Nov 16, 2022 - Health

Hospitals seek more aid to house patients they can't discharge

Illustration of a hospital bed with a price tag.

Illustration: Aïda Amer/Axios

Health worker shortages are keeping hospitals from discharging patients for post-acute care and prompting pleas to Congress for per diem Medicare payments to cover the longer stays.

Why it matters: The requests add to a long list of health industry asks that Congress will have to sort through in the lame-duck session and underscore how the fallout from the pandemic is still rippling through the health care system.

How it works: Discharging patients to long-term care facilities was challenging even before the pandemic, but COVID-19 dramatically disrupted the process, making it hard for facilities to accept patients in the midst of outbreaks.

  • It's costly to keep patients in a hospital when they no longer need to be there, since facilities are typically paid a fixed rate based on a patient's condition or diagnosis.
  • The patients who can't be discharged are still too sick to go home and may have mobility issues, conditions like diabetes, or mental health needs.
  • Providence Health in Spokane, Wash., for example, is on track to spend nearly $18 million this year on nursing care for patients who no longer need to be hospitalized at its two facilities. A handful of patients have been on the premises for more than 100 days, Susan Stacey, Providence chief executive for inland northwest Washington state, told Axios.
  • "We're having workforce issues downstream, so that per diem could provide some targeted temporary relief to hospitals," said Aimee Kuhlman, a vice president of advocacy at the American Hospital Association.

Zoom in: Long-term care facilities continue to grapple with staffing problems, which limits the available spots for a hospital to discharge to.

  • The backlog has left patients with medical emergencies waiting on beds and sometimes dying, the American College of Emergency Physicians wrote in a letter to President Biden this month.
  • Some emergency departments that board patients have had backups extending into hallways, waiting rooms, and ambulances waiting to offload patients.
  • Normally, an emergency department can handle a challenge of tight capacity, high acuity or a staffing shortage, but when all three come together at once, it can quickly overwhelm an ER.
  • "The system is at a breaking point," Christopher Kang, president of the American College of Emergency Physicians, told Axios. His group has asked the administration to establish a nationwide council to address capacity problems and other stresses throughout the health system.

Yes, but: The requests could be drowned out by myriad other health interests seeking their own relief by year's end.

  • Nursing homes, long-term care and home health providers each cite a severe shortage of workers as threatening their business models.

What we're watching: The siloed health care system has many potential gaps in care, and while the pandemic forced closer collaborations, alliances may be difficult to formalize.

  • Facilities that accept Medicaid patients could limit the number of spots for those patients, due to payment rates that are lower than private coverage.
  • Skilled nursing facilities are still rejecting patient referrals from hospitals at higher rates than before the pandemic, data from WellSky shows.
  • The rejection of hospital referrals also could be a sign some facilities are trying to stay above water and maintain higher standards of care.
  • "You shouldn't bring a person in you can't care for because it would cause harm to that individual," said Lori Smetanka, executive director of the advocacy group Consumer Voice.
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