Delta Variant Continues to Hit Hospitals Hard

Rising COVID-19 infection rates and hospitalizations from the hyper-transmissible Delta variant continued to strain U.S. hospitals and health systems in August, according to Kaufman Hall’s latest National Hospital Flash Report.

Hospital margins remained below pre-pandemic levels from 2019, not including federal Coronavirus Aid, Relief, and Economic Security (CARES) Act funding. Most volume metrics also were down versus pre-pandemic levels, but up compared to lows seen in the first eight months of 2020, when COVID-19 mitigation efforts drove significant declines in overall demand. However, Average Length of Stay increased versus 2019 and 2020, as hospitals saw a rise in high-acuity cases—including more severe COVID-19 cases—requiring longer stays. Meanwhile, expenses continued to climb and revenues rose for a sixth consecutive month.

“Hospitals nationwide have faced significant recent setbacks in the wake of the Delta variant,” said Erik Swanson, a senior vice president of Data and Analytics with Kaufman Hall. “COVID-19 rates appear to be tapering in September, but the August data show we are not out of the woods yet, and hospitals face additional uncertainties as we move into the fall and winter.”

The median Kaufman Hall Operating Margin Index was 3.1% in August without CARES funding, and 3.9% with the aid. The median change in Operating Margin was down 2.9% year-to-date versus pre-pandemic levels in the first eight months of 2019, not including CARES. With CARES, the median change in Operating Margin rose 11.2% versus January-August 2019.

Revenues and expenses also rose year-to-date versus 2019, due in part to the increase in higher acuity patients. Gross Operating Revenue was up 9.6% compared to 2019, while Total Expense per Adjusted Discharge was up 16.6% over the same time frame.

Key volume metrics in the latest report versus January-August 2019 include:

  • Adjusted Discharges: Down 4.8%
  • Emergency Department Visits: Down 11%
  • Operating Room Minutes: Down 1%
  • Average Length of Stay: Up 7.9%

The National Hospital Flash Report draws on Syntellis Performance Solutions data from more than 900 hospitals.

Kaufman Hall experts are available for comment, please contact Tyler Williams at