Length of stay management in acute care facilities represents a critical frontier for providers and payers to improve their own bottom lines, and also improve patients’ experience with the healthcare system.
Let’s take a closer look at how today’s systemic inefficiencies arose, and how collaboration within provider networks, and between payers and providers, might improve length-of-stay procedures and inefficiencies in the future.
Acute care facility bed shortages, and how they arose
From 2010-21, 136 rural hospitals closed, according to data from the American Hospital Association. Another 36 have closed since 2020 — a pattern that was not helped, if not outright hurt, by the COVID-19 pandemic.
One study found that urban hospitals increased bed capacity by around 35 percent during the pandemic, while rural hospitals increased bed capacity by 15 percent. COVID-19 effectively served as a stress test for hospitals to manage capacity. While neither urban nor rural hospitals necessarily passed the test, one group clearly struggled more than the other.
Now, in 2024, the healthcare environment is constrained with mass layoffs, provider shortages, and hospitals who don’t have enough staff to keep certain units open. Simply put, there are not enough doctors to accept new patients, not enough nurses for hospitals to open new units, and more acute patient care episodes than there are beds.
Trickle-down effects
How does this affect length of stay? As reported in Becker’s, the average length of stay dropped by 4 percent over the last year, but has risen by 2 percent compared to 2020, according to Kaufman Hall’s August National Hospital Flash Report.
Care shortages in hospitals have a trickle-down effect on the rest of the healthcare ecosystem. When hospitals and health systems don’t have the people and processes in place to optimize patient flow out of overcrowded ERs, this affects skilled facilities, rehab centers, and home care. Care coordinators were historically focused on length of stay and are often among staff affected by layoffs, especially at smaller hospitals.
Case managers are often left to fill this void. But they have different skill sets than care coordinators, nor are they coders who can help automate workflows that can be managed with the assistance of AI scripts.
Other factors can also increase length of stay. Not all of a patient’s critical information might transfer when the patient goes from one system to another, delaying discharge. Transportation delays — a social determinant of health — and patient choice documentation are among the other factors often involved.
Communication and collaboration
Length of stay delays tend to indicate that something is broken. Technology, human resources, and hospital processes must be firing on all cylinders in order for patients to move throughout their care journey efficiently. Technology can transform processes — an understaffed hospital can use AI tools to fill certain administrative gaps, for example — but even the best tech solutions can prove inefficient when broken processes are in place. Length of stay might suffer as a result.
Of all the contributing factors behind length of stay delays, technology solutions can help solve for some, but not all of the pain points. Patient transportation, for example, is beyond a provider’s control. Also, the availability of post-acute care facilities is beyond a health system’s control. Directors and other C-suite executives might need to form ad hoc committees to address these more difficult challenges. Improved communication and collaboration are key to any holistic fixes that are needed.
This is where a dedicated care coordinator is essential: as a point guard who facilitates collaboration among members of a hospital care team. Without one, the team might miss some basic needs that affect length of stay. For example, when transferring patients to a skilled facility or rehab facility, are there enough male- and female-specific beds? If the patient is obese, will the facility have a bed that can accommodate their size? If the patient needs a specialized service such as wound care or intravenous (IV) therapy, can they provide the services needed? These questions speak to the degree of communication and collaboration needed with post-acute care facilities.
Using technology and better processes can help existing personnel work more effectively. AI and machine learning tools can learn the most probable diagnostic related groups, and the corresponding length of stay for a patient while they are receiving care. Enabling hospital staff with more data points allows them to create better processes and prioritize discharge planning.
The power and potential of these systems can be great, but unless all the clinics, hospitals, health systems, and skilled nursing facilities, rehab centers, and other relevant parties are on board, it won’t maximize its potential to reduce length of stay.
Keep in mind that payers are incentivized to reduce length of stay too and deserve a seat at this table. Patients are their “members,” and payers have a responsibility to every member on their roster. They are just as much responsible for assisting the facility to locate, find, and secure post-acute care needs for their members.
The potential for collaboration, communication, and improved workflows is more possible than ever thanks to advancements in AI. The key is getting buy-in from all stakeholders.
About Michelle Wyatt DNP, MSN, RN, CMS, LSSGB
Michelle Wyatt, DNP, MSN, RN, CMS, LSSGB is Senior Director, Utilization Review Services overseeing experienced nursing staff that provide comprehensive utilization review services for Xsolis clients. She has been with Xsolis for over 6 years and has over 20 years’ experience in healthcare with a focus on utilization review and case management functions. Prior, she was Director of Case Management and Utilization Review at HCA Healthcare, and Director of Utilization Management at Vanderbilt University Medical Center. Michelle received her Doctorate of Nursing Practice, Nursing Administration, from Vanderbilt University School of Nursing. She began her career in utilization review performing care management reviews for Universal Care of TN.
