- Increased delays in discharging patients who require additional care after a hospital stay could slow their recovery, potentially harming health outcomes and quality of life, the American Hospital Association cautioned in a report released Tuesday.
- The inability to discharge patients is putting additional strain on hospitals operating with thin workforces, and health systems are bearing the cost of care for patients who stay excess days without appropriate reimbursement, the AHA said.
- The association has urged Congress to help offset the costs of care for patients' additional days in the hospital by creating a temporary per diem Medicare payment targeted to acute, long-term care, rehabilitation and psychiatric facilities.
Severe shortages of both clinical and non-clinical workers have challenged acute care hospitals, rehab centers, long-term care facilities and post-acute care providers alike, resulting in bottlenecks that are preventing timely transfer of patients ready to be moved.
Longer patient stays have some hospitals such as the Mayo Clinic operating near capacity, even as admissions decline. In an effort to better manage patient flows, the Cleveland Clinic recently entered into an agreement with Palantir Technologies for use of the software company’s artificial intelligence models to free up capacity by matching supply and demand with workforce scheduling.
The average patient length of stay in hospitals has increased by 19% this year, compared to 2019 levels, the AHA said, citing data from Strata Decision Technology. For those awaiting discharge to post-acute care settings, the increase in delay is nearly 24%.
Holdups in discharging patients to post-acute providers such as skilled nursing, behavioral health care or therapy at home come as hospitals struggle under the weight of financial pressures from labor challenges and historic inflation. Consulting firm Kaufman Hall has predicted that 68% of hospitals will end the year operating at a financial loss.
Even before the pandemic, costs for workforce recruitment, retention, benefits, incentives and training accounted for more than 50% of hospitals’ total expenses. By the end of 2021, hospitals’ labor expenses per patient were 19% higher than pre-pandemic levels, the AHA said in a letter to Congress.
The hospital lobby said the per diem payment it is asking Congress to authorize would be made for cases identified with a specific code for long stays where the patient is ready for discharge but unable to be released appropriately. The relief funding could be modeled after an existing per diem Medicare mechanism, with a cap on payments, the AHA said.
"It is critically important to ensure that hospitals and health systems remain financially stable, so that they can continue to provide high quality care to patients and communities throughout the country," the AHA said.