Hospitals Don’t Know If Patients Are Dead

An interesting research letter in JAMA Internal Medicine highlighted a grim trend in health system record keeping: EHRs frequently overlook patient deaths.

That’s a major issue for plenty of reasons, which UCLA Health researchers laid out after analyzing roughly 11,700 seriously ill primary care patients across 41 clinics (2020-2022).

Almost 700 patients whose medical records showed them as alive were actually deceased according to California public health filings, nearly 20% of the entire cohort. 

The discrepancy led to hundreds of unnecessary interactions such as prescription refills and appointment reminders, needlessly straining resources and staff bandwidth.

Of the patients found to be deceased:

  • 310 had an active appointment on the calendar
  • 