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July 31, 2023

Beds, Bureaucracy, and Breakthroughs: Overcoming Discharge Delays with Prior Authorization Software

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization

Our healthcare landscape is riddled with challenges. Recently, research has called attention to a growing problem: patient discharge delays. An increase in the length of patient stays in hospitals creates capacity issues and delays in new patient admissions. This scenario not only strains hospital resources, but it also has adverse effects on patient health. 

The culprit? A range of factors contribute—from prior authorization delays and denials to staffing shortages. Prior authorization software can help turn the tide. Before we dive into how, let’s look at the challenges at hand. 

Patients stays on the rise, according to AHA report

A December 2022 report from the American Hospital Association (AHA) revealed that patient stays have surged 19 percent compared to 2019, and a whopping 24 percent for patients requiring post-acute care. Bharath Krishnamurthy, AHA Director of Health Analytics and Policy, told Becker’s Hospital Review that “We’ve seen massive increases in the length of stay for patients, especially those that are waiting to be transferred to the appropriate care setting.” And the AHA isn’t the only one sounding the alarm. The Massachusetts Hospital Association (MHA) recently noted that 1 in 7 medical surgical beds are occupied by patients awaiting discharge. Moreover, MHA research found that the No. 1 contributor to patient discharge delays in the state were delays or denials for prior authorization requests for post-acute care. 

Unfortunately, evidence also suggests that when administrative hurdles prevent patients from timely discharges, it can lead to mobility issues and hospital-acquired infections that further endanger health outcomes. And those aren’t the only problems that discharge delays cause. 

Not only are these delays detrimental to patients, but they also pose significant financial threats to hospitals. Krishnamurthy points out that once a patient is ready for discharge, hospitals are not reimbursed for the additional days a patient stays while awaiting discharge. With 68% of hospitals currently operating at levels of financial loss, undertaking unreimbursed care puts their financial stability at greater risk. Ongoing staffing shortages only add to the burden. 

How does prior authorization software alleviate the problem? 

Payer’s prior authorization requirements often necessitate receiving approval before a patient discharge, particularly when the patient requires post-acute care such as in-home nursing support or a stay in a short-term rehabilitation center. Delays in this process can lead to extended hospital stays for patients ready for discharge, hence exacerbating the issue at hand.

While no single, sweeping solution exists to solve discharge delays, automating the prior authorization process can be a difference maker. When Myndshft first started out, our streamlined process helped a terminal patient get discharged quickly in order to spend the holidays at home with family. That moment turned into the inspiration behind our North Star metric—tracking how many patients we’ve helped connect to the care they need. 

Automating your prior authorization process offers numerous benefits. Notably, automation reduces the chance of human error and removes repetitive, mundane tasks from the hands of hospital staff, allowing them to focus on more patient-centric tasks. 

What else can you expect from prior authorization software like Myndshft? 

  • A payer rules engine and policy library that automatically identifies prior authorization requirements based on the payer, plan, and CPT or HCPCS codes entered.
  • Real-time connections to 600+ payers covering 94% of covered US patients. 
  • Use of patient demographic and clinical data to improve the accuracy of prior authorization determinations. 
  • Pre-checking of submissions for errors and missing information, which eliminates up to 90% of rework associated with preventable denials. 

It also provides a more transparent process, allowing you to monitor the status of prior authorization requests from a single, convenient dashboard. By comparison, today’s manual process requires establishing multiple credentials in order to visit different payer portals or—even more frustrating—spending precious time on hold while waiting to speak with payers by phone.

Prior authorization software tackles discharge delays with ease

Underestimating the  impact of patient discharge delays affects not just the hospitals and their financial sustainability, but also the health and well-being of patients. Despite the multifaceted challenges ahead, automation of the prior authorization process presents a promising solution. 

By integrating software like Myndshft into your healthcare processes, you can streamline and accelerate patient discharges, reduce financial losses, and get back to the business of providing timely, quality patient care rather than navigating a labyrinth of administrative tasks. 

The time to overcome beds, bureaucracy, and seize the breakthroughs of prior authorization software is now. Let’s take action to ensure a more efficient, compassionate, and patient-centered healthcare system.

Want to squash discharge delays with ease?  Connect with Myndshft to get started.