The Hospital Discharge Crisis: Defining the Challenge

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AUTHOR – ATI Advisory

In the aftermath of the COVID-19 pandemic, hospitals are struggling to find appropriate post-acute care placements for patients. The convergence of clinical workforce shortages, rising patient acuity, and the national mental health crisis has dramatically extended hospital stays, and left patients ready for discharge stranded in hospital beds. Anne Tumlinson, CEO and Founder of ATI Advisory, and Fred Bentley, Managing Director of ATI Advisory’s Post-Acute and Long-Term Care practice, hosted the first in a series of webinars unpacking challenges and solutions to this crisis.  

Hospital discharge delays have been documented across the United States in both high-income and low-income areas, impacting hospitals in urban, suburban, and rural communities. In Massachusetts, nearly 1 in 7 non-ICU hospital beds are currently occupied by a patient who no longer needs acute hospital care, and in Nebraska in January 2023, more than 100 patients waited more than 30 days to be discharged to a post-acute care facility.  

Over the last decade, the average hospital length-of-stay (LOS) for Medicare FFS beneficiaries had been declining, dropping to a low of 3.42 days in Q4 2019. During the pandemic, the average hospital LOS for these beneficiaries peaked at 3.79 days in Q1 2022. As of Q3 2023, it was resting at 3.62 days, not yet returned to pre-pandemic levels. This current spike in discharge delays will likely persist for many years given the U.S.’s rapidly aging population.  

While there are multiple root causes for today’s discharge crisis, the delays can be attributed largely to bottlenecks in SNF and psychiatric facility capacity. Severe SNF workforce shortages have resulted in limits being placed on new admissions, and many SNFs do not have the experience or capacity required to treat the growing behavioral health needs among the patient population. Other factors, including the lengthy Medicaid long-term care determination process and insurers’ prior authorization processes, also exacerbate delays in discharges to appropriate post-acute care settings.  

Addressing this crisis will require collaboration from states and providers across the healthcare continuum in aligning policy, physical infrastructure, and human infrastructure. States can incentivize timely hospital discharge and capacity growth in nursing facilities, providers can implement care management strategies to prevent unnecessary hospitalizations, and post-acute care providers can develop specialized capabilities to accommodate complex patient needs.  

ATI will continue to explore solutions to address the hospital discharge crisis in future webinars.

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