Improving Post-Acute Care Transitions to Manage Capacity in a Pandemic

20 Mar 2020

Although the current focus is on how the COVID-19 pandemic is affecting hospitals, managing post-acute care (PAC) capacity will soon be just as critical to public health as the volume of COVID-19 patients grows, overburdening PAC physical and human-resource capacities.

Harvard University health care policy professor David Grabowski explained that “we need to start investing in PAC capacity & capability for the surge of patients that will need to be discharged from hospitals over the coming weeks and months.”

The influx of patients needing care after hospitalization will require hospitals and PAC providers such as skilled nursing facilities (SNFs) and home health agencies (HHAs), to coordinate patient transfers more efficiently than ever. As providers are stretched thin, hospital staff must have visibility into the broader regional PAC market, including capacity and clinical capabilities, as they transition acute care patients and free up beds for incoming patients.

Unfortunately, PAC transitions have historically been very resource-consuming and inefficient. Hospital case managers spend hours sending out referrals to a handful of prospects, awaiting responses that sometimes never come, and sending multiple follow-ups to get an answer. Responses are often late thanks to something as mundane as an unmonitored fax machine – leading to an acute care discharge delay. Other times they indicate that a provider is booked or otherwise unequipped to accept the patient – necessitating that the process begin all over again. These delays, already burdensome to patients, hospitals, and PACs, are exacerbated on placements outside a hospital’s usual partners. As PAC capacity dries up, hospitals will have to look farther and administrative delays will be untenable in the context of the pandemic. Already this week medical record fax lines are tied up as hospital staff rush to get discharging patient records to downstream facilities.

Recommended Actions for Hospitals and Health Systems:

As resources tighten, expand referral distribution to all qualified regional providers.
Staff should immediately contact an expanded assortment of providers in their region to properly distribute patient volume and to build visibility into the regional market’s capacity and capabilities. The time for outreach and partnership is now.

Data collected since January 1, 2020 by Aidin, a web application that connects healthcare entities through a secure, timed, transparent marketplace, for clients in Columbus Ohio, Nashville, Houston, and Los Angeles, shows that PAC capacity is currently underutilized – meaning there is more opportunity to transfer hospital patients out. For every patient placed with a SNF or HHA, Aidin identified three additional beds/nurses that could have been available to the patient (i.e., three excess offers of care).

Skilled Nursing and Home Health Care Transitions for Health Systems in Nashville, Houston, Los Angeles and Columbus Ohio

On average, in those markets, hospital staff contact 15 providers for each patient. Results of the outreach are below:

If excess capacity is identified and utilized now, it will help diminish at least some of Mr. Grabowski’s early capacity concerns. Hospital’s must upgrade their workflow and the rigor of their collaboration tools to ensure every regional provider, not just local favorites, are identified and included in the referral process and that standardized processes and documents are ready to finalize placements.

Track PAC providers who are offering and declining care.Closely tracking reasons that PACs give for declining care will help you identify capacity and capability trends in your PAC market. PAC capacity is directly tied to your ability to create space for more patients. Hospitals should monitor this PAC response information in real-time to see where staffing and capacity concerns emerge and then develop strategies to help support your community providers.

Clearly communicate patients’ COVID-19 status.Communicating the clinical status of the patient is always necessary but increased transparency on a patient’s COVID status is necessary to protect both patients and staff. Referrals to new care providers and shared resources like transportation providers especially must clearly identify a patient’s COVID-19 status with every communication.

Recommended Actions for PAC Providers:

Closely manage capacity and offer care to hospitals in a timely fashion.

Be transparent about why you are unable to accept patients so as to help referral partners respond when critical gaps emerge.

Communicate your ability to manage COVID-19 patients safely by updating your settings on referral tools and communicating to referral source leadership.

Monitor the overall volume of referrals and COVID-19 cases seeking PAC care in your area to stay one step ahead of increased volume and staffing demands. Some referral systems make market-wide data available to PACs.


Historically, onerous processes have limited the ability of most health systems and providers to work together to expedite PAC transitions. The COVID-19 crisis brings to the forefront the critical importance of expanding the purview of your PAC community to a regional scale to efficiently connect patients with high-quality care.