Many patients, not enough beds: Here’s how to solve a care crisis

A patient suffered a massive stroke and was admitted to Harborview Medical Center’s Emergency Department, leading to a 75-day stay in Harborview’s inpatient unit. He was eventually moved to a skilled nursing facility, which receives ongoing payments from Harborview to subsidize his care. He stayed there for more than 330 days.  

This patient is an example of a large and growing challenge known as complex discharge, occurring at UW Medicine’s hospitals — Harborview Medical Center, UW Medical Center and Valley Medical Center — as well as other hospitals throughout the state. Patients who medically no longer need acute care remain in the hospital for weeks, months or even years because we are unable to transfer them to a post-acute care facility.

Many barriers exist to discharging patients from hospitals, particularly for people with complex social, behavioral and medical issues. In many cases, staffing and reimbursement challenges limit the ability of post-acute care facilities to accept these patients. There might also be legal and regulatory barriers to discharge.  

One significant barrier for our Harborview patient was the need to be assigned a guardian, a rigorous process that was necessary due to the cognitive effects of his condition. He was able eventually to be transferred to a nursing home that participates in Harborview’s bed readiness program, which subsidizes nursing homes with hospital funding to care for patients with complex conditions.

On any given day, roughly 200 patients remain at UW Medical Center, Valley Medical Center and Harborview despite no longer needing inpatient care. About half of these patients are at Harborview, and last year it cost the hospital over $50 million to care for them. At the same time, Harborview is paying for an additional 100-plus patients to receive services in its bed readiness program, at a cost of over $8 million per year.

UW Medicine has worked with legislators, state policymakers and other health care partners to meet these challenges head-on. Last legislative session, the state adopted our proposal to pilot a model based on the Bed Readiness program in Everett, Spokane, Tacoma, Vancouver and at Harborview in Seattle. The state also adopted recommendations to create a Complex Discharge Task Force, which will oversee and assess pilot implementation, and create recommendations for policymakers to comprehensively address complex discharge.

This effort is an example of broad-based collaboration to address a systemic challenge. Gov. Jay Inslee, Sen. June Robinson, D-Everett, and Rep. Nicole Macri, D-Seattle, led state efforts to establish and fund the pilot and task force. A coalition of hospitals, post-acute care providers, patients’ rights advocates, Medicaid-managed care organizations and many others are working together to ensure the success of the initiative.

Residents of Washington depend on UW Medicine and other hospitals to be there for everyone who needs our services. Complex discharge challenges imperil our ability to provide those services and put a strain on our health care system. Pilot sites will begin enrolling patients in April, and we hope through this process and the work of the task force, we can address these significant challenges statewide.