Nonprofit Hospitals Research Articles

Deficits in cognitive control during alcohol consumption after bariatric surgery.

While bariatric surgery results in substantial weight loss, one negative side effect of surgery is that patients often experience more rapid and intense intoxication effects after consuming alcohol. Given that alcohol use has been associated with impaired cognitive functioning in the general population, this study examined whether acute alcohol consumption after bariatric surgery immediately led to impaired cognitive control, and whether this effect was impacted by baseline levels of cognitive control. Nonprofit teaching hospital, United States. Participants were 34 adults who attended a laboratory visit before and 1 year after Roux-en-Y gastric bypass surgery, wherein they consumed a weight-based dose of alcohol and completed cognitive testing over the course of 3 hours. A series of generalized mixed-effect models demonstrated that performance on the cognitive task generally improved over time, likely due to practice effects. However, following bariatric surgery, individuals with impaired cognitive control before consuming alcohol experienced greater commission errors immediately afterward. These findings suggest that alcohol use after bariatric surgery may produce immediate deficits in inhibitory control among individuals who are already vulnerable to impaired cognitive control. Clinicians should seek to educate bariatric surgery candidates on this possible effect, as deficits in inhibitory control may ultimately lead to risky behaviors and poor adherence with postsurgical medical recommendations.

The Opportunity for Quality Malnutrition Care to Improve Rural Health Outcomes and Health Equity for Older Americans

Older adults have a heightened risk of malnutrition that occurs with age. Many factors can increase their risk for malnutrition, including factors associated with disease, function, social and mental health, and hunger and food insecurity. Risk for malnutrition is also linked to disparities and may disproportionately impact people living in rural areas. This Perspective paper outlines the issue of malnutrition and its impact on health outcomes and health disparities as well as summarizes existing evidence on malnutrition in rural healthcare institutions. Further it describes opportunities for malnutrition quality improvement and a new malnutrition quality measure, the Global Malnutrition Composite Score measure, that has recently been recommended by the National Quality Forum as a health equity measure for rural healthcare. The Perspective also suggests how this measure may help meet new health equity requirements of the Joint Commission and may help address needs identified in non-profit hospital community health needs assessments. The Perspective identifies resources for malnutrition quality improvement and the Composite measure, and shares key learnings from McPherson Hospital, a rural institution that has worked to improve malnutrition quality care. Finally, the Perspective suggests opportunities for rural healthcare institutions to better connect with community-based nutrition programs/services and recommends where more program development and policy support is still needed.

Trends in the Provision of Community-Building Activities by Nonprofit Hospitals, 2010-2019.

As part of their annual tax report, nonprofit hospitals are asked to report their community-building activities (CBAs); yet, little is known to date about hospitals' spending on such activities. CBAs are activities that improve community health by addressing the upstream factors and social determinants that impact health. Using data from Internal Revenue Service Form 990 Schedule H, this study used descriptive statistics to examine trends in the provision of CBAs by nonprofit hospitals between 2010 and 2019. While the number of hospitals reporting any CBA spending remained relatively stable at around 60%, the share of total operating expenditures that hospitals contributed to CBAs decreased from 0.04% in 2010 to 0.02% in 2019. Despite the increasing attention paid by policy makers and the public to the contributions that hospitals make to the health of their communities, nonprofit hospitals have not made corresponding efforts to increase their spending on CBAs.

Hospital adoption of harm reduction and risk education strategies to address substance use disorders

