Hospitals say hundreds of local patients waiting to discharge over delayed health insurance approvals [The San Diego Union-Tribune]

This week, the California Hospital Association sued Anthem Blue Cross, the state's largest health insurance company, alleging that the health care giant takes far too long to approve placement in skilled nursing and other sorts of "post-acute" settings, causing an estimated 4,500 Californians to languish in emergency departments and hospital beds "waiting for their insurers to approve and arrange for their discharge."

It's a problem often decried in San Diego County and a request for estimates last week found that Scripps Health and Sharp HealthCare, two of the region's largest medical providers, collectively had 163 patients in hospitals waiting for discharge. In Scripps' case, the largest concentration of patients waiting to leave was at Scripps Mercy Hospital San Diego, which had 52 patients ready for discharge Wednesday. Sharp reported 21 "delayed discharge patients" at Sharp Chula Vista Medical Center.

It is an issue that Chris Van Gorder, Scripps' chief executive officer, has been focused on for more than a year. Though he said he is not familiar with the hospital association's lawsuit, he said Scripps generally supports compliance with state requirements for transferring patients from hospitals to long-term care.

State law, he noted, requires hospitals to hold on to patients until they can be discharged.

"That is abused by insurance companies every day with their denials, delays (and) failure to have 24/7 staff available to give authorizations for care while hospitals operate 24/7," Van Gorder said. "The insurance companies don't have sufficient networks under contract to take patients ready for discharge immediately."

Delays can be longest in hospitals' behavioral health units. Scripps has an extreme example of that with one patient who needs discharge having now occupied a bed for 1,212 days or 3.3 years.

To make its case, CHA attorneys cite the Knox-Keene Act, a state law that "requires that a licensed care services plan 'shall provide for or arrange for the provision of covered health care services in a timely manner appropriate for the nature of the enrollee's condition consistent with good professional practice.'"

Anthem has not issued rebuttal to the hospital association's claims. Its media desk did not respond Friday to a request for comment.

Statewide statistics cited by the CHA come from a survey of its 400 member hospitals in 2023.

Results indicate that 9 percent of all hospital patients, 12 percent of those in psychiatric units and 4 percent of emergency patients were holding beds after they were ready to be discharged.

All told, the hospital association calculates that California's medical centers burn about 1 million "patient days" per year caring for those who could be discharged and about 7.5 million hours of usable time taken from emergency departments. These numbers, the CHA calculates, add up to about $3.25 billion per year in avoidable costs.

This story originally appeared in San Diego Union-Tribune.

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