Ben Sawyer

Amidst the media coverage of the U.S. hospital staffing shortage crisis, less often reported is the disruption outside hospitals – namely post-acute care (PAC) facilities. Skilled nursing and rehabilitation facilities, long-term care centers and assisted living facilities are facing an even more dire workforce disruption than their acute care counterparts. 

When hospitals struggle to promptly discharge and transfer patients, it can trigger unfortunate consequences across the broader industry.

Shortages of nurses and other clinicians in PAC facilities mean hospitals in turn must spend even more of their limited time and resources locating an appropriate provider due to heavy patient loads or capacity issues downstream. This process inside many hospitals is already often under-resourced and inefficient, which leads to avoidable days spent in the hospital for the patient, all its associated health and safety risks as well as excess costs for the hospital. 

Transitions to PAC facilities, however, can be more automated and efficient in the hospital as well as the PAC facilities. Tech-enabled, centralized workflows have transformed the ways leading health systems admit and transfer patients into their network for acute care.

This highly automated model can also be used to transfer patients to PAC settings. Standardizing the discharge planning and coordination process across case management departments and utilizing best practices and workflows to seamlessly orchestrate prompt transition to the PAC facility can maximize the hospital throughput and optimize the patient journey and outcomes.

PAC demand growing 

In 2013, approximately 8 million patients were discharged to PAC facilities, or about 22% of all hospitalized patients, based on a 2016 report from the Agency for Healthcare Research and Quality. Of those transfers, 42% of patients had Medicare, 12% patients had private insurance, 8% were Medicaid beneficiaries, and 5% were uninsured. More than 40% of PAC discharges were to skilled nursing facilities.

Those numbers have likely only grown since this report was published given that millions more Baby Boomers have signed up for Medicare in the past nine years and have utilized both hospital and PAC facility services. 

One 2020 report predicts the number of people needing long-term care services, including SNFs, is expected to nearly double by 2030, reaching 24 million individuals. While this growth has likely slowed due to COVID-19, there is no doubt that the steadily aging patient population will continue to require specialized post-acute care that is too costly for hospitals and not feasible for home care.

However, if the transfer from the hospital to the SNF or any PAC facility is delayed due to staffing shortages at the next care venue or inefficient discharge planning, both patients and hospitals bear the fallout. For the patient, longer hospital admissions are associated with higher rates of readmission within 30 days and higher mortality rates. 

As evidence of this PAC facility discharge challenge, a study involving 100 patients admitted for neurological conditions who required PAC in a special facility found 39% of the days spent in the hospital were after the patients were determined medically ready for discharge to the PAC facility. The median excess days were 2.5, although one patient spent as long as 80 extra days in the hospital. For each unnecessary day the patient spends in the hospital, the risk of contracting a healthcare-acquired infection increases, as does their risk of harm due to medical error or falls

The costs for the associated care related to these conditions vary widely, with hospitals bearing the brunt of the financial burden. In 2021 alone, the Centers for Medicare& Medicaid Services reduced its payments to 2,499 hospitals, or 47% of all facilities, due to avoidable readmissions – a total reduction in payments of $521 million.

Modernize discharge workflows

Although most hospitals strive to begin planning for the patient’s anticipated discharge upon admission, the overwhelming need to solve immediate problems forces case managers to de-prioritize this important task. They are then required to locate an appropriate PAC facility in a shorter timeframe. But unless the PAC facility is an affiliate of the health system, the case manager has zero visibility into PAC center availability. They are likely then forced to use cumbersome manual processes to locate appropriate care, which can lead to an increase in a patient’s hospital length of stay, which accounts for as much as 30.7% of total patient costs.  

Discharging and transferring patients to PAC facilities, however, can be far more streamlined through system-wide automation and seamless data sharing between entities. Maximizing these resources is how large, integrated health systems across the country are strategically navigating patients inside their network, which is crucial for achieving their clinical and financial goals. 

Dedicating these mission-critical patient access and retention operations to a healthcare access and orchestration center that has real-time patient capacity visibility across the entire enterprise can help ensure a patient is discharged when medically cleared, thus reducing their health and safety risks. A prompt discharge and transfer process also creates a virtuous benefit across the care continuum by creating acute care access for the next patient, who could be sitting in an emergency department waiting for admission.

The smoother flow of patients enabled by automated technology alleviates some of the workforce disruptions that health systems everywhere now face. More importantly, though, ensuring prompt access to the appropriate level of care at every stage of the care journey promotes an optimal patient outcome, which is the primary and ultimate objective.

Ben Sawyer is the Vice President of Market Development at ABOUT (ABOUT Healthcare, Inc.), leading provider of access and orchestration solutions that empower health systems to operate as one connected network of care. Ben has his MBA in Healthcare Administration, is a licensed physical therapist, board-certified Orthopedic Clinical Specialist, and an experienced Lean Black Belt.

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.