AHA: Average length of stay in hospitals up 19%

Photo: Xavierarnau/Getty Images

The American Hospital Association has released a new report on delays in hospitals' ability to discharge patients to the most appropriate care setting, finding that average length of stay has increased by about one-fifth over the past few years.

The average length of stay in hospitals has increased by about 19% for patients in 2022 compared to 2019 levels, according to data from Strata Decision Technology, a healthcare consulting firm. The increase is even more pronounced for patients being discharged to post-acute care providers – nearly 24% from 2019 to 2022. 

This remains true even after accounting for patients being sicker and requiring more complex and intensive care now as compared to pre-pandemic levels.

The report uncovered some of the negative consequences these delays are having on patients and the hospitals that care for them.

WHAT'S THE IMPACT

Delays in discharge can negatively impact patients' health outcomes, or slow their recovery by forcing them to stay in the hospital longer than medically necessary, according to the AHA.

Instead, the group said, many of these patients should be discharged in a timely manner to post-acute care providers, including behavioral health providers, who specialize in caring for patients after a hospitalization. 

Delays in discharges also impact hospitals and health systems by putting additional pressure on an already overwhelmed workforce, and can put access to care at risk for the wider community.

Hospitals do not receive reimbursement for the costs associated with caring for patients for the additional days they are in the hospital while they wait to be discharged. According to the AHA, these additional costs further strain hospitals that are dealing with a range of financial pressures, from historic levels of inflation to skyrocketing costs, as well as their own workforce challenges.

Data from the healthcare consulting firm Kaufman Hall found that hospitals' expenses are projected to increase by $135 billion in 2022 alone, with 68% of hospitals possibly ending the year operating at a financial loss.

To help mitigate the costs of caring for patients for these excess days, and to ensure that patients are getting the most appropriate care, 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.

This per diem payment would be made for cases identified and assigned with a specific discharge code that fall under the types of long stays in which the patient is documented to be ready for discharge but is unable to be discharged appropriately. The solution could be modeled after an existing per diem Medicare payment mechanism and be temporary, with a cap on payments, said the AHA.

THE LARGER TREND

A 2020 study in the INFORMS journal Information Systems Research found that wider use of telehealth in the ER can reduce wait times and length of stay.

It looked at all emergency room visits in New York from 2010 to 2014. The researchers found that, on average, telehealth availability in the ER significantly reduces average patients' length of stay, which is partially driven by the flexible resource allocation.

Adoption of the virtual care platform works best when there's a surge in demand or a shortage of supplies, because it leads to a larger reduction in ER length of stay when those factors are present, it said.

ON THE RECORD

"Hospitals and health systems are dedicated to providing patients with the right care, in the right place, at the right time," said AHA President and CEO Rick Pollack. "Delays in patient discharges create bottlenecks in the healthcare system, adding to the already overwhelming challenges facing our hospitals and caregivers. Temporary relief to overburdened hospitals and other providers will help ensure patients get the most appropriate care and will relieve stress on front-line healthcare workers."
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com