ABSTRACT Background: Hospitals are well-positioned to integrate harm reduction into their workflow. However, the extent to which hospitals across the United States are adopting these strategies remains unknown. Objectives: To assess what factors are associated with hospital adoption of harm reduction/risk education strategies, and trends of adoption across time. Methods: We constructed a dataset marking implementation of harm reduction/risk education strategies for a 20% random sample of nonprofit hospitals in the U.S (n = 489) using 2019–2021 community health needs assessments (CHNAs) and implementation strategies obtained from hospital websites. We used two-level mixed effects logistic regression to test the association between adoption of these activities and organizational and community-level variables. We also compared the proportion of hospitals that adopted these strategies in the 2019–2021 CHNAs to an earlier cohort (2015–2018.) Results: In the 2019–2021 CHNAs, 44.7% (n = 219) of hospitals implemented harm reduction/risk education programs, compared with 34.1% (n = 156) in the 2015–2018 cycle. In our multivariate model, hospitals that implemented harm reduction/risk education programs had higher odds of having adopted three or more additional substance use disorder (SUD) programs (OR: 10.5: 95% CI: 5.35–20.62), writing the CHNA with a community organization (OR: 2.14; 95% CI: 1.15–3.97), and prioritizing SUD as a top three need in the CHNA (OR: 2.63; 95% CI: 1.54–4.47.) Conclusions: Our results suggest that hospitals with an existing SUD infrastructure and with connections to community are more likely to implement harm reduction/risk education programs. Policymakers should consider these findings when developing strategies to encourage hospital implementation of harm reduction activities.

When States Mandate Hospital Community Benefit Reports, Provision Increases.

We examined the variation in community benefit and charity care reporting standards mandated by states to determine whether state-mandated community benefit and charity care reporting is associated with greater provision of these services. We used 2011-2019 data from IRS Form 990 Schedule H for 1,423 nonprofit hospitals to create a sample of 12,807 total observations. Random effects regression models were used to examine the association between state reporting requirements and community benefit spending by nonprofit hospitals. Specific reporting requirements were analyzed to determine whether certain requirements were associated with increased spending on these services. Nonprofit hospitals in states that required reports spent a higher percentage of total hospital expenditures on community benefits (9.1%, SD = 6.2%) compared to states without these requirements (7.2%, SD = 5.7%). A similar association between the percentage of charity care and total hospital expenditures (2.3% and 1.5%) was found. The greater number of reporting requirements was associated with lower levels of charity care provision, as hospitals allocated more resources to other community benefits. Mandating the reporting of specific services is associated with greater provision of certain specific services, but not all. A concern is that when many services must be reported, the provision of charity care might be reduced as hospitals choose to allocate their community benefit dollars to other categories. As a result, policymakers may want to focus their attention on the services they most want to prioritize.

The Reality of Commercial Payer-Negotiated Rates in Cleft Lip and Palate Repair.

Commercial payer-negotiated rates for cleft lip and palate surgery have not been evaluated on a national scale. The aim of this study was to characterize commercial rates for cleft care, both in terms of nationwide variation and in relation to Medicaid rates. A cross-sectional analysis was performed of 2021 hospital pricing data from Turquoise Health, a data service platform that aggregates hospital price disclosures. The data were queried by CPT code to identify 20 cleft surgical services. Within- and across-hospital ratios were calculated per CPT code to quantify commercial rate variation. Generalized linear models were used to assess the relationship between median commercial rate and facility-level variables and between commercial and Medicaid rates. There were 80,710 unique commercial rates from 792 hospitals. Within-hospital ratios for commercial rates ranged from 2.0 to 2.9 and across-hospital ratios ranged from 5.4 to 13.7. Median commercial rates per facility were higher than Medicaid rates for primary cleft lip and palate repair ($5492.20 versus $1739.00), secondary cleft lip and palate repair ($5429.10 versus $1917.00), and cleft rhinoplasty ($6001.00 versus $1917.00; P < 0.001). Lower commercial rates were associated with hospitals that were smaller ( P < 0.001), safety-net ( P < 0.001), and nonprofit ( P < 0.001). Medicaid rate was positively associated with commercial rate ( P < 0.001). Commercial rates for cleft surgical care demonstrated marked variation within and across hospitals, and were lower for small, safety-net, or nonprofit hospitals. Lower Medicaid rates were not associated with higher commercial rates, suggesting that hospitals did not use cost-shifting to compensate for budget shortfalls resulting from poor Medicaid reimbursement.

