Discharge delays have a chokehold on America's hospitals

Patients are staying longer than they need to in hospital beds, leading to adverse health issues, capacity issues and delayed access to those beds for incoming patients, and this issue is only getting worse, experts at the American Hospital Association told Becker's.

Nationally, patient stays have increased by 19 percent in 2022 compared to 2019, and by 24 percent for patients in need of being discharged to post-acute care providers, a December 2022 report from the AHA found.

In certain states, the issue is growing significantly. A June 12 report from the Massachusetts Health and Hospital Association revealed that 1 in 7 medical surgical beds across the state are occupied by patients who no longer need acute care. 

"We've seen massive increases in the length of stay for patients, especially those that are waiting to be transferred to the appropriate care setting," said Bharath Krishnamurthy, AHA's director of health analytics and policy. "So what that tells us is that this issue of patients waiting to be transferred to the appropriate care setting is becoming a bigger and bigger deal for hospitals."

The issue, however, isn't isolated to hospitals, but extends to the care patients are able to receive as a result as well. 

Hurry up and wait

When a patient is ready to be discharged, but cannot due to myriad factors ranging from prior authorization issues to insurance denials, staffing shortages etc., they can suffer from mobility issues and are put at further risk for hospital-acquired infections, according to a March 2023 study. Discharge delays also place burdens on the health of individuals who are waiting to be admitted and take the place of a patient who has not yet been discharged.

"These increased days when patients are waiting to be transferred to the appropriate care setting — hospitals aren't reimbursed for those additional days that the patients have to stay there. And frankly once they are ready to be discharged, the hospitals are not necessarily the best place for them to be receiving that extended care," Mr. Krishnamurthy said. "It's really important that they be transferred to that appropriate care setting, but unfortunately, due to a number of reasons hospitals are unable to discharge those patients. So this is not only an issue for hospitals, but it's also an issue for patients who can't get that appropriate care that they need." 

During a time when 68 percent of hospitals nationally are operating at levels of financial loss, according to the AHA, not being reimbursed for those additional days can have a significant impact, he said. 

Technology and policy

AHA executives told Becker's that pinpointing a single solution to the issues caused by discharge delay burdens is nearly impossible, but a combination of policy changes and technological advances could aid struggling hospitals in the meantime. 

Some hospitals in rural areas have ramped up their use of technology to help with video monitoring of patients, for instance, rather than having a nurse sit with them for hours, Shannon Wu, senior associate director of payment policy at the AHA said. 

However, Mr. Krishnamurthy added that what is not often said in conversations surrounding hospital technology solutions to aid issues like discharge delays or short staffing, is that they always come at a cost, and hospitals are struggling to maintain profit margins as it is. 

"I just can't underscore enough the fact that hospitals are doing more and more with unfortunately, less and less," Mr. Krishnamurthy said. "Medicare, reimbursement for inpatient care has gone up over the past three years, about 7.5 percent. During that same time, hospitals' costs have increased 17.5 percent. That data alone illustrates in a nutshell the problems that hospitals are facing. So, when you talk about patients needing care staying in the hospital longer, it's just adding more and more burdens to hospitals."

Lacking one sweeping solution to the growing nationwide issue, the AHA executives said the biggest factor that will help is policy changes at a federal level. 

"As we're working to address these ongoing workforce shortage issues, which is just one part of our advocacy agenda, we've also been encouraging Congress to implement a temporary per diem Medicare payment to ensure that hospitals and health systems are properly reimbursed amid these discharge delays," said Devin Gerzof, senior associate director of federal relations at the AHA. 

Not only that, hospitals need federal officials and the public to understand the mountain of issues they are facing, Ms. Wu said. Behind the scenes of these growing discharge delays are the other issues mentioned above including a workforce pipeline that is not ready to replace all of those set to retire from the healthcare field, and work needs to be done there as well, she said.

"First it is important to recognize that this challenge still exists for hospitals and providers, and then to support these hospitals, clinicians and other providers, both with Medicare costs, but also with really increasing the workforce pipeline," Ms. Wu said. "Although that's not an immediate solution to discharge delays, but it is something that would at least get the conversation going and increase that pipeline to help across the healthcare continuum as well."

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars