(102) Financial Impact of the COVID-19 Pandemic on Pediatric Intensive Care Units

Introduction: The COVID-19 pandemic had a significant impact on healthcare systems. Our objective was to understand how changes in PICU admission numbers and finances contributed to the financial impact of the pandemic. We hypothesized that PICU cost and charges per day increased during the pandemic.

Methods: We queried 29 diagnostic categories in two unlinked national databases, PHIS and VPS, from January 2017 to March 2023. PHIS and VPS admissions were mirrored by diagnosis, year, region, and freestanding hospital status. Costs were calculated from PHIS charges using the hospital’s specific ratio of cost to charges. From PHIS, median cost and charges per PICU day were determined for each diagnosis for year, region, and hospital status and were matched to VPS PICU days by diagnosis, year, region, and hospital status. Multivariable mixed modeling was run for each diagnosis and controlled for center, length of stay (LOS), illness severity (PRISM score), use of mechanical ventilation and ECMO. The independent variable was date of admission (COVID-19 vs. pre-COVID-19) and primary outcomes are PICU daily costs and charges.

Results: There were 484,328 PHIS and 331,740 VPS admissions. Number of admissions was lower during COVID-19 compared to pre-COVID-19 (reduction in PHIS of 163,138 and VPS 31,520). For the top ten diagnoses, there were significant increases in daily charges (ranging 17.7 to 29%) and daily costs (ranging 17.1 to 31.8%) per PICU day (all P< 0.001). Admissions for bronchiolitis, asthma, pneumonia, and respiratory failure decreased. In contrast, admissions for diabetes mellitus, poisoning/ingestion, and head trauma increased. However, this increase did not offset the cumulative decreased admissions and charges due to respiratory illnesses. There was a decrease of $247 million in charges during the first year of the COVID-19 pandemic. The ratio of cost to charges was stable at 0.33 throughout the pandemic.

Conclusions: During the pandemic, costs and charges per PICU day increased for the top ten diagnoses. The $247 million reduction in PICU charges during the first year of the pandemic represents a decrease in revenue given fixed overhead costs and increasing variable costs. Further investigation is needed to understand the impact of decreased admissions and LOS on hospital revenue.