the
continued strain on the
hospital system
Hospital emergency departments (ED) also experienced significant capacity strains as they saw an uptick in patients seeking treatment for mental health conditions and substance use disorders. By the end of 2021, patients seeking care related to a mental health condition were averaging 26.4 hours in the emergency department — nearly six times as long as patients in the ED for other conditions.
Average Length of Stay: Emergency Department Treat-and-Release Visits
Utilization and the
continued strain on the
hospital system
Hospital emergency departments (ED) also experienced significant capacity strains as they saw an uptick in patients seeking treatment for mental health conditions and substance use disorders. By the end of 2021, patients seeking care related to a mental health condition were averaging 26.4 hours in the emergency department — nearly six times as long as patients in the ED for other conditions.
Average Length of Stay: Emergency Department Treat-and-Release Visits for Mental Health and Substance Use Disorders
Utilization and the
continued strain on the
hospital system
These challenges were compounded by critical staffing shortages. By December 2021, the percentage of Massachusetts hospitals reporting critical staffing shortages had nearly doubled, rising from 13% of hospitals in January to 24% in December.8
Percent of Hospitals Reporting Critical Staffing Shortages
New Treatments
Hospitals were not the only health care providers in the system adapting to a new normal. Physicians' offices, pharmacies, and state and municipally run vaccination and testing sites had to quickly absorb high demand for newly available vaccinations and testing. At the same time, hospitals, long-term care facilities, and other providers had to keep up with evolving policies and incorporate new COVID-19 treatments into their practice. And as payers covered vaccine administration costs and new testing and treatments that became available, COVID-19-related spending grew.
New Treatments
Hospitals were not the only health care providers in the system adapting to a new normal. Physicians' offices, pharmacies, and state and municipally run vaccination and testing sites had to quickly absorb high demand for newly available vaccinations and testing. At the same time, hospitals, long-term care facilities, and other providers had to keep up with evolving policies and incorporate new COVID-19 treatments into their practice. And as payers covered vaccine administration costs and new testing and treatments that became available, COVID-19-related spending grew.
COVID-19 Vaccine Doses
New Treatments
Hospitals were not the only health care providers in the system adapting to a new normal. Physicians' offices, pharmacies, and state and municipally run vaccination and testing sites had to quickly absorb high demand for newly available vaccinations and testing. At the same time, hospitals, long-term care facilities, and other providers had to keep up with evolving policies and incorporate new COVID-19 treatments into their practice. And as payers covered vaccine administration costs and new testing and treatments that became available, COVID-19-related spending grew.
Spending on COVID-19-Related Services
Health care delivery
transformation here to stay
Telehealth became an essential part of how patients interacted with their providers and the health care system at large. The COVID-19 pandemic transformed care delivery in 2020 and 2021, with emergency policies issued at the state and federal levels requiring payers to cover medically necessary services via telehealth. In 2021, 45% of residents reported having a telehealth visit.
Health care delivery
transformation
here to stay
Telehealth became an essential part of how patients interacted with their providers and the health care system at large. The COVID-19 pandemic transformed care delivery in 2020 and 2021, with emergency policies issued at the state and federal levels requiring payers to cover medically necessary services via telehealth. In 2021, 45% of residents reported having a telehealth visit.
Spending on COVID-19-Related Services
Health care delivery
transformation
here to stay
This led to dramatic telehealth spending growth in 2020 that held stable and well-above 2019 levels through 2021, when in-person visits became widely available again. Telehealth spending in 2021 represented an increase of 500 times what was spent on telehealth services in 2019.
Telehealth Spending
Throughout 2021, COVID-19 continued to impact the lives of Massachusetts residents and the health care system they rely on. While the year began with newly available vaccines and treatments that charted a hopeful path out of the pandemic, 2021 brought new challenges to the health care system and ended with a resurgence of COVID-19 cases with the onset of the highly transmissible Omicron variant. Though new cases have not since reached that peak, the impacts of the pandemic on Massachusetts and its health care system persist today. CHIA will continue to monitor these trends in the coming years.
For more information, please see our annual report at www.chiamass.gov/annual-report.
Sources:
- Katie Lannan. "Optimism reigns as first Covid-19 vaccine doses are rolled out locally." State House News Service, December 30, 2020. Available at https://www.dotnews.com/2020/optimism-reigns-first-covid-19-vaccine-doses-are-rolled-out-locally
- Damian Garde and Matthew Herper. "Pfizer and BioNTech to submit Covid-19 vaccine data to FDA as full results show 95% efficacy." Stat News, November 18, 2020. Available at https://www.statnews.com/2020/11/18/pfizer-biontech-covid19-vaccine-fda-data/.
- Martha Bebinger."Mass. Vaccine Rollout Plan Will Be In 3 Phases." WBUR, December 9, 2020. Available at https://www.wbur.org/news/2020/12/09/massachusetts-vaccine-rollout-plan
- U.S. Food and Drug Administration. "FDA News Release: FDA Approves First Treatment for COVID-19." Available fromhttps://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-covid-19
- Massachusetts Executive Office of Housing and Economic Development. "Reopening Massachusetts." Available at https://www.mass.gov/info-details/reopening-massachusetts
- Massachusetts Department of Public Health. "COVID-19 Response Reporting." Available at https://www.mass.gov/info-details/covid-19-response-reporting
- Center for Health Information and Analysis. "Massachusetts Acute Care Hospital Inpatient Discharge Reporting." Available at https://www.chiamass.gov/reports-on-massachusetts-acute-hospital-case-mix-database/
- U.S. Department of Health & Human Services. "COVID-19 Reported Patient Impact and Hospital Capacity by State Timeseries." Available at: https://healthdata.gov/Hospital/COVID-19-Reported-Patient-Impact-and-Hospital-Capa/g62h-syeh