Are CEOs rewarded for managerial ability? Evidence from nonprofit hospitals

PurposeMost prior studies investigating determinants of CEO compensation in nonprofit hospitals ignore how managerial ability affects compensation. This study aims to examine whether CEOs with greater ability to manage corporate resources efficiently receive more payment in nonprofit hospitals.Design/methodology/approachThis study employs a sample of 764 observations from 85 Pennsylvania nonprofit hospitals for the period 2010–2020.FindingsThis study finds a positive and statistically significant association between managerial ability and CEO compensation. The results are robust to alternative measures of managerial ability.Practical implicationsThe measure of managerial ability proposed in this study could be used by boards of directors to quantify, evaluate and benchmark CEO ability. The results are also relevant to policymakers, stakeholders and the public interested in understanding the determinants of CEO compensation in nonprofits.Originality/valueThis study is among the first to use a more precise measure of managerial ability, which captures the unobserved manager-specific aspects of CEO ability. In addition, this study contributes to the literature by providing evidence that CEO's ability to manage hospital resources efficiently plays an essential role in designing executive compensation contracts.

Establishing Self-Harm Registers: The Role of Process Mapping to Improve Quality of Surveillance Data Globally.

Self-harm registers (SHRs) are an essential means of monitoring rates of self-harm and evaluating preventative interventions, but few SHRs exist in countries with the highest burden of suicides and self-harm. Current international guidance on establishing SHRs recommends data collection from emergency departments, but this does not adequately consider differences in the provision of emergency care globally. We aim to demonstrate that process mapping can be used prior to the implementation of an SHR to understand differing hospital systems. This information can be used to determine the method by which patients meeting the SHR inclusion criteria can be most reliably identified, and how to mitigate hospital processes that may introduce selection bias into these data. We illustrate this by sharing in detail the experiences from a government hospital and non-profit hospital in south India. We followed a five-phase process mapping approach developed for healthcare settings during 2019-2020. Emergency care provided in the government hospital was accessed through casualty department triage. The non-profit hospital had an emergency department. Both hospitals had open access outpatient departments. SHR inclusion criteria overlapped with conditions requiring Indian medicolegal registration. Medicolegal registers are the most likely single point to record patients meeting the SHR inclusion criteria from multiple emergency care areas in India (e.g., emergency department/casualty, outpatients, other hospital areas), but should be cross-checked against registers of presentations to the emergency department/casualty to capture less-sick patients and misclassified cases. Process mapping is an easily reproducible method that can be used prior to the implementation of an SHR to understand differing hospital systems. This information is pivotal to choosing which hospital record systems should be used for identifying patients and to proactively reduce bias in SHR data. The method is equally applicable in low-, middle- and high-income countries.

Price transparency of prostate cancer care in the United States: An analysis of pricing and disclosure following the centers for medicare and medicaid mandate.

Starting January 1, 2021, Centers for Medicare and Medicaid Services required United States hospitals to publicly disclose prices of their services provided. We analyzed publicly-disclosed prices of prostate cancer-related services. All United States hospitals were queried for publicly-disclosed prices of total and free prostate-specific antigen, prostate magnetic resonance imaging, prostate biopsy, radical prostatectomy, and intensity-modulated radiation therapy as of May 2022. Prices were adjusted by regional price parity. Hospitals disclosing prices were compared with non-disclosing hospitals. Of 6013 hospitals, 3840 (64%) disclosed pricing for at least one prostate cancer-related service. Compared to non-disclosing hospitals, disclosing hospitals had higher median gross annual revenue ($318,502,426 vs. $62,930,436, p < 0.001) and were more likely to be non-profit (56% vs. 30%, p < 0.001), academic-affiliated (46% vs. 13%, p < 0.001), and in neighborhoods with low hospital density (68% vs 62%, p < 0.001). Self-pay prices were higher than insurance-negotiated prices for all services (p < 0.001) other than prostate biopsy. The range of pricing was widest for self-pay prostatectomy, with a 32-fold difference from 90th to 10th percentile ($47,445 to $1476). Self-pay prices of total prostate-specific antigen, magnetic resonance imaging, biopsy, intensity-modulated radiation therapy, and prostatectomy were higher at academic vs. non-academic, for-profit vs. non-profit hospitals, and hospitals in the top quartile of gross annual revenue vs. the third and fourth quartiles (p < 0.01). Self-pay prices of prostate biopsy and prostatectomy were higher in urban vs. rural neighborhoods and neighborhoods with high vs. low hospital density (p < 0.001). Self-pay prices of prostate cancer services were generally higher than insurance-negotiated prices and were higher at for-profit hospitals, academic hospitals, and hospitals in the highest quartile of gross annual revenue. Higher neighborhood hospital density was not associated with higher likelihood of price disclosure nor lower pricing of services, suggesting that local competition does not lead to lower prices and may disincentivize disclosure of prices.

