Members of the Washington Senate Health & Long Term Care Committee heard testimony for a bill that would increase payments to acute care hospitals for difficult-to-discharge Medicaid patients on Tuesday.
Harborview Medical Center CEO Sommer Kleweno Walley testified in support of Senate Bill 5103. She said the hospital faces many challenges when dealing with patients with complex medical, behavioral, and social needs.
“These challenges can make it difficult to transition these patients into post-acute care settings, resulting in these patients staying in Harborview beds, despite no longer needing hospital care, creating severe space constraints for those who actually need the critical services Harborview offers,” Walley said. “This started when our Medicaid system transitioned to a managed care model.”
In the past year, Harborview has regularly had over 100 patients in its care who no longer meet inpatient criteria on a daily basis, Walley said.
“That’s 100 patients over a 413-licensed bed facility,” Walley said. “This has pushed our daily census into historically high levels, at times reaching over 560 patients. This has required us to do what we never want to do, which is to go on divert for basic life support out of desperation in order to remain open for the most critically ill of the state.”
If the hospital does not divert less acute patients, some must board in parts of the hospital that are typically not used for boarding, Walley said.
“This includes hallways, conference rooms, recovery rooms, different areas we have created to ensure we’re able to remain open for the most seriously ill,” she said.
Sean Gregory, chief executive for southwest Washington at PeaceHealth, said the hospital was caring for 405 hospitalized people last Friday, 97 of whom no longer met the clinical criteria to be in the hospital. But they were stuck there because they had difficulty accessing services at another facility.
“These 97 people have collectively spent 1,901 additional nights in our hospital waiting for services,” Gregory said. “These patients require more than 90 nurses to care for them.
As of yesterday, 11 of our patients were waiting for adult family homes. The average wait times for these patients was 57 days.”
In addition to the systemic access issues, the difficult-to-discharge situation has created a financial crisis at Harborview, Walley said.
“In fiscal [year] 2021, the daily cost of a bed at Harborview was about $1,675,” she said. “We’re paid only $270 on average by managed Medicaid plans to care for these patients, which translates to 16% of the cost.”
In addition to increased Medicaid payments to hospitals, Gregory asked lawmakers to require the state Department of Social and Health Services (DSHS) to complete functional assessments for patients within 48 hours. When DSHS is unable to complete a functional assessment within 48 hours, Gregory asked lawmakers to authorize DSHS to delegate the assessments to hospital staff to expedite a patient’s transfer to an appropriate setting.
June Altaras, chief quality, safety, and nursing officer for MultiCare Health Systems, also testified in support of SB 5103.
“Unfortunately, the payment we receive from Medicaid and enrolled patients at the current administrative day rate is a fraction of the actual cost of the care provided,” Altaras said.
Altaras said the monetary cost for difficult-to-discharge patients is about $866 per day at the hospital, which costs $157 million per year.
“However, I believe the larger cost is the potential patient safety issues and real-patient safety issues,” Altaras said.
Jennifer Ziegler, a lobbyist for the Association of Washington Healthcare Plans, testified in opposition of the bill.
“This is a multi-faceted solution and it’s important to not just pass one component in isolation as you move forward to address the difficult to discharge issue, but really work on a lot of the different elements,” Ziegler said.
Administrative funding for developmental disabilities, guardianship concerns, workforce challenges, and making sure facilities are adequately funded so patients have a place to go when they are discharged are all factors that are essential to the discussion, Ziegler said.
“The opposition testimony is not saying there’s not a problem to address, we just feel so strongly that the way to address the problem has to be multi-faceted,” she said.
Committee members also heard testimony for SB 5122—which would extend the expiration date of the ambulance transport fund—and SB 5142—which would create an account for the pharmaceutical rebate revenue generated by the purchase of medications for people living with HIV who are enrolled in the state’s Early Intervention Program—during the meeting.