AHA: Delayed Discharges Led to 19% Increase in Patient Length of Stay

The average patient length of stay in hospitals has increased by 19.2 percent in 2022 compared to pre-pandemic levels, according to an issue brief from the American Hospital Association (AHA).

Patients have been facing delays in discharges, making it harder for them to access additional care after a hospitalization, such as skilled nursing care, behavioral health services, or at-home therapy.

These delays can impact patient health outcomes and quality of life by slowing their recovery. In addition, hospitals and health systems must care for patients during the excess days without receiving proper reimbursement.

All sectors of the healthcare industry have been facing significant workforce shortages throughout the COVID-19 pandemic, including both acute care hospitals and post-acute care facilities. As a result of these staffing shortages, post-acute providers have been unable to accept new patients, creating patient bottlenecks at acute care hospitals.

Rehabilitation and long-term care hospitals have also reported patient bottlenecks as they struggle to discharge patients to post-acute care providers, like skilled nursing facilities.

The discharge delays have led to patients staying longer in hospitals. According to data from Strata Decision Technology, the average length of stay increased by 19.2 percent in 2022 from 2019 levels. The average length of stay for patients discharged to post-acute care providers grew by nearly 24 percent.

After adjusting for case mix index (CMI), which measures patients’ level of sickness and complex care needed, the average hospital length of stay still increased.

The adjusted length of stay rose by 15.4 percent for patients being discharged to all post-acute providers. The length of stay increased by 12.6 percent for patients discharged to home health agencies, 14.4 percent for those released to inpatient rehabilitation facilities, and 20.2 percent for those discharged to skilled nursing facilities.

The length of stay increase was the highest for patients discharged from acute care hospitals to psychiatric hospitals, at 28.9 percent.

When hospitals are left to care for patients during excess days, they do not receive reimbursement for the costs associated with this care. Hospitals are already facing financial challenges, including negative operating margins, rising expenses, and declining revenues.

“To help mitigate the costs of caring for patients for these excess days in the hospital and to ensure that patients are getting the most appropriate care possible, the AHA is asking Congress to establish a temporary per diem Medicare payment targeted to hospitals, including acute, long-term care, rehabilitation, and psychiatric, to ease capacity issues,” the issue brief stated.

The per diem payment would be made for stays where the patient is documented to be ready for discharge but cannot be discharged appropriately. These stays would be identified and assigned with a specific discharge code.

AHA suggested lawmakers model the strategy after an existing per diem Medicare payment mechanism and make it temporary with a cap on payments.