Patients who no longer need expensive, acute care in hospitals are nonetheless occupying 15% of medical-surgical beds in Massachusetts as they wait for discharge plans, causing a chain reaction in the system that requires other patients to get stuck in emergency rooms, according to a new report.
The Massachusetts Health & Hospital Association (MHA) report said nearly one of every seven medical-surgical beds in the state are occupied by patients who are ready to be discharged but are waiting for spots to open in a post-acute care facility, a community-based setting, or a psychiatric unit.
"Hospital case managers are spending endless hours and dozens of phone calls trying to get patients to the next level of care they need," said Amanda Ford of Lowell General Hospital. "But the obstacles have become so numerous and so intense that it sometimes feels like an impossible task. We want to share a glimpse into this crisis and the solutions that have been identified from those of us on the front lines of patient care."
The report — titled "A Clogged System: Keeping Patients Moving Through their Healthcare Journey" — cited "pervasive discharge delays" and backups that require patients in need of hospital-level care to instead wait for long periods in emergency departments.
MHA President Steven Walsh, who formulated health care policy when he was a member of the House, said resolving capacity issues in health care will require the "same level of focus" that it took to hold the health care system together through the COVID-19 pandemic.
Walsh said the state still has a "world-class health care system" but cautioned that it is in "major distress" as evidenced by longer patient wait times.
Citing feedback from hospital case managers, the association said reasons for delayed discharges include private insurance administrative barriers and a lack of secondary insurance, capacity and staffing constraints at post-acute care facilities, a lack of guardianship and health care proxies, and the need for specialized behavioral health and substance use disorder services. Other discharge obstacles include inadequate insurer post-acute care networks, a need for specialized medical services, lack of access to community services, and unvaccinated patients and patients' COVID status.
The report lands amid growing consensus that the Legislature needs to act on proposals to contain rising health care costs. Asked if he thinks the House and Senate would be in alignment on their approach to cost containment legislation this session after previously taking different approaches, Health Care Financing Committee Co-chair Rep. John Lawn last week told the News Service, "I do."
"I think it'll be a comprehensive bill that will involve a lot that we talked about, whether it's the [determination of need] process and dealing with expansions of hospital systems, to PBMs, to other drivers of our health care costs," Lawn said. "But I think we'll see something, probably, hopefully very early next year."
