The California Hospital Association is suing Anthem Blue Cross of California, alleging the insurer does not follow state laws related to patient discharge requirements.
The suit, filed Tuesday in Los Angeles County Superior Court, alleges the payer delays patient discharges and refuses to transfer patients from hospitals to post-acute care facilities or services such as skilled nursing, behavioral health, long-term care, rehabilitation facilities or home health services. The costs of the extra care fall to hospitals, leading to higher staffing and equipment costs, the complaint alleges.
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The suit comes as demand for post-acute care rises and reimbursements don't keep up. Many health systems and hospitals have had difficulty finding post-acute care facilities that can accept patients due to staffing challenges and lack of Medicare or Medicaid reimbursement.
Additionally, communication breakdown between hospitals and post-acute providers has been an issue due to a lack of compatible electronic health record systems and insurance reimbursement for discharge processes.
The association's suit alleges the insurer violates a California law requiring insurers to arrange and authorize post-acute care for its members, regardless of whether the insurer has communicated with a member's provider and agreed on a care plan.
The association filed the suit against Anthem since it is one of the largest payers in the state and nation, a spokesperson for the association said.
Anthem Blue Cross of California declined to comment on the suit.
In January, the association released a report showing that delays in patient discharges cost hospitals in the state an estimated $3.25 billion annually in additional labor costs and equipment.
The report noted that delayed transfers from acute beds to facilities outside hospitals lead to overcrowded emergency departments and delays for ambulance crews. The report also found hospitals are not receiving sufficient reimbursement to cover the extra costs.
Payers most often delay discharge care for patients who need to be transferred to skilled nursing facilities, according to the report.
On Tuesday after the suit was filed, the California Association of Health Plans said in a news release that insurers provide $4.5 billion in payments to California hospitals through a capitated payment model by providing upfront payments to hospitals as well as funds toward patient claims within 30 to 45 days. It also said insurers supply financial support for managed care organizations through tax revenue and emergency grants for hospitals.
“Significant harm could be caused to our health care financing and delivery system if health plans are forced to diminish patient safety and affordability measures,” the California payer association said.