Americans rely on hospitals to care for them when they are sick and injured and to help them improve and maintain their health. As evidenced by the COVID-19 pandemic, hospitals are where Americans turn in times of disaster and emergency – the blue “H” represents safety, security and healing at all hours of every day.
To be there for a community, hospitals require a vast constellation of physical, technological, and human infrastructure – from brick-and-mortar buildings to the highest skilled clinical workforce to digital connectivity. Over the past decade, groundbreaking technological advancements have paved the way for new, more effective ways to deliver care, yet many hospitals lack the physical capacity and skilled workforce to utilize these new tools. That is why it is imperative that Congress invest in America’s hospitals and health systems to ensure that the nation’s health care needs can be met today and into the future.
Advancements in technology, changes in the U.S. workforce and the evolution of the U.S. economy have created the need to modernize how the term “infrastructure” is perceived. There is no better example of organizations that are necessary to the growth of other businesses and to improved quality of life than America’s hospitals and health systems. Hospitals and health systems are steadfast in their mission to serve their communities, not just through the provision of vital health care services, but through public health and education initiatives and as economic engines that provide good-paying jobs and support local businesses in every congressional district across the country.
Recognizing the unique and foundational role hospitals play requires an understanding that each component of a modern infrastructure package – from increased access to broadband and physical infrastructure improvements to workforce training and updates to emergency preparedness programs – are interwoven and must work together to realize the full benefit. When considering what infrastructure encompasses, it is necessary to include America’s hospitals and health systems in that conversation. Simply put, an investment in the infrastructure of our nation’s health care system is a direct investment in the physical, mental and economic health of our country, without which communities across the U.S. will not be able to fully enjoy the other investments in infrastructure currently being considered.
The AHA urges Congress and the Biden Administration to prioritize funding for America’s hospital infrastructure. These investments are critical to ensure the overall health and security of our country, the long-term sustainability and viability of hospitals, and the wellbeing of patients and communities.
The AHA specifically urges Congress and the Administration to:
- Invest in Hospital Physical Infrastructure
- Strengthen the Health Care Workforce
- Build Capacity for Emergency Preparedness and Response
- Expand the Digital and Data Infrastructure for Health Care
- Secure the Health Care Supply Chain
- Investment in hospital infrastructure is an investment in American jobs and communities. Hospitals and health systems are economic anchors that create jobs and purchase goods and services from others in their community. In 2019, hospitals employed more than 6 million individuals in full- or part-time positions; purchased more than $1 trillion in goods and services from other businesses; supported almost 18 million, or one out of nine, jobs; and generated roughly $2.30 of additional business activity in the economy for every dollar they spent.
- Hospital physical plants need to be modernized to maintain access to high quality, safe and environmentally sustainable health care. America’s hospital infrastructure is highly vulnerable to several rapidly emerging challenges. Hospitals and health systems also have been hit hard financially due to the COVID-19 pandemic. Hospitals’ losses were expected to be at least $323 billion through 2020, and significant losses are expected to continue into 2021, with key credit rating agencies viewing the hospital and health sector as negative. This results in significant challenges accessing capital.
- A strong workforce is the foundation of our nation’s health care infrastructure. A qualified, engaged, diverse workforce is the core infrastructure of our health care system. Yet COVID-19 has taken a heavy toll on our health care heroes who have been on the front lines of the pandemic, with many suffering from trauma, burnout and increased behavioral health challenges. A number of hospitals have experienced critical staffing issues due to the demands of surges of very ill COVID-19 patients, as well as needing assistance in helping control the pandemic through testing, contact tracing and vaccine deployment. Additionally, practitioners are choosing to retire early given the strain of the past year.
- The nation needs to build capacity for emergency preparedness and response. When a disaster hits, people turn to hospitals for help. Congress created the Hospital Preparedness Program (HPP) after 9/11, but its funding has not kept pace with needs, and monies are often siphoned off by the state – never making it to the intended recipient of hospitals. These funds are critical to ensure infrastructure support and flexibility hospitals need to respond to a public health emergency. During the COVID-19 pandemic, hospitals have had to “reinvent” their physical structure, such creating bed capacity, separate COVID-19 and non-COVID-19 wings/entrances, new airflow and ventilation, and adjusted medication handling and distribution.
- A robust health care digital and data infrastructure is necessary to address key gaps in access, quality and equity. The COVID-19 emergency highlights the importance of a strong digital health infrastructure. This includes access to adequate, affordable broadband connectivity, which is essential to enabling telehealth and increasing access to care, as well as support for telehealth infrastructure to ensure all Americans, particularly those in underserved communities, can realize the promise of digital health. Additionally, we must prioritize strong cyber defenses to protect the privacy and safety of patients and their health information. Finally, we must continually modernize the key data systems that support the ability of government and health care organizations to identify, track and respond to issues that affect health equity, racial and ethnic disparities, the quality of health care delivery and public health responses.
- Supply chain reliability is critical to protecting patient care. A strong medical supply chain is critical to delivering safe and effective high-quality care to patients; however, it has become increasingly clear that the level of fragility across our national medical supply chain is unsustainable. A disruption anywhere in the supply chain process has the potential to create a series of prolonged difficulties in supply acquisition for providers, which ultimately can directly affect the patients they treat, or even their ability to offer treatment. To mitigate these challenges, investment in strengthening the supply chain is crucial. In addition, a focus on increasing domestic production capacity and manufacturing redundancy, while reinforcing the strategic national stockpile (SNS), will provide significant improvements for providers and patients.
- Investment in the physical, workforce and digital infrastructure related to behavioral health services is crucial. Behavioral health needs have long gone under-addressed in the U.S., and the COVID-19 pandemic has and will continue to exacerbate this issue. For example, the Centers for Disease Control and Prevention reported that overdose deaths spiked after the start of the pandemic, driven by synthetic opioids like fentanyl. It is essential that hospitals and health systems are able to serve patients experiencing mental illness and/or substance use disorders both in-person and remotely, and that the capacity to respond to the unique behavioral health needs of children and adolescents is expanded. Inpatient psychiatric facilities, as well as general acute care hospitals that offer inpatient and outpatient behavioral health programs like partial hospitalization and opioid treatment programs, face unique infrastructure challenges that are critical to address now before the increasing surge of behavioral health needs stemming from the pandemic becomes insurmountable.
- Hospitals are interested in improving the environmental sustainability of their own operations but will need support and regulatory modernization. As essential infrastructure, hospitals consume a significant amount of energy due to factors such as their continual operations, need for high-energy diagnostics, and high ventilations rates for airborne infection prevention. Many hospitals are taking steps to become more energy efficient, including renovating electrical systems, retrofitting to moreenergy-efficient technology, installing solar panels, or procuring from more-sustainable sources. Many hospitals also are considering new ways to manage the waste they produce, such as improving recycling programs. These steps often come with significant cost at a time when hospitals are still experiencing financial pressure due to the COVID-19 pandemic. Furthermore, it will be important to modernize rules to ensure hospitals that are ready to implement environmentally friendly changes are not constrained by outdated regulations.