Delays experienced during a patient’s discharge to a post-acute care facility are one of the biggest challenges facing hospitals in the U.S., according to a report published April 30 by the American Hospital Association.
The AHA’s “The Cost of Caring: Challenges Facing America’s Hospitals in 2025” report outlines key issues influencing the financial stability of hospitals.
According to data from Strata Decision Technology, Medicare Advantage patients are staying at hospitals longer than patients with traditional Medicare before being discharged to a post-acute care facility. Despite the longer stays, MA reimbursement fell 8.8% between 2019 and 2024.
Here is how much longer length of stay was for Medicare Advantage patients compared to patients with traditional Medicare:
| Year | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |
| Percentage difference | +6.4% | +6.0% | +10.5% | +14.7% | +13.9% | +12.6% |
Delays during patient discharge can be attributed to prior authorization requirements and a lack of post-acute providers within MA plans, the report said.
An added discharge-related challenge some hospitals will be required to navigate in 2026 is CMS’ new alternative payment system, called the Transforming Episode Accountability Model.
Under the new payment system, more than 700 hospitals will be required to coordinate post-acute care for Medicare beneficiaries who have undergone one of five surgeries: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft and major bowel procedure.
When the model takes effect, participating hospitals will be held responsible for the patient’s care quality and costs for 30 days after discharge from the hospital.
CMS said the new model aims to “incentivize care coordination, improve patient care transitions and decrease the risk of avoidable readmission.”
