The American Hospital Association (AHA) has released a new report on delays in hospitals’ ability to discharge patients to the most appropriate care setting and the negative consequences these delays are having on patients and the hospitals that care for them.
The average length-of-stay in hospitals has increased by approximately 19% for patients in 2022 compared to 2019 levels, according to data from Strata Decision Technology, a health care consulting firm. The increase is even more pronounced for patients being discharged to post-acute care providers – nearly 24% from 2019 to 2022. This remains true even after accounting for patients being sicker and requiring more complex and intensive care now as compared to pre-pandemic levels.
Delays in discharge can negatively impact patients' health outcomes or slow their recovery by forcing them to stay in the hospital longer than medically necessary. Instead, many of these patients should be discharged in a timely manner to post-acute care providers, including behavioral health providers, which specialize in caring for patients after a hospitalization. Delays in discharges also impact hospitals and health systems by putting additional pressure on an already overwhelmed workforce and can put access to care at risk for the wider community.
"Hospitals and health systems are dedicated to providing patients with the right care, in the right place, at the right time," said AHA President and CEO Rick Pollack. "Delays in patient discharges create bottlenecks in the health care system, adding to the already overwhelming challenges facing our hospitals and caregivers. Temporary relief to overburdened hospitals and other providers will help ensure patients get the most appropriate care and will relieve stress on front-line health care workers."
Hospitals do not receive reimbursement for the costs associated with caring for patients for the additional days they are in the hospital while they wait to be discharged. These additional costs further strain hospitals across the country that are dealing with a range of financial pressures from historic levels of inflation to skyrocketing costs, as well as their own workforce challenges. Data from the health care consulting firm Kaufman Hall found that hospitals’ expenses are projected to increase by $135 billion in 2022 alone, with 68% of hospitals possibly ending the year operating at a financial loss.
To help mitigate the costs of caring for patients for these excess days in the hospital, and to ensure that patients are getting the most appropriate care possible, the AHA is asking Congress to establish a temporary per diem Medicare payment targeted to hospitals, including acute, long-term care, rehabilitation, and psychiatric, to ease capacity issues. This per diem payment would be made for cases identified and assigned with a specific discharge code that fall under such type of long stays where the patient is documented to be ready for discharge but is unable to be discharged appropriately. The solution could be modeled after an existing per diem Medicare payment mechanism and be temporary, with a cap on payments.