Category Archives: Care Transition

Do insurers have a disincentive to help with transitions of care? 

Posted on by • Posted in Average Length of Stay (ALOS), Care Transition, Case Rates, Denial, Denial Rates, Health Insurance Industry, Health System, Hospital, Hospital Industry, Medicare Advantage, Medicare Denials, Post Acute Care, Post Acute Networks • Leave a comment

https://mailchi.mp/b7baaa789e52/the-weekly-gist-september-29-2023?e=d1e747d2d8

A number of health systems have recently noted increasing financial challenges for Medicare Advantage (MA) patient admissions. 

One CFO shared, “our rates from MA plans are roughly on par with fee-for-service Medicare. Denials have always been a problem, making our [revenue] capture about 90 percent. But this year it’s dropped to 80 percent…it’s a crisis for us, given fast how MA volumes are growing.”

His team investigated the change and found the cause: mean length of stay for MA patients has jumped sharply. The rise was almost entirely due to difficulties in discharging patients to rehab and skilled nursing facilities. 

Key insurers have narrowed their postacute networks, resulting in patients spending days waiting for a bed. “The payers told us they had focused the network on ‘high-performing’ providers. Our data and doctors’ experiences say otherwise. They chose a handful of facilities that are cheap, with questionable quality,” their CMO reported. Attempts to engage payers to solve the problem have gone nowhere:

“They have a disincentive to work with us on this. With case rates, they are saving money if patients are languishing in an expensive hospital bed rather than going to rehab.”

This system is exploring expedited placement and expanding their portfolio of home-based care and postacute offerings, while even considering guaranteeing payment themselves. If you’re having similar challenges or have found solutions to help with transitions of care, we’d love to hear from you and learn more. 

Financial performance worsens in July, Kaufman Hall says

Posted on by • Posted in Care Transition, Discharge Planning, Health System, Hospital, Hospital Industry, Operating Expense Reduction, Operating Expenses, Operating Margin, Operating Metrics, Operating Performance, Operating Revenue, Payor Authorizations, Post-Discharge Transition, Pre-Authorization, Process Improvement • Leave a comment

Click to access KH-NHFR_2023-08.pdf

Healthcare expenses declined in July, but not by enough to offset revenue losses, Kaufman Hall said in its latest National Hospital Flash Report.

Key Takeaways

  1. Hospital performance declined on a month-over-month basis in July.
    All volume indicators registered declines this month. However, when compared
    to 2022, there is some slight improvement in operating margins.
  2. Outpatient volumes decreased slightly more than inpatient.
    Some of this decline may be attributed to less patients seeking elective procedures in summer.
  3. Expenses declined, but not enough to offset revenue losses.
    Labor continues to be the biggest share of hospital expenses, and expenses will likely
    continue to fluctuate due to inflation.
  4. Bad debt and charity care rose month-over-month.
    Medicaid eligibility redetermination continues to affect hospitals and patients, with more
    than 30 states disenrolling people in June and July.

Action Steps


In an environment where hospitals continue to feel the effects
of Medicaid disenrollment and labor expenses, those that have
been more successful have made care transition a priority.


Hospitals should consider:

  • Starting off right by obtaining the necessary pre-certifications
    and payer authorizations before the patient comes in the
    door, as well as planning for discharge as soon as they are
    admitted.
  • Collecting data and using it to inform process improvement.
    Hospitals need to quantify lengths-of-stay and related data,
    and more importantly, use this data to make change.
  • Establishing relationships with post-acute care settings and
    having a clear pathway for patients’ post-discharge transition.