Hospitals, postacute providers, and payers are facing new pressure amid unprecedented resource constraints due to the COVID-19 pandemic and other industry changes.
“The pandemic has disrupted traditional acute-to-postacute transition patterns, leaving hospitals with limited options to safely and efficiently discharge patients to skilled nursing, postacute rehab, and other settings,” said Mary Kay Thalken, RN, MBA, chief clinical officer at Ensocare.
During a recent HealthLeaders presentation, Thalken shared key industry transformations occurring in response to this challenge, including innovative hospital programs and new technology solutions that are improving how patients transition between acute and postacute care settings.
Pandemic introduces new challenges while exacerbating old ones
“Historically, the transition from acute to postacute settings has been a bumpy road under fee-for-service reimbursement,” said Thalken. Discharge planners faced several challenges, including having to reconcile each patient’s clinical and functional status with many nonclinical factors such as postacute capacity, speed of acceptance, and payer willingness to pay.
“The COVID-19 pandemic has further complicated the process of selecting the right level of care for a patient,” she adds. “New regulations, overcrowded hospitals, and outbreaks in postacute settings have upended the way hospital discharge planners need to think about postacute patient placement.”
New discharge barriers include extensive testing requirements, postacute admission restrictions, and patients avoiding care. Moreover, federal and state support has focused primarily on creating hospital capacity rather than post-discharge care.
“Without a follow-up site of care, patients remain in the hospital for extended stays, increasing length of stay and costs,” said Thalken, noting that poorly coordinated care transitions from the hospital to other postacute care settings cost an estimated $25 billion to $45 billion each year.
Digital tools and other game changers
The good news is healthcare organizations are making critical changes. Thalken said that as COVID-19 stormed through the United States and patients fell into a no-man’s land between acute and postacute care, hospitals began to innovate, creating specialized postacute care environments, including centers of excellence for COVID-19 patients. Others have converted inpatient units into COVID-19 recovery centers. For example, in Massachusetts, Partners Healthcare created a new center for patients recovering from COVID-19 on the fourth floor of its Spaulding Center for Continuing Care.
Still, Thalken pointed out that acute-to-postacute care patient transitions are bogged down by manual processes. She said recent research shows that 36% of acute care providers still use manual-only strategies to coordinate patient transitions, while 62% of postacute care facilities rely on phone calls between case workers to transfer patient information and other clinical details.
However, demand for technology that streamlines hospital-to-postacute care transitions is on the rise.
“COVID-19 has highlighted the need for automation and interoperability to care for patients,” said Thalken. “Using automation in the postacute care referral workflow reduces waste, redundancy, rework, and the likelihood of error. It also can reduce avoidable readmissions, length of stay, and operating costs associated with avoidable days. The clerical burden is also dramatically reduced from an average of 20 hours per planner per week to about three hours per planner per week or less.”
Thalken said in one case study, a safety-net hospital using automation technology dropped from 4,800 to 3,800 excessive days per year, a 25% reduction that yielded $500,000 in net savings.
Preparing for more change
The COVID-19 pandemic rapidly changed—and continues to change—the way hospitals think about discharging their patients.
“One of the results of the capacity crunch in hospitals is that those traditional boundaries of postacute providers were broken,” said Thalken.
This will continue to shift discharge patterns as the industry begins to recover from COVID-19’s immediate impact.
“As the industry continues to pivot, digital transformation initiatives and real-time information sharing are absolutely essential to well-managed transitions of care in the new normal,” she concluded.