Legislation would provide Oregon hospitals with needed compensation for difficult-to-discharge patients


Shane Ersland


Lawmakers discussed legislation that would provide Oregon hospitals with needed compensation for patients who are difficult to discharge on Tuesday.


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Members of the House Committee on Behavioral Health and Health Care discussed House Bill 2537 during a public hearing. The bill would require the Oregon Health Authority (OHA) and coordinated care organizations to pay reasonable per diem rates for patients whose discharge from a hospital is delayed due to circumstances beyond a hospital’s control.

Becky Hultberg, president and CEO of the Oregon Association of Hospitals and Health Systems, testified in support of HB 2537. She discussed hospital capacity challenges

“When the healthcare system is working as it should, people get moved to the right healthcare setting for their needs at the right time,” Hultberg said. “Unfortunately, for a variety of reasons, that’s not happening today. And that has consequences, both for patients and for hospitals.”

As of Tuesday, 458 patients were hospitalized and could not be discharged and cared for in the appropriate care setting statewide, Hultberg said. That number had actually recently declined, as patient totals were in the 700-range in that category less than a month ago, she said.

“An additional 153 patients needed to be admitted to hospitals or needed another outpatient placement, but there was no place for them to go,” she said. “So they were boarded in hospital emergency departments. I worry that this is going to be normalized, and we’re going to grow to accept the unacceptable.”

Jessica Adamson, executive director of state government relations at Providence Health and Services, said Providence currently has 75 individuals in hospitals who did not need an acute level of care, but remained hospitalized because they had nowhere else to go. 

“These are individuals that may need a guardian, and there is no public guardian that can help them,” Adamson said. “And that is a process that can take weeks, months, or much longer. They may be behavioral health patients awaiting a bed or awaiting state hospital-level of care. They may be in need of rehab, or a long-term care bed, or an adult foster home.”

Hultberg said the problem is going to get worse in May when the federal public health emergency (PHE) ends

“Hospitals now are operating under waivers that have allowed them to expand their physical capacity, and those waivers will end when the PHE ends in May,” she said.

Hospitals are typically paid a fixed rate based on a diagnosis or condition, so whether a patient stays for three or 13 days, the payment is the same, Hultberg said. 

There are very real cost issues for hospitals in relation to difficult-to-discharge patients, Adamson said.

“But most of all, we would really love our patients to be in the space where they belong to reduce the burden on our caregivers who work very hard to provide excellent care for patients that are in the wrong setting,” she said.

The average patient length of stay has increased as well. The average length of a patient’s stay prior to the COVID-19 pandemic was 4.7 days, but it has now gone up to 5.6 days, Hultberg said. 

“We’re asking for the state to pay hospitals a reasonable daily payment for each patient with a delayed discharge,” she said. “This per diem rate would be paid regardless of whether a patient is insured or has public or private insurance. Costs are not being covered for all of the care they are providing for patients. Our hope is that, in the short-term, these payments will help hospitals take care of patients. And in the long-term, it will incentivize changes in our continuum of care.”

Under HB 2537, hospitals would be reimbursed reasonable per diem rates for a patient enrolled in a medical assistance program when they no longer need hospital care but their discharge is delayed due to the following reasons:

  • OHA has delayed approving the patient’s hospital stay
  • The patient is homeless
  • A community facility will not accept a transfer of the patient to the facility because of the patient’s behavioral or complex care needs
  • Caregivers or other appropriate providers are unavailable
  • The appropriate post-acute care setting does not have the capacity to accept the patient

Rep. Rob Nosse (D-Portland), chief sponsor of the bill, said he has heard feedback that the costs associated with HB 2537 could be prohibitive. But he said the governor is planning to convene a table of industry professionals (including nursing home, behavioral health, and outpatient settings representatives) to try to address the issue. 

“It’s unclear if that conversation will land in time for when our session ends, or if it goes beyond the session, and shows up as some solution we might have the opportunity to vote on,” Nosse said. “Part of the challenge around this is that other entities that might take these patients have the right to refuse.”

No action was taken on the bill.