A recent article in the American Journal of Managed Care caught my attention because it specifically addressed transitions of care for obese patients, which now constitute more that 20% of the adult U.S. population. This study, published in the Western Journal of Nursing Research, surveyed discharge staff in Pennsylvania and Arkansas, and found that one third of respondents reported being unable to transfer obese patients due to barriers such as lack of bariatric equipment, staffing availability, and reimbursement challenges.
We have found similar trends in our data. Post-acute providers create profiles in CarePort Guide to indicate the clinical services they can provide, and bariatric bed is one such service. These profiles populate a database that powers a post-acute search tool that discharge planners use to find appropriate post-acute care for patients. For example, a discharge planner checks off bariatric beds as part of the search criteria when trying to place an obese patient.
Within CarePort’s database, which now encompasses thousands of skilled nursing profiles across multiple states, we found that only 39% of the skilled nursing facilities even offered bariatric beds. This reinforces results of the study. Lack of available equipment in nursing homes poses a significant barrier to discharge for obese patients.
Anecdotally, there is also a general sense that “cherry-picking” compounds the problem of difficult-to-place patients. Even when equipment or staffing may be available to service obese patients, current reimbursement models may incentivize facilities to prioritize accepting other patient types.
The challenges facing transitioning obese patients are important to highlight from a quality and cost perspective. Patients are at risk for adverse outcomes associated with prolonged hospital length of stay. In addition, obese patients who are placed at facilities that cannot meet their needs are at risk for readmission events. With rising obesity rates, there will only be increasing urgency to address these challenges.
