A recent MedPage Today article sheds light on the escalating problem of avoidable bed days in hospitals, where patients remain hospitalized despite being medically ready for discharge to step-down facilities. Scripps Health hospitals have seen their avoidable bed days more than double over the past three years, reflecting a nationwide issue. This situation negatively impacts patients needing step-down care and limits bed availability for new emergency patients.
On May 13, Scripps Mercy Hospital discharged its longest-stay patient, who had spent 1,193 days hospitalized. For 948 days, the patient had no medical need to remain in the acute care bed but could not be transferred to an appropriate facility. Melody Thomas, RN, Scripps Mercy Hospital's director of patient care and case management, explained that the patient’s prolonged stay was due to the lack of facilities willing to accept him.
This case is common. As of May 14, 85 patients at Scripps hospitals were experiencing avoidable bed days, with some staying up to a year despite being ready for discharge. The number of such patients at Scripps has surged from 9,586 in 2019 to 33,417 in 2023. Costs associated with these extended stays have skyrocketed, from $17.4 million in 2020 to $59.7 million in 2023, with Medi-Cal reimbursing only a fraction of the expenses.
The challenge extends beyond Scripps Health, affecting hospitals across San Diego and the country. Many patients have complex medical, behavioral, or mental health issues that make finding suitable step-down care difficult. Additionally, staffing shortages and inadequate reimbursement rates contribute to the problem.
Scripps Health has been implementing creative strategies to mitigate these issues, such as adjusting medications and facilitating family video visits to reduce the need for sitters. Despite these efforts, the burden on acute care hospitals remains significant.
Chris Van Gorder, president and CEO of Scripps Health, emphasizes higher reimbursement rates for downstream care facilities and better funding for training programs to manage this patient population. Without these changes, the problem of hospital boarding is expected to worsen, especially with new laws expanding the definition of gravely disabled.
The problem is pervasive nationwide. A 2022 survey by the Healthcare Association of New York State reported that long-term boarding of patients in hospitals due to the lack of appropriate care settings resulted in significant delays and costs. Addressing avoidable bed days is critical for improving patient care and hospital efficiency.