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

16 Nov 2022 6:44 AM | Matt Zavadsky (Administrator)

This could be another value-added reason for EMS agencies to partner with hospitals to create Mobile Integrated Healthcare (MIH) ‘safe landing’ programs for patients who might be able to be discharged, either from the ED, or from an IP stay, if community paramedics were able to make scheduled visits, and be available 24/7 for any patient needs.


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

Arielle Dreher

November 16, 2022


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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