Discharge delays: Hospitals are forced to keep patients who could be released

Hospitals and health systems say they are essentially boarding patients who are ready to be discharged, due to a lack of post-acute care options.

And they say it’s another factor adding to their ongoing financial challenges.

Throughout the COVID-19 pandemic, hospitals have said they’ve been forced to keep patients longer than necessary because there aren’t enough available beds at nursing homes and other post-acute facilities. The problem has continued in recent months.

During a forum held by the Washington State Hospital Association earlier this month, leaders said the inability to discharge patients continues to be a thorny problem.

“Hospitals get paid very little or nothing to care for these patients once their acute care issue is resolved,” said Cassie Sauer, CEO of the Washington State Hospital Association. “And additionally, hospitals lose revenue from patients whose care is delayed because the beds are full.”

• Read more: Washington state hospitals say ongoing losses are unsustainable

Sauer also expressed her frustration at a common response she said she has received from state officials, who have said that’s just one patient.

If that one patient has been in the hospital for 90 days, that patient is actually taking the place of up to 30 different patients, Sauer said. And hospitals don’t get the same reimbursement from insurers or the government for patients who aren’t receiving acute care, she says. (The story continues below the video.)

Hospital officials said they have long faced hurdles in transferring patients to post-acute facilities when they are ready to be released, but they say the problem is worsening.

California health systems are also feeling the strain of housing patients who no longer need acute care but remain in hospital beds because they are waiting to be transferred to a nursing home or long-term care facility.

The California Hospital Association said earlier this month that housing patients that could be discharged is costing the state’s hospitals up to $2.9 billion annually.

The California association surveyed its members and said that at least 5,000 patients each day are seeing their discharge delayed. The survey says that includes 2,250 patients in general acute care, 2,000 temporarily staying in emergency departments and 750 in acute psychiatric care.

More than three-quarters (78%) of those surveyed by the California Hospital Association cited the lack of available beds at skilled nursing facilities as the chief factor in the delays. Some also cited delays or denials from insurance companies as a factor in discharge delays.

California hospitals also say they are more likely to see delays in discharge that are related to the payer mix. Patients relying on Medicare and Medicaid are more likely to see delays in discharge, according to the survey.

On the other side of the country, hospitals in Massachusetts say they are keeping too many patients who no longer require acute care.

The Massachusetts Hospital Association released a report in June 2023 that found that one out of every seven medical-surgical beds are unavailable due to patients that no longer need hospital care. About 1,200 patients are awaiting discharge to a nursing home or other post-acute care facility, a community-based setting, or a psychiatric facility, the association said.

Steve Walsh, president and CEO of the Massachusetts Hospital Association, said the delays are also making it harder for other patients to get the care they need.

“This backlog of stuck patients is playing a major role in driving up wait times and obstructing access to care,” Walsh said in a June statement. “We saw a tremendous level of collaboration across healthcare throughout COVID-19, and it will take that same level of focus to resolve capacity issues.”

The American Hospital Association released a report in December that found patients nationwide are staying in hospitals longer.

In 2022, the average length of stay was 19% higher than in 2019, according to the report. For patients awaiting transfer to post-acute care facilities, the typical length of stay rose 24% from 2019 to 2022.

The AHA has been pressing lawmakers in Washington to offer more assistance for health systems that are housing patients who are ready to be discharged. The organization has asked lawmakers to approve a temporary Medicare payment for hospitals who are continuing to house patients due to a lack of post-acute care options.

Hospitals and health systems are seeing some improvement in their financial performance this year, but many providers continue to see modest operating margins.

Nursing homes say they have had to limit capacity due to their struggles in recruiting and retaining workers, and that has made it more difficult for hospitals to transfer patients.