Rampant discharge delays last spring cost New York hospitals an average of $168,000 per inpatient case and $18,000 per day in the emergency department, much of which was not reimbursed by payers, according to hospital data from the Healthcare Association of New York State (HANYS).
The data collection pilot, published Tuesday, pulled information from 52 New York hospitals from April 1 to June 30, 2022.
Among these, HANYS found 1,115 patients who “for circumstances largely outside hospitals’ control” couldn’t be discharged from the ED for at least four days or from an inpatient unit for 14 days. These patients collectively represented about 60,000 days of “avoidable” delays, according to the pilot.
“These numbers are astounding, and they only represent a sliver of the crisis,” Bea Grause, president of HANYS, said in a release. “The current system is failing thousands of patients annually, their loved ones and hospitals’ healthcare professionals who, despite their best efforts and intentions, lack the resources and robust system needed to ensure these individuals are in the most appropriate care setting for their unique needs.”
The average ED discharge delay among the sample lasted nearly two weeks, according to the report, while the average inpatient discharge delay spanned two months. HANYS found that children and older adults with medically complex and/or behavioral health conditions experienced discharge delays more often and more frequently.
Nearly half of all delay days were caused by difficulties finding another care setting that could accept a patient due to, for instance, mental illness, infection status or other medical care needs such as dialysis.
Behind placement setting declinations were other issues such as insurance or financial coverage, guardianship and “extended administrative processes” related to agency referrals and eligibilities, per the report.
Altogether, the 1,115 patient delays cost the 52 hospitals an estimated $169 million, which HANYS said is likely a “conservative” guess by the participating hospitals. The group also noted that the total number of discharge delays among those hospitals is likely higher than their tally, as patients who met the inclusion criteria but had not yet been discharged by the end of the sample period were not included in the pilot.
HANYS paired its results with a framework for cutting down on delays across New York, which has between 160 to 220 hospitals “depending on the definitions used.” At the top level, these included recommendations to prevent unnecessary hospitalizations, intervene early when patients at higher risk of delay first arrive at a hospital, reimburse hospitals for the “extraordinary” costs incurred delivering care during discharge delays and better visibility and documentation of care delays.
“Our complex case discharge delay data collection pilot’s results demonstrate tremendous care gaps for individuals with complex care needs,” the group wrote. “The healthcare system must be designed for individuals with these care needs as the expectation, not the exception. The need for change is urgent.”
Patient backlogs and frequent ED boarding issues extend beyond New York. Hospital groups from states such as Washington and Minnesota have warned of discharge delays harming care access and costing hospitals millions.
In November 2022, a coalition of 33 provider groups penned a joint letter to President Joe Biden warning that “gridlocked” hospital EDs were threatening patients’ lives and the well-being of healthcare workers alike. About a month later the American Hospital Association floated discharge delays as a key driver of hospital length-of-stay and expenses in a plea to Congress for temporary financial support.