Washington hospitals will be getting needed extra funds to care for patients who are difficult to discharge following the state’s 2023 legislative session.
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Lawmakers passed Senate Bill 5103, which will increase payments to acute care hospitals for difficult-to-discharge Medicaid patients. State of Reform discussed the impact of SB 5103, and other insights from the legislative session, with Washington State Hospital Association (WSHA) Vice President and Associate General Counsel Zosia Stanley and Senior Vice President of Government Affairs Chelene Whiteaker.
“SB 5103 is about the fact that there are patients stuck in hospitals pending discharge,” Stanley said. “These are patients who don’t have an acute care need, but still need some care.”
SB 5103 requires hospitals to be reimbursed for medical assistance enrollees who are staying in a hospital when they do not meet inpatient care criteria and are not discharged because an appropriate placement is not available. It directs the Washington State Health Care Authority (HCA) to adopt rules to identify which healthcare services must be included in the daily reimbursement rate, and which services may be billed separately for patients who are in a hospital and do not meet inpatient criteria.
Testimony for the bill showed that Seattle’s Harborview Medical Center recently had 120 of their 413 beds filled with difficult-to-discharge patients. And the cost for some hospitals to care for these patients is between $800 to $1,600 per day, while some were only being reimbursed for $700 per day, according to testimony.
“The overarching issue is that we have patients who aren’t getting the right care at the right time in the right care setting. The average length of stay is five days in an acute hospital. This is not about hospitals wanting to keep these patients. This is about, if you have to leave a patient in a bed without that (acute) need, there has to be a more appropriate rate for those patients. There’s still an overarching concern that patients are in beds when they don’t need to be there.”
The ultimate goal of lawmakers is to make more beds available to those who desperately need them. But in the short-term, hospitals need to be adequately compensated for the time difficult-to-discharge patients are there.
“Looking from a long-term basis, the goal is to not have patients in the wrong setting for no fault of their own,” Whiteaker said. “But Washington has the fewest beds per capita compared to other states. We do not have enough beds for the population, and we need to make sure patients are in the right setting.”
Lawmakers passed a bill that helps a different population that often finds themselves stuck in hospitals as well. WSHA supported the passage of House Bill 1580, which creates a system to help children in crisis, Stanley said.
“They don’t need acute care, but their family can’t take them home,” Stanley said. “And we have found that has led to kids getting stuck in hospitals. Nobody has the capacity to take them, and they’re leaving kids in hospital beds. For a kid who needs behavioral healthcare, it’s not the right place for them, and it’s not good care for them.”
HB 1580 requires the governor to maintain a multisystem care coordinator to serve as a state lead on addressing complex cases of children in crisis.
It requires the care coordinator—in coordination with the Department of Children, Youth, and Families the HCA, the Office of Financial Management, and the Department of Social and Health Services—to develop and implement a rapid care team to support and identify appropriate services and living arrangements for a child in crisis, and that child’s family, when appropriate. It allows the care coordinator to access funds to support the discharge of children in crisis from hospitals, and the long-term placement of children in crisis.
“The bill establishes a process whereby there’s a central point for the state to require a conversation to get these kids the right care at the right time. There’s probably more left to do to create capacity, but the bill will begin to move that issue forward.”
The state still needs to make progress on another common barrier for hospitals in discharging patients who no longer need to be there, however, which is the waiting period a patient has to endure if they need a guardian’s assistance, Stanley said.
“One of the pieces we continue to work on is the issue of patients who get stuck in hospitals who are waiting for a guardian to be appointed,” she said. “The guardianship process takes some time. Those patients are waiting in a hospital bed for no other reason than they are waiting for a guardian. Patients shouldn’t be stuck in hospitals just because of a legal process.”
Whiteaker noted that lawmakers passed legislation that supports hospital workforces during the session. The legislature passed Senate Bill 5499, which enters Washington into the Nurse Licensure Compact. The compact expedites licensure for registered nurses and licensed practical nurses who are already licensed in another state.
“We believe it will help with some workforce issues. It makes it a more competitive landscape in attracting a workforce. Thinking longer term, we have a population that is aging. What will that mean for healthcare? More people will need more services. Hospitals will need to be flexible in taking care. How are we going to need to do things differently to deliver the care that we are known for in Washington? Flexibility and the workforce will continue to be on our minds.”
Lawmakers increased Medicaid payment rates for hospitals this year. Large acute care hospitals had not seen a Medicaid rate increase in 20 years, Whiteaker said.
“Imagine what wages looked like 20 years ago compared to now,” Whiteaker said. “What other type of organization could have a period like that? The costs have rapidly changed so fast in healthcare, in wages, supplies that have had cost increases, and pharmaceutical costs. The Medicaid increase is fundamental to hospital stability.”