Hospitals are seeing higher acuity patients, struggling to discharge to post-acute care settings, report finds

Hospitals are finding it harder to place patients into post-acute care settings, a new report finds.

The report was put together by WellSky, a health tech company, based on data from CarePort, its care transition solution supporting more than 2,000 hospitals and 130,000 post-acute care providers. The number of referrals to nursing homes and home health agencies per patient has increased over the last year, as has patient acuity. At the same time, referral rejection rates are also on the rise, according to the report.

The pandemic has led more patients to prefer home-based care, which is also a more cost-effective care setting, according to Lissy Hu, M.D., president of connected networks at WellSky and founder of CarePort. But acute and post-acute care providers are facing a multitude of challenges, from more complexity in patients to staffing shortages. That has made it more difficult to place patients at home.

“You’re seeing more complex patients with more complex needs than ever in a supply-constrained environment,” Hu told Fierce Healthcare. More patients wanting to recover at home means more primary care physicians (PCPs) having to manage them, which further strains the healthcare system, Hu noted: “This is a really concrete example of what we mean when we say care continuum. It’s truly connected.” 

Referral volume to skilled nursing facilities (SNFs) has grown 10% since 2022, the data showed, while referrals to home health agencies (HHAs) grew 11%. These increases are likely due to the rise in demand for care and ongoing staffing shortages, the report said. HHA rejection rates rose 40% since 2022, despite rejection rates already reaching an all-time high in 2022.

Patients in the hospital are now 6% more acute at discharge compared to 2019 averages, the report found. These types of patients typically have more complex care needs and a higher risk of complications and readmissions after discharge, which makes transitioning them to post-acute settings more difficult. 

One thing contributing to higher patient acuity is age. By 2030, The U.S. Census estimates that 73 million baby boomers in the U.S. will be 65 or older. Chronic conditions like hypertension, diabetes and arthritis are more common in older adults and can contribute to higher acuity, the report said.

As patient acuity rises, so does hospital length of stay and the complexity and number of referrals required to secure care. Though improving since its peak in winter 2022, the hospital average length of stay prior to post-acute discharge remains high and has increased by about one day since 2019. Longer lengths of stay can increase costs and lead to longer wait times, as well as reduce the overall capacity of the hospital, the report noted. 

For patients discharged to SNFs, hospital length of stay has increased by 12% since 2019. For those discharged to home health, that’s increased by 11%. 

More than half of nursing homes are denying patients due to staffing challenges, while 87% of nursing homes are facing moderate to high staffing shortages, the report noted. And 61% of nursing homes are limiting new admissions.

The end of the PHE could have a positive impact on patient choice by increasing transparency and access to information, the report noted. The PHE did not require hospitals to provide a full list of participating providers in the area where a patient lives or share provider performance on quality metrics.

Though the home setting holds a lot of promise from a value-based care perspective, Hu said, the right technology needs to be in place to ensure care coordination. 

While it is important to staff up in healthcare, that alone won’t keep up with the scale of demographic change that’s occurring with the aging population, according to Hu. “I don’t think this is a problem we can just hire our way out of,” she said.