In the face of sweeping changes to care delivery due to the Affordable Care Act, concerns over hospital efficiency and access to services are unsurprising. Indeed, though more Americans are insured today than ever before, over 20% report that nonfinancial barriers have led to “unmet needs or delayed care,” with accessibility to hospitals cited as one of the primary reasons. That’s despite the fact that admissions are, in fact, continuing to go down.

So, what’s going on here? The answer is complicated.

Shortage of clinicians
The dearth of primary care doctors and nurses was anticipated, and solutions have been suggested and tested, including the greater use of physician assistants and nurse practitioners to handle lower-level care decisions. But by some estimates, the shortage will become even more pronounced in the next five years — upwards of 20,000 missing primary care providers by 2020, and as many as 90,000 by 2025.

With 16.4 million newly insured and sometimes chronically ill patients now covered under Obamacare, bottlenecks of quite sick people are likely to continue to occur in hospitals across the country. And a clinician shortage affects more than just efficiency. For obvious reasons, well-staffed hospital departments see lower patient mortality rates and higher care quality scores, too.

Poorly-managed patient flow
For over a decade, smooth patient flow has been recognized as one of the most critical factors in preventing overcrowding, delays in care delivery, and maintaining efficiency in hospital settings. Yet data shows that hospitals, particularly emergency departments, remain overcrowded and marked by lengthy average wait times. Part of this is certainly attributable to the ongoing provider shortage.

Lengthy hospital stays, or delayed discharges
Whether because patients aren’t being discharged as soon as they can be, hospital inpatients are sicker than ever before, or planning and coordination among specialists is poor, the length of the average hospital stay has been gradually increasing, standing in 2015 at just under five days. These longer stays aren’t just costly, running between about $1,800 and $2,300 patient per day — they also cost hospitals beds, resulting in fewer spots for inbound patients.

High readmission rates
Despite the provisions of the ACA’s Hospital Readmission Reduction Program, which implements Medicare payment reductions for hospitals with too many readmissions, the number of hospitals being penalized for 30-day readmissions were higher in 2015 than in prior years.  What’s causing this “u-turn” or “revolving door” syndrome? According to a report by the Robert Wood Johnson Foundation, avoidable readmissions often occur because inpatient care quality and care coordination is poor.

Poor communication
At the root of poor patient flow, lengthy stays, and high readmission rates may well be inefficient communication among care teams. A survey from the Ponemon Institute of more than 400 providers found that poor communication is costing upwards of $11 billion industry-wide. What is causing communication breakdowns? Some point to shortcomings in or total lack of technology — inadequate pagers or wireless connectivity, for instance.

Others blame cumbersome processes, like those around patient admissions and transfers. The same Ponemon survey revealed, for example, that more than half of the amount of time required for admitting one patient (51 minutes) was wasted on communication inefficiencies. And it’s not just communication between doctors, nurses, and other medical staff that’s affecting the bottom line. Poor communication between patients and providers has been shown to lead to costly readmissions.

In the face of a multifaceted problem, where do solutions lie?  One option may be found in focusing on the “handful” of conditions that are the costliest in terms of time and money to treat, the top five being septicemia, osteoarthritis, complication of device implant or graft, newborn infants, and acute myocardial infarction. Scheduling optimization, including the use of better tools to help schedule outpatient procedures and manage patient flow from department to department, presents another avenue of improvement. Regardless, options would be best sought quickly given the number of newly insured patients sure to enter the market in years to come.

To learn more about models of care efficiency and tools that can help improve care delivery, contact Everseat.