Angie Franks

During the COVID-19 pandemic, acute and post-acute care (PAC) providers have experienced their own unique crises.

In acute care, providers have scrambled to find available ICU beds, physicians and critical care resources. Simultaneously, PAC providers have valiantly fought the virus’s spread among their vulnerable residents, so those critical care resources would not be required.

While the arrival of vaccines has helped alleviate some of the capacity and resource issues, acute and post-acute care providers now jointly share another major challenge: economic devastation. In addition to an estimated 55.6% drop in operating margin in 2020, hospitals are expected to lose as much as $122 billion in 2021 due to COVID-19, while 65% of nursing homes are operating at a loss.

The risks of delayed discharge

Along with the pandemic, value-based care is placing increasing pressure on hospital and health system expenditures, so it’s incumbent on these organizations to get back in the black by paying close attention to key metrics that drive reimbursements in shared risk and reward payment models. 

One study pinpoints how delaying a discharge to a PAC provider can directly impact a hospital’s bottom line. Researchers examined the records of 100 admitted neurology patients who were medically ready for discharge with plans for post-acute care. Nearly 40% of these patients’ inpatient days were after they were determined medically ready for discharge, with a median of 2.5 excess days spent in the hospital. 

Considering the average adjusted expense per inpatient day is $2,600, health systems can experience millions of dollars in unreimbursed costs if they cannot promptly discharge when a patient is medically ready. 

Such avoidable inpatient days could account for up to 30.7% of total costs, according to a meta-analysis in which researchers found the excessive inpatient days are also associated with cancellations of elective procedures, treatment delays for other patients and negative impacts on the discharged patient’s overall health trajectory, especially elderly patients, all of which are also financially damaging. 

Delayed discharge also contributes to an increase in mortality, infections, depression, reductions in patients’ mobility and their daily activities. Since clinicians are under significant pressure to discharge quickly, delays appear to contribute to staff stress and interprofessional relationships, which may influence patient care. 

Systemwide orchestration

One mutually beneficial way hospitals and PAC providers can respond to these economic and patient care challenges is by striving to improve the timeliness of hospital discharges and transfers to PAC facilities. With rapid approval of referrals from the hospital to an appropriate PAC provider, hospitals can expedite the transition of care while turning over the inpatient bed to accommodate another patient, representing a dual quality-of-care and financial benefit for the hospital. The PAC facility receiving a new patient also increases its revenue and avoids a costly vacancy. 

Post-acute care coordination technology is available to help hospitals discharge to PAC facilities sooner. Similar to a hotel-booking website, these solutions allow a discharge planner in the hospital to electronically search for and identify available PAC providers that best fit the patient’s clinical needs. The discharge planner can then electronically refer the patient to the PAC provider and receive a response, typically within the hour. This process is vastly more efficient and clinically sound compared to the typical way these referral requests are performed through phone calls, faxes and waiting hours or days for a response.

Continuum-wide reach

This newer, automated electronic process is similar to how large, integrated health systems across the country are strategically navigating patients into one of their Centers of Excellence for heart, stroke, trauma and other specialty areas since improving care access and retaining complex patients inside their health system is crucial to achieving their clinical and financial goals. 

Healthcare access and orchestration operations are consolidated to a single business unit inside health systems called the access or transfer center. These integrated units, increasingly necessary inside competitive healthcare markets, are focused on improving visibility, clinical and operational performance across the entire care journey beyond an isolated hospital stay, including PAC and beyond.

By agreeing to electronically link with such a care coordination solution and rapidly accept referrals, PAC providers can become valuable collaborators to the health system, especially if patients experience positive outcomes while under the PAC provider’s care. The PAC provider, in turn, is supported in their post-COVID-19 financial recovery and long-term sustainability through this mutually beneficial collaboration.

Angie Franks is CEO of Central Logic, which provides purpose-built access and orchestration solutions to ensure efficient patient navigation across health systems and through the continuum of care.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.