THE IMPACT OF EMPLOYEE EMPOWERMENT ON CONTINUOUS IMPROVEMENT OF HEALTH CARE: AN EMPIRICAL AND COMPARATIVE STUDY BETWEEN HOSPITALS

The study has been aimed to know the impact of Employee Empowerment on CI of health care between hospitals (government and private). The required data for the purpose of this study were collected by a questionnaire designed on the basis of related practices. It consisted of 73 items divided into two domains, the first one to measure employee empowerment practices (37 items), and the second one to measure CI practices (36 items). The study sample was applied to the (326) respondents; The total number of respondents from hospitals was 326; That is, 76% of the total number of the target group, which is (431) respondents, with a response rate of 96%, which is high percent because the researcher distributed the questionnaires personally. Using IBM SPSS and a comparative descriptive-analytical approach. Three themes emerged from the respondents’ trends. First, the existence of employee empowerment application in government hospitals was moderately level, and in private hospitals was in a high level, and also the existence of CI application in government hospitals was in a low level, and in private hospitals was in a high level. Second, there is a strong correlation between employee empowerment and CI of health care in hospitals (government, private). Third, there is statistically significant impact at the level (α ≤ 0.05) of the Employee empowerment on CI of health care whether the dimensions of CI are combined or fragmented in hospitals. The limitation of this study was in fixed bureaucracy structure in governmental hospitals and competitiveness issues in private hospitals. The study dealt with a dependent variable that was rarely studied by previous Arab studies and also rarely comparative study between profit and nonprofit hospitals.

Relative Productivity of For-Profit Hospitals: A Big or a Little Deal?

This study asks: Does the empirical evidence support the conclusion that for-profit (FP) hospitals are more productive or efficient than private not-for-profit (NFP) hospitals or non-federal public (PUB) hospitals? Alternative theories of NFP behavior are described. Our review of individual empirical hospital studies of quality, service mix, community benefit, and cost/efficiency in the United States published since 2000 indicates that no systematic difference exists in cost/efficiency, provision of uncompensated care, and quality of care. But FPs are more likely to provide profitable services, higher service intensity, have lower shares of uninsured and Medicaid patients, and are more responsive to external financial incentives. That FP hospitals are not more efficient runs counter to property rights theory, but their relative responsiveness to financial incentives supports it. There is little evidence that FP market presence changes NFP behaviors. Observed differences between FP and NFP hospitals are mostly a "little deal."

Comparison of the Financial and Operational Characteristics of For-Profit and Nonprofit Hospitals Receiving Federal Graduate Medical Education Payments, 2011-2020

This study compares graduate medical education (GME) payments between nonprofit and for-profit hospitals between 2011 and 2020 to assess how hospitals value GME.

