Referral Rejection Rate for Hospice Reaches ‘All-Time High’ of 41%

Skyrocketing demand for post-acute care services has put providers in a pickle, often forcing them to turn away new hospital referrals due to limited labor capability.

This problem has been particularly pervasive for home health agencies, but it’s increasingly an issue in the hospice setting as well, according to the latest data from CarePort, a WellSky company.

Because of this supply-and-demand imbalance, hospice providers are rejecting new referrals at record levels, with hospital patients in need of end-of-life care having to wait in the acute care setting about a day longer.

Advertisement

“I would say that the story we are seeing across post-acute providers – skilled nursing facilities (SNFs), home health care and hospice – is very similar,” Tom Martin, director of post-acute care analytics at CarePort, told Hospice News. “I might just boil it down to: We are seeing very high demand for post-acute services. And we are now experiencing sort of this supply shortage of available post-acute beds and staff to care for people.”

On the demand side of the equation, referral volume for CarePort’s hospice clients reached 113% of pre-pandemic levels in January, after hitting 118% of pre-COVID levels at the end of last year.

In actuality, the only time CarePort’s hospice providers saw lower-than-normal volumes was in the spring of 2020. That didn’t last long, however, with home health agencies also experiencing a V-shaped volume recovery.

Advertisement
Source: CarePort, a WellSky company

Due to rising demand and clinician burnout, hospice operators haven’t always been in a position to “say yes” to new referrals from the acute care setting.

Rejection rates from hospice providers have been on the rise throughout the public health emergency, but hit a relative peak in January, CarePort data shows. Specifically, the average rejection rate from 163 CarePort hospice clients was 41% last month, a major jump from the pre-pandemic baseline of about 25%.

“I believe this is an all-time high,” Martin said.

The rejection rates from hospice providers were about 36% from May 2020 to November 2021.

“With hospice providers, and really all the other post-acute providers using our tools to accept these referrals, we are clearly seeing an increase in the percentage of the patients they are turning away,” Martin added.

What has this all meant for patients? Well, for starters, it has meant spending more time in the hospital prior to receiving hospice care.

In January, for example, patients in a hospital referred to a CarePort hospice client spent an average of 7.8. days in the hospital. From January 2019 to March 2020, that average was around 6.7 days.

“Average length of stay is up by about a day, which is a big deal,” Martin said. “A lot of people are staying in the hospital an extra day before they find a post-acute provider.”

Looking forward, Martin said he expects that the demand for post-acute care services will continue to rise for the foreseeable future. As far as the capacity challenges, that’s much more uncertain.

“On the supply side, do I think they’re going to get out of hot water and suddenly be able to find the staff that they need to capture some of this volume,” he said. “That I don’t know.”

Companies featured in this article:

,