Why hospitals struggle to get patients discharged, sometimes for months


Due to severe staffing shortages in post-acute care facilities, many hospitals are struggling to discharge patients, leading to months-long delays and increased costs, writes Ginger Christ for Modern healthcare.

Aftercare facilities face severe staff shortages

According to industry experts, Skilled Nursing Facilities (SNFs) and Home Health Agencies (HHAs) have been the hardest hit by staffing shortages throughout the pandemic, leading to ‘bottlenecks’ in hospitals awaiting discharge of these patients, writes Christ. In some cases, patients waiting to be discharged to post-acute care facilities face months of delays as hospitals struggle to find an open placement.

According to federal data analyzed by GoodSkythe rejection rate in SNFs reached 88% in the first quarter of 2022, while the rejection rate in HHAs reached 71% in the second quarter of 2022. American Healthcare Association / National Center for Assisted Living (AHCA/NCAL) found that 61% of its members were limiting admissions due to a lack of staff.

When discharges are delayed, many patients have to stay in hospital, occupying inpatient beds and costing hospitals and health systems money. “I liken it to traffic. You hit the roadblock, and everything else comes to a screeching halt,” said Heather Thompson, patient care manager at Tillamook Adventist Health in Oregon.

To improve this situation, Holly Harmon, senior vice president of quality, regulatory and clinical services for the AHCA/NCAL, said post-acute care facilities will need more Medicaid funding and support. increased in training programs.

“Nursing home providers have done everything they can to recruit and retain staff, but with fixed government resources, we cannot solve this crisis on our own,” Harmon said.

How hospitals are improving their discharge processes

To address this growing problem, many hospitals and healthcare systems are working to improve their discharge processes, perform insurance authorizations in-house, and pay facilities to accommodate patients.

For example, Corey Leber, Associate Vice President of Nursing and Patient Care Services at ProMedica Hospital of Toledo, said the organization is reassessing its discharge processes to eliminate potential roadblocks. So far, it has reassessed who is included in daily transition cycles and moved a director to a capacity management role so he can focus on efficiency.

To Indiana University (UI) Health, authorities last November launched a pre-authorization process for post-acute care discharges with four insurance companies. According to Adria Grillo-Peck, vice president of integrated care management at IU Health, the pre-authorization process with these payers now takes eight hours, down from 48 to 72 before the change.

This decision saved IU Health 3,600 days, filled 682 beds, and realized more than $10 million in savings. Currently, the system handles about 17% of its pre-authorizations, but Grillo-Peck said it plans to work with two other insurers to increase that number.

To increase patient discharge rates from post-acute care, Sommer Kleweno Walley, CEO of the University of Washington Medicineit is Harborview Medical Centersaid the hospital has given post-acute care facilities additional payments to help them hire more staff to care for patients.

“We pay, per individual, an increased payment on top of what [facilities] get some insurance,” Kleweno Walley said. While those payments cost the hospital $8 million last fiscal year, it also benefited from the freeing up of beds.

In addition to these payments, Harborview also sends members of its post-acute care team, which includes doctors, nurse practitioners, social workers and behavioral health specialists, to help patients at the facilities free of charge. “He gives [post-acute facilities] the medical expertise and support they need,” said Kleweno Walley.

State hospital associations also help coordinate care

According to Christ, some state hospital associations, as well as local government agencies, have also stepped in to help reduce delayed discharges on behalf of their members.

For example, Washington Department of Social and Health Services (DSHS) last year began offering admission incentive payments of $6,000 to SNFs, as well as smaller payments to HHAs, to help patients get out of hospitals more easily.

The Washington State Hospital Association now try to get DSHS and the Washington State Health Authority to speed up their authorization process for patients staying in nursing homes.

Elsewhere, the Massachusetts Health and Hospital Association (MHHA) in February partnered with public hospitals and the Massachusetts Aged Care Association to form a collaboration on post-acute care transitions. So far, the collaboration has helped facilitate more than 200 referrals, though the MHHA said it doesn’t have placement numbers.

The Massachusetts Department of Public Health this spring launched a short-term rehabilitation program, which sent state-contracted nursing teams to post-acute care facilities to help care for patients. According to Adam Delmolino, MHHA’s director of virtual care and clinical affairs, the effort has helped release about 1,300 patients.

However, even with those efforts, Delmolino said many hospitals across the state are still experiencing a large backlog of patients awaiting discharge. In May, 1,066 patients from 44 Massachusetts hospitals were waiting to be discharged to post-acute care facilities.

“The need has been so great for our hospitals to find placements for our patients,” Delmolino said, but “the number of patients falling into that bucket continues to rise.” (Christ, Modern healthcare10/4)

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