Oregon hospitals and healthcare facilities are facing serious capacity challenges, and stakeholders are considering options to address the issue.
Members of the Joint Task Force on Hospital Discharge Challenges met last week. The task force was established in 2023 with the passage of House Bill 3396, and members plan to submit a report about their findings and recommendations to the legislature by November.
Oregon has the second-lowest number of hospital beds per capita (1.6 beds per 1,000 individuals) in the country, behind only Washington, according to KFF. Cleo Kordomenos, senior analyst at ATI Advisory, noted that the average hospital length of stay in Oregon has increased statewide.
“We’re looking at a 20 percent increase from 3.1 to 3.9 days from 2017 to 2022,” Kordomenos said. “That is a 27 percent increase. There is an increase in total hospital days, indicating that individuals waiting to be discharged are experiencing (a) longer length of stay. This maps back to hospital capacity constraints.”
Individuals with commercial coverage experienced the greatest change in average length of stay (from 2.4 to 3.4 days), while dual Medicare/Medicaid-covered individuals consistently had the highest average length of stay year over year (from 3.7 to 4.7 days) from 2017 to 2022, Kordomenos said.
Average hospital lengths of stay among insured Oregonians with complex care diagnoses increased by 18 to 48 percent between 2017 and 2022, while statewide stays among insured Oregonians increased by 27 percent during that period, Kordomenos said.
“Individuals with (serious mental illness, substance use disorder), and housing insecurity are most likely to be discharged to home or self-care (59 percent) compared to other complex-care diagnoses. What’s important to note with this group, in particular, is what does ‘home’ mean? Are these individuals being connected with the right services and supports? Looking at housing insecurity, you can imagine that a good portion of them are not being connected with continuing care.”
— Kordomenos
ATI Advisory conducted interviews with a variety of stakeholders, including hospitals, Area Agencies on Aging, the Oregon Health Authority, and coordinated care organizations to highlight possible solutions, ATI Advisory Director Kristen Lunde said.
“Stakeholders shared that there can sometimes be a misalignment between entities related to the care needs of an individual and the ability of various care settings to meet those needs,” Lunde said. “This came up frequently in our conversations with providers. In some instances there are delays in the discharge process due to different understandings of the best type of care for a given patient.”
Solutions focused on four key themes, Lunde said, including:
- A shared understanding of alignment between needs and post-discharge care settings
- More responsive scheduling and contact between hospitals and eligibility assessment leads
- Expectation-setting on timelines and updates
- Clarification of available services and roles, and responsibilities for eligibility assessments and case management
“One potential process improvement tool is to develop a protocol that is standardized and clearly outlines stakeholders’ roles, actions, timelines, communication, and puts ownership on a variety of stakeholders to step forward and work with other stakeholders to resolve any delays that might be happening (an escalation protocol). It can be tailored to meet a variety of needs.”
— Lunde
Dr. Charles Rudy, an emergency medicine doctor at Providence, discussed the challenges physicians face during the meeting.
“As a member of our healthcare community working on the frontlines, I want to explain the challenges we’re facing on a daily basis,” Rudy said. “The beds in our hospitals are full and there’s basically a traffic jam that forms in our emergency departments. It has a lot of downstream consequences. The capacity of our emergency room decreases. The only way to compensate for this loss of capacity is to use nontraditional areas of care (hallways, waiting rooms, and triage rooms). At best, this results in a loss of privacy. And at the worst, it jeopardizes the health of our patients.”
The task force will meet again on June 27.