NEW ORLEANS (AP) — Stressed with too little staff and too many patients in an unrelenting COVID-19 resurgence, some hospitals in Louisiana are pressing insurance companies to ease up on requirements that can slow the transfer of recuperating patients to other facilities.
At issue are “Medicare Advantage” plans that supplement government-funded Medicare coverage. These insurance policies require extensive reviews and sometimes consultations with other doctors before transfers to inpatient facilities providing skilled nursing care, rehabilitation or long-term care.
Some of these patients are clearly ready to be moved to a non-hospital setting, but the bureaucracy has them stuck in badly needed beds, said Dr. Leslie Dean, of the Willis-Knighton system in northwest Louisiana.
“It’s almost impossible for them to move these people along in a timely manner right now because of these delays with some of these insurance plans, unfortunately,” she said.
The delays are critical as COVID-19 numbers grow, but the issue doesn't just involve coronavirus patients. The paperwork also can slow transfers of Medicare Advantage-covered patients recuperating from a stroke, a heart attack or some other illness or injury that will need post-hospital attention.
“There’s this crunch for beds, particularly in the South. And it just doesn’t help to have this administrative burden,” Dr. John Heaton, of the New Orleans-based LCMC system said Wednesday.
Hospitals and insurer conflicts over the approval of expensive procedures or transfers to possibly more costly settings long predate the pandemic, but they've taken on new urgency as Louisiana suffers through its fourth coronavirus surge. Statewide hospitalizations have set records almost daily through most of August, and doctors say the bureaucratic requirements contribute to long waits in emergency rooms.
“Just yesterday, I had five or six patients waiting for beds at post-acute care facilities all waiting for authorization from an insurance company,” Jason Lindsey, case management director at North Oaks Medical Center in Hammond, said Thursday. The emergency department "didn't have one minute yesterday where we didn't have somebody waiting on a bed,” he added.
Heaton said these insurers need to allow hospitals to unilaterally move out patients who are ready for post-hospital care, and receive approval retroactively.
Some insurers are easing up on at least some of their requirements.
The Louisiana Hospital Association released a statement by Humana on Wednesday suspending prior authorization requirements through Sept. 3 for transfers to skilled nursing facilities, long-term care facilities, inpatient rehab and home health care. Another Medicare Advantage insurer, People's Health, did the same for skilled nursing care and long-term acute care, but its announcement made no mention of rehabilitation facilities.
Nationally, many insurers temporarily suspended their prior authorization requirements at the start of the pandemic. In Louisiana, the Department of Insurance issued an emergency rule restricting the use of prior authorization policies that could bog down transfers.
But a department spokesperson and the Louisiana Hospital Association said regulation of the Medicare plans falls to the federal Centers for Medicare and Medicaid Services. The hospital association has asked Louisiana’s congressional delegation to urge the agency to require that the prior authorization practices be waived.
On Friday, the agency issued a memo that stopped short of requiring a waiver of the practices, although it “strongly encourages Medicare Advantage Organizations ... to waive or relax" the requirements.
At Willis Knighton, meanwhile, the need for beds has been so serious that the hospital has at times made transfers without waiting for insurer approval. “We've had to even move patients — go ahead and just move them — and try to get the qualification on the back end," said Dean. "Because, we're just out of beds."