By Mary Mayhew, FHA President and CEO

Achieving superior health care outcomes depends on delivering the right care at the right time in the right setting. Whether that’s a primary care clinic, hospital emergency department (ED), inpatient unit, or post-acute facility, patients’ outcomes depend on getting timely, medically necessary care appropriate for their condition and needs.

Unfortunately, today, too many patients remain unnecessarily hospitalized because of delays in securing appropriate post-acute placement. These are placements in skilled nursing facilities, assisted living facilities, home health, hospice, long-term acute care settings, behavioral health units, and rehabilitation facilities.

Patients who no longer require a hospital level of care because of their medical status or needs are staying hospitalized because of delays in transitioning to another, more appropriate care setting. The results for patients are avoidable hospital days and impediments in progressing in their healing journey. The results for hospitals are operational inefficiencies and increased costs. The result for the health care system … and for anyone needing to be hospitalized … is a potential lack of inpatient capacity to admit in a timely manner patients from the emergency departments. With ED boarding times steadily increasing, getting patients from the ED to a medical/surgical unit, if necessary, is critical for patient care and operational efficiency. That cannot occur if patients medically ready to be discharged from the hospital cannot do so.

Statewide, patients with an average hospital stay of less than 10 days before being medically ready for discharge remain in the hospital for an average of 3.5 more days while hospital staff try to secure post-acute placement, according to a survey by the Florida Hospital Association. Patients whose length of stay before being ready for discharge exceeds 10 days remain in the hospital for an average of 27 more days before being successfully transitioned to post-acute care. More than 50 percent of these patients waiting for more than 10 days are awaiting discharge to a skilled nursing facility. This means patients are staying in hospital beds longer than necessary for their medical needs.

The estimated cost to hospitals of keeping patients hospitalized after they are medically ready for discharge is more than $540 million a year. These are avoidable costs. But avoiding them requires additional post-acute capacity and more streamlined authorization requirements from health plans. A quarter of patients are not being timely transitioned to care because of payer prior authorization issues, according to the FHA survey. Twenty percent are facing discharge delays because of bed or staffing shortages at the post-acute facility.

With one of the country’s largest growing elderly populations, Florida is likely the tip of the spear for addressing this challenge. FHA is working with the South Florida Hospital & Healthcare Association (SFHHA), which represents hospitals and post-acute providers, to collaborate on needed, workable solutions. Together, FHA and SFHHA convened a Long-Term Care Roundtable last month to bring together regional providers in Southeast Florida to explore all aspects of long-term care, including barriers, proven solutions, and alternative options. The Roundtable focused on policy changes that would truly move the needle toward closing the gaps in care for this population.

The causes are multi-faceted. Solutions will need to be as well. But, with a commitment to ensuring no patient stays in a hospital bed longer than necessary for their medical needs, Florida can lead the way in identifying strategies and solutions to accelerate care transitions so that every patient can continue their healing journey without delay, impediment, or setback.

Mary C. Mayhew is the Florida Hospital Association President and CEO.