The Value of Core and Noncore Activity Fit for Corporate Social Responsibility: An Expectation-Based Study of Nonprofit Hospitals

Corporate social responsibility (CSR) fit is the congruence between an organization's CSR and core activities. Previously, researchers have typically studied CSR fit as a single dimension, often finding that high-fit CSR is more effective than low-fit CSR for for-profit firms. The current research distinguishes between two dimensions of CSR fit—CSR that fits with core or noncore organizational activities—to uncover how the magnitude of investment in each type of CSR affects customer satisfaction. The authors examine the valuable and understudied context of nonprofit organizations, specifically hospitals. Results of a six-year study of over 1,500 nonprofit hospitals suggest that noncore activity CSR positively predicts customer satisfaction, but core activity CSR does not. These findings are best explained using expectation-based theories (expectancy violation and disconfirmation): customers likely expect core activity CSR from hospitals (e.g., charity care for uninsured patients) but are delighted by noncore activity CSR (e.g., green-space renovations). In addition, noncore activity CSR becomes even more important for customer satisfaction for more affluent hospitals, whereas core activity CSR becomes increasingly important for hospitals when the community socioeconomic status is low. These nuanced results provide guidance for hospitals regarding specific CSR investment strategies that ultimately impact downstream financial reimbursements.

Availability of Evidence-Based Diabetes Programs in U.S. Children's Hospitals.

Diabetes affects Americans across the lifespan requiring individual and community-level interventions for prevention and management. Nonprofit hospitals are required to address community health needs under current tax law. The study objective was to assess what strategies children's hospitals implemented in prevention and care of diabetes and determine how many hospitals used evidence-based strategies. We identified the most recent Children's Hospital Needs Assessments and implementation strategies for each hospital. Data were thematically coded. Twenty-nine of the 233 U.S. children's hospitals addressed diabetes in their community benefit investments. Of the 130 hospital programs, 48 (37%) aligned with the DSMES framework. Programs focused on prevention (32%), healthy eating (18%), education (15%), physical activity (12%), quality improvement (11%), and self-management (5%). Most children's hospital interventions (85%) did not state a focus on reducing health disparities and none addressed problem solving or diabetes technology. Minimal hospitals are using evidence-based programming for diabetes management and are not targeting health disparities which undercuts their efforts. Hospitals are not adopting structural evidence-based approaches, missing key opportunities to implement strategies shown to reduce diabetes prevalence and lower A1c. This study suggests that children's hospitals need improvement in their diabetes programming to better serve their communities.

Self-Assessment of Patient Safety Reporting and Learning System in Private Hospitals in Indonesia.

Hospitals are required to implement patients safety incident (PSI) reporting, analysis, and problem-solving. Self-assessment is important for exploring gaps and strengthening PSI reporting and learning system. This study examined PSI reporting and learning systems through self-assessment based on WHO guidance, analysis of section scores by hospital class, and analysis of section relationships. This cross-sectional study was conducted on 193 health workers from 47 Indonesian non-profit private hospitals selected using non-probability sampling. Samples in each hospital consisted of seven hospital staff, including quality and patients' safety committee, infectious diseases control committee, manager/head of nursing, as well as functional staff comprising doctors, nurses, pharmacists, and nutritionists. Six aspects based on WHO guidance were measured in this study namely 1) environment for reporting, 2) reporting rules and content, 3) analysis and investigation, 4) governance, 5) action and learning, as well as 6) patients' and family engagement. The data obtained were analyzed using univariate and bivariate analysis. The results showed that the total average score was 64.7 ± 3.3, and the average score on all components of PSI reporting and learning system was minimum 59.3 and maximum 69.6 of a total score of 100. The lowest average score was found in patients' and family engagement component at 59.3 ± 8.4. Class B hospitals had higher average scores on each component than class C and D hospitals, except on the action and learning and patients' and family engagement section. There was a significant positive linear correlation between each section of PSI reporting and learning system (p-value < 0.01). The PSI reporting and learning system in hospitals is in need of improvement across all aspects. One specific area that requires attention is the implementation of mechanisms for patient and family engagement, which can play an important role in promoting safety programs.

The Early Impact of the COVID-19 Pandemic on Hospital Finances.

The COVID-19 pandemic has caused both short- and long-term impacts on every aspect of society. Hospitals are among the most critical frontliners and have had to continually navigate the challenges caused by the pandemic. In this study, we examined hospitals' financial performance following the onset of the pandemic. We used data from the Centers for Medicare & Medicaid Services Healthcare Cost Report Information System. The study sample included all general acute care and critical access hospitals that receive Medicare payments. The primary outcomes included operating margins, net patient revenues, operating expenses, and uncompensated care costs. We tested for average changes from 2019 to 2020 in hospitals' financial outcomes. We also tested for changes in financial outcomes across samples stratified by hospital characteristics: ownership type (investor-owned, nonprofit, and public), Medicaid disproportionate share hospital status, rural status, county uninsured rate quartile, and Medicaid expansion status. Our sample consisted of a balanced panel of 4,059 hospitals (8,118 observations) with data spanning 2019 and 2020. Across the full sample of hospitals, operating margins declined by an average of 5.3 percentage points between 2019 and 2020, equating to a 130% reduction from 2019 levels. Underlying these margin declines, net patient revenues declined by 3.2% on average, while operating expenses increased by 1.5%. We observed no changes in uncompensated care costs despite the large number of job losses that accompanied the pandemic. When stratifying the analysis by hospital characteristics, differences were observed across ownership types. Notably, investor-owned facilities were less affected financially than nonprofit and public hospitals. Although safety-net and rural hospitals generally fared no worse than their non-safety-net and nonrural counterparts, hospitals located in Medicaid expansion states experienced steeper declines in operating margins relative to hospitals located in nonexpansion states, driven by larger relative declines in patient revenues. The operating margin declines we observed can be attributed to supply-chain issues, persistent labor shortages, and suspension of elective services. The Affordable Care Act reforms in health insurance markets likely helped to insulate hospitals from increases in uncompensated care costs. In the shifting context of the pandemic, it is important to understand hospitals' financial performance so that measures can be taken to address further financial distress that may eventually lead to increased consolidation, hospital closures, and lower quality of care. Our findings stress the need for targeted responses that are tailored to underlying hospital characteristics. Temporary and targeted increases in inpatient and outpatient service prices can help offset revenue losses from the deferment of nonurgent care. Other policies can address the ongoing workforce challenges and supply-chain issues.

Hospital-based health technology assessment of innovative medical devices: insights from a nationwide survey in France.

To better understand the process of hospital acquisition of innovative medical devices (MDs) and the hospital-based health technology assessment (HB-HTA) pathways in France, an in-depth study based on a quantitative approach is needed. The aim of the present study was to assess through a national survey how HB-HTA is currently implemented in French hospitals and to identify its level of formalization. A quantitative online survey was conducted among hospitals performing HB-HTA in France, with a focus on the acquisition of innovative MDs for individual use. The survey, conducted between March and June 2022, was developed by a scientific board composed of members of the French-speaking Society for HB-HTA. Sixty-seven out of 131 surveyed hospitals with HB-HTA activities responded, including 29 university hospitals, 24 nonprofit private hospitals, and 14 local hospitals. Sixty-one respondents (91 percent) reported the existence of a process dedicated to evaluating innovative MDs; of these, 16 declared that their hospitals had a formalized unit with HB-HTA activity. These units were more frequently found in larger hospitals with more than 500 inpatient beds (n=16, p=0.0160) and in university hospitals (n=12, p=0.0158). No hospital reported any collaboration with HAS, the French national HTA agency. A diverse range of HB-HTA organizations with different structural levels exist in France for MD procurement linked to the category of hospitals. The study highlights the need for recognition of HB-HTA activity at the regulatory level in France and for direct collaboration between HTA activities performed at local and national levels.

What Should Antiracist Payment Reform Look Like?

Racism reduces eligibility for health insurance and access to high-quality care for people of color in the United States, and current payment structures exacerbate the resultant de facto racial segregation. Payers and health plans do not adequately support and incentivize clinicians and health care delivery organizations to meet the health needs of minoritized communities. This article describes foundational work needed to create an antiracist culture of equity; the Roadmap to Advance Health Equity; and specific, actionable antiracist payment reform strategies, including increasing access to and the scope of health insurance coverage, antiracism accountability in managed-care contracts, support for the safety-net system, strengthened nonprofit hospital tax status requirements, and payment incentives to advance health equity. Antiracist payment reforms have great potential to desegregate health care systems and to ensure that everyone has a fair opportunity to receive good health services and optimize their health.

Trends in the Prioritization and Implementation of Substance Use Programs by Nonprofit Hospitals: 2015-2021.

Hospitalizations are an important opportunity to address substance use through inpatient services, outpatient care, and community partnerships, yet the extent to which nonprofit hospitals prioritize such services across time remains unknown. The objective of this study is to examine trends in nonprofit hospitals' prioritization and implementation of substance use disorder (SUD) programs. We assessed trends in hospital prioritization of substance use as a top five community need and hospital implementation of SUD programing at nonprofit hospitals between 2015 and 2021 using two waves (wave 1: 2015-2018; wave 2: 2019-2021) by examining hospital community benefit reports. We utilized t or χ 2 tests to understand whether there were significant differences in the prioritization and implementation of SUD programs across waves. We used multilevel logistic regression to evaluate the relation between prioritization and implementation of SUD programs, hospital and community characteristics, and wave. Hospitals were less likely to have prioritized SUD but more likely to have implemented SUD programs in the most recent 3 years compared, even after adjusting for the local overdose rate and hospital- and community-level variables. Although most hospitals consistently prioritized and implemented SUD programs during the 2015-2021 period, a 11% removed and 15% never adopted SUD programs at all, despite an overall increase in overdose rates. Our study identified gaps in hospital SUD infrastructure during a time of elevated need. Failing to address this gap reflects missed opportunities to engage vulnerable populations, provide linkages to treatment, and prevent complications of substance use.

1040. Comparative Surge Data on SARS CoV-2 Variants in a Rural Community – A Virtual Hospital Experience

Abstract Background UNC Health Blue Ridge is a nonprofit community teaching hospital with 145 staffed beds. The COVID-19 pandemic has challenged rural hospitals like ours with high occupancy and periodic surges. UNC Health Blue Ridge COVID Virtual Hospital (CVH) created a home monitoring program for enrolled patients with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection utilizing disease risk stratification and pulse oximeter readings to dictate nurse and clinician follow-up. We report raw data that compare surge levels in our community for the Alpha (B.1.1.7), Delta (B.1.617.2) and Omicron (B.1.1.529) surges. Methods From April 2020 to present, the CVH enrolled patients diagnosed with COVID-19 based on FDA approved PCR tests. For this abstract, we defined any surge as an outpatient CVH census of greater than 50 patients or an inpatient census of &amp;gt;10 patients. We defined the maximum intensity of the surge as &amp;gt;20% outpatient SARS CoV-2 positivity and a CVH census &amp;gt;100 patients or &amp;gt;20 inpatients with SARS CoV-2 infection. Results For the outpatient setting, days of surge and maximum intensity were 144 / 98 days for Alpha, 92 / 71 days for Delta, 74 / 47 days for Omicron, respectively. Average daily CVH admissions during surges were 17.7 for Alpha, 26.15 for Delta, and 27.15 for Omicron. Total emergency department (ED) and urgent care visits were 12,765 and 23,696 for Delta, and 9701 and 16102 for Omicron. In the inpatient setting, days of surge and maximum intensity days were 102/76 days for Delta and 78/48 days for Omicron. Our peak inpatient COVID-19 daily census was 51 and 50 patients for Delta and Omicron. Conclusion Our CVH has enrolled over 8700 patients, and our hospital has not been on diversion during the COVID-19 pandemic, unlike many surrounding hospital systems of similar size. More importantly, the CVH has helped create a sustainable model that gathers local data to aid predictive algorithms and facilitate proactive rather than reactive resource allocations. This virtual model can be adapted for multiple other health conditions in the outpatient setting to improve patient safety and quality care. Disclosures All Authors: No reported disclosures.