Association Between COVID-19 Relief Funds and Hospital Characteristics in the US.

Importance: In response to financial stress created by the reduction in care during the COVID-19 pandemic, hospitals received financial assistance through the Coronavirus Aid, Relief, and Economic Security (CARES) Act program. To date, the allocation of CARES Act funding is not well understood. Objective: To examine the disbursement of the High-Impact Distribution CARES Act funds and the association between financial assistance and hospital-level financial resources prior to the COVID-19 pandemic. Design Setting and Participants: This cross-sectional analysis of US-based hospitals and health systems assesses the hospital characteristics associated with CARES Act funding with linear regression models using linked hospital and health system-level information on CARES Act funding with hospital characteristics from Hospital Cost Report data. Exposures: Hospital and health system CARES Act financial assistance. Main Outcomes and Measures: Hospital and health system affiliation, status, and financial health prior to the COVID-19 pandemic. Data analysis took place from December 2020 through June 2021. Results: The analysis included 952 hospital-level entities with an average payment of $33.6 million, most of which was received during the first payment round. Wide ranges existed in CARES Act funding, with 24% of matched hospitals receiving less than $5 million in funding and 8% receiving more than $50 million. Academic-affiliated hospitals, hospitals with higher pre-COVID-19 assets and hospitals with higher COVID-19 cases received higher levels of funding, while critical access hospitals received lower levels of financial assistance. A 10% increase in hospital assets, endowment size, and COVID-19 cases was associated with 1.4% (95% CI, 0.8% to 2.0%; Conclusions and Relevance: In this cross-sectional study of US hospitals and health systems, findings suggest that High-Impact Distribution CARES Act funds may have disproportionately gone to hospitals that were in a stronger financial situation prior to the pandemic compared with those that were not, but funds also went disproportionately to those that eventually had the most cases.