Post-acute care bottlenecks represent a financial concern for health systems. In general, hospitals do not accept payments to patients beyond the number of days recommended by the insurance provider for their condition.
ProMedica Toledo Hospital in Ohio calls such overtime, sometimes referred to as bed-lost days, an “opportunity day”—and it focuses on minimizing that time, said Corey Leber, vice president of services. nursing and patient care services.
The hospital is re-evaluating discharge processes to find ways to improve, Leber said. It defined each worker’s role, reassessed who was included in daily transition rounds, and moved a director into a capacity management role to focus on efficiency.
“At any point where a patient is in and out of the system, there are opportunities for barriers,” says Leber.
One of those barriers is getting insurance company approval for post-acute care. Usually assigned to staff at receiving facilities, the task can introduce more delays. ProMedica hospitals in Michigan have for many years handled pre-authorization at home; ProMedica Toledo is exploring how to implement a similar strategy. It plans to hire a few workers responsible for submitting referrals to insurance companies and adopt the same platform that post-acute facilities use for approvals.
The Indiana University School of Medicine in Indianapolis began its own pre-authorization process with four insurers for post-acute discharges last November. To prepare, it hired three people and moved two existing employees to its pre-certification team. Adria Grillo-Peck, IU Health’s vice president of integrated care management, said a process that previously took 48 to 72 hours has been cut to eight hours for patients with those payers. The move saved the system 3,600 days, allowed 682 beds to be filled, and saved more than $10 million.
Currently, IU Health processes approximately 17% of its pre-authorizations. The system plans to start working with two more insurers to increase that percentage, Grillo-Peck said.
In addition to speeding up the approval process for patients, IU Health relies on an established network of 43 long-term care providers with good quality and patient satisfaction scores and recurrence rates. low examination.
“That partnership made fundraising a little easier because we built relationships with these post-production partners,” says Grillo-Peck.
Relationships are also key at the University of Washington Medical Center Harborview Medical Center in Seattle.
As a county safety net hospital and Level 1 trauma center, Harborview is often filled with complex patients awaiting discharge for long-term care, said Sommer CEO Kleweno Walley. It is licensed for 413 beds, but has filled more than 500 in its entire public health emergency, with about 100 patients awaiting post-acute facilities.
Some take months to find a position.
