Listen to this article 4 min
California hospitals are getting aggressive in trying to address what they say is a big contributor to long hospital stays and crowded emergency departments: insurance companies.
On Tuesday the California Hospital Association filed a lawsuit against Anthem Blue Cross over what the association says are regular violations of the insurer's legal obligation to arrange and authorize patients to be transferred from hospitals to skilled nursing facilities or other post-acute settings.
In a Tuesday morning conference call announcing the lawsuit, hospital workers described instances of patients remaining in the hospital for weeks or months after it was medically necessary while hospital staff tried to work with the patient’s insurance to find a post-acute care facility that would accept them.
“It’s not uncommon for people to be here seven to 10 days beyond what they need to be here before they can be discharged,” said Dr. Sean Maiorano, the chief medical officer at Enloe Health in Chico.
Anthem Blue Cross representatives didn't immediately respond to requests for comment.
On any given day, Maiorano said that between 10% and 20% of the inpatients at his hospital no longer need hospital care, and are just waiting to be discharged to another facility.
“There’s a toll this takes on patients,” Maiorano said. “It’s not just the time spent, but the time they spend in an acute setting adds complications, potentially to their hospitalization, increases risks of secondary illnesses or infections in a hospital setting, as well as delays the ultimate care they need for the condition they have.”
Vicki White, who is chief nursing officer at Henry Mayo Newhall Hospital in Valencia, said that during the busy season this winter, there were upward of 30 people on any given day taking a bed in the emergency department while waiting for insurance authorization to be discharged.
“This caused long waits, patients leaving without being seen, and incredible stress on the health care team, both in the emergency department and throughout the house,” White said.
For one patient who needed to go into a skilled nursing facility, White said, when hospital staff called the patient’s insurance company after four days of waiting for an authorization, they were told it could take up to 14 days to receive a determination.
“Patients and family members are distressed when they find they must wait to get to their next level of care,” White said. “They cannot understand why, when they have insurance coverage, that they cannot be allowed to move, and start their post-acute care.”
On top of that, the lawsuit alleges, insurers deny payment to hospitals for those extra unnecessary days caused by the delays, contributing to $3.25 billion in avoidable costs to California hospitals every year. That figure is according to a CHA survey of its members, which includes more than 400 hospitals across the state.
Hospital association CEO Carmela Coyle said that the lawsuit names Anthem because it's one of the biggest insurance companies in the state which contracts with the most hospitals. However, she described the problem as “endemic in California.”
“We are hopeful that the action that the court may take will influence the actions of other insurance companies,” Coyle said. “And, ultimately, put an end to these harmful practices, by spurring others to comply with existing state of California law."
In a statement, the California Association of Health Plans, pushed back against the hospital association's characterization of the industry.
"It is unfortunate that the California Hospital Association has decided to embark on a public relations campaign based on mischaracterization of the facts," the association, which represents health insurance companies across the state, said in the statement.
It accused the hospital association of "cherry picking patient stories in an attempt to influence support for misguided changes to our health care system that would remove important checks and balances that are proven to ensure quality care, patient safety and affordability."
The insurers group said it planned to review the hospital association's allegations closely and respond in more detail at a later date.