Hospitals and health systems are under increasing financial pressure due to lower revenue and higher costs, with many provider organizations falling into the red. 

“Nine months into an extremely challenging year characterized by dramatic fluctuations in margin, U.S. hospitals and health systems are still operating substantially below pre-pandemic levels,” writes Kaufman Hall in its September 2022 National Hospital Flash Report. Additional reports continue to surface that highlight the challenges that health systems face in 2023. 

Supply and drug costs have increased due to inflationary pressures, and labor shortages across all disciplines have significantly reduced revenue-generating potential. Hospitals and healthcare systems continue to transfer out or materially delay patient treatment opportunities due to resource constraints. Further, competition from healthcare disruptors, especially in the retail sector, is taking market share from traditional provider organizations. 

In the face of these market challenges and economic uncertainties, hospitals and health systems must aggressively seek to redesign internal and external processes that are inefficient or frankly ineffective. Though the traditional issues of demand, capacity and throughput must remain top-of-mind for healthcare leaders, previous methods of addressing these, in the face of elevated operating costs and reduced staffed capacity, must be replaced with innovative approaches. 

The clinical and financial costs of inefficiency

Healthcare leaders nationwide are focused on improving patient throughput in their organizations. They realize that they cannot meet the demand in their communities, given reduced capacity, without improving the throughput rate. In addition, patients that exceed their expected length of stay often result in non-reimbursed expenses. Reducing avoidable days, for example, saves nearly $2,900 per day for each patient while making more capacity available for waiting patients. It is important, however, to identify patient populations where the greatest throughput impact can be realized.

In 2019, a sweeping analysis of more than 17 million hospital discharges was conducted. It showed that 40% of Medicare patients required post-acute care at hospital discharge, and 90% of those required skilled nursing facility placement. The substantial number of patients in this category makes it an excellent target for innovative change with high impact.

Discharge to SNF is often an inefficient process that results in hours or days of delays and accumulated PAD, or possibly avoidable days. Many of these inefficiencies are due to poor orchestration between care teams and a lack of standardized patient transition processes and workflows. Those delays are traced to insurance authorization, SNF approval response time, engaging appropriate care providers, timeliness of recognizing need for SNF and initiating the process, arranging transportation, and more. 

In recent years, tech-enabled standardized workflows have transformed the ways leading health systems admit and transfer patients into their network for acute care. Similarly, highly automated systems can be used to transition patients out to PAC settings. These can also generate valuable data and visibility into the process, which have not traditionally been available. Leading systems automate secure communication, reduce faxing and phone calls, cast a broad net to multiple candidate facilities, improve patient choice compliance, standardize documentation, and generate valuable real time data. These systems are generally not part of EHRs but integrate and complement their functionality.

Solutions are not found through technology alone, however. Processes must be designed to work effectively in concert with technology. These must focus on overcoming the inefficiencies identified above. Many organizations implement some methods needed to improve discharge coordination to PAC, however most are fragmented and poorly understood by those involved. Additionally, no data is generated to review and improve the practices in place. The result is often a burdensome addition to daily nursing and physician activities with no appreciable benefit over doing nothing at all.

High-impact areas of PAC placement modernization

Hospitals and health systems that effectively modernize transitions to PAC through technology and redesigned processes realize numerous benefits, including: 

Reduced administrative burden for case managers

  • Eliminating most faxing and phone calls to PAC providers
  • Automating and accelerating transportation coordination, resulting in earlier discharges
  • Improving care manager employment satisfaction by functioning at top-of-license

Increased operational efficiencies and excellence

  • Gaining systemwide view of PAC network performance
  • Improving processes across multiple care management teams
  • Shared and reduced patient flow service and technology costs for transfers in and out to post-acute care settings 
  • Better understanding and adoption of MDR best practices

Shorter length of stay, improved patient outcomes

  • Earlier initiation of PAC placement processes in connection with timelier discharge planning
  • Mitigation of traditional delays, such as insurance authorization, SNF capacity constraints, patient and family choice reviews, etc. 
  • More complete communication between inpatient and post-acute care representatives to ensure successful patient transitions and improved preferred partnerships

Need for unified patient throughput platform and process

There is need for consolidated technology and processes that not only modernize the PAC placement action, but that also connect the discharging event “upstream” to patient progression through the episode of care and ultimately back to the admitting event, whether that began in the ED, as an interfacility transfer, direct admission, or PACU transfer, or through some other portal of entry. Additionally, it is important that the silos that the responsible parties function in be removed, and that their interests be more strongly aligned and coordinated. Only then can we effectively address the inseparably connected concepts of demand, capacity, and throughput.

Ultimately, as we do this, we will functionally overcome many other significant issues, such as the impact of staffing shortages, ED crowding and boarding, unnecessary transfers, delayed or poor accessibility to care, various administrative burdens, and so on. We have new issues facing us, and only innovative approaches, often leveraging existing resources, will address them fully. 

Darin Vercillo, M.D., is the Chief Medical Officer and co-founder of ABOUT, which draws upon his expertise in developing and implementing medical information systems specifically designed to manage complex patient needs, medical education, and faculty and staff logistics. A board-certified hospitalist practicing in the Salt Lake City area, Darin also served as a clinical advisor and technical developer at the University of Utah Health Sciences Center, and served as a physician knowledge engineer and interim Chief Medical Officer at TheraDoc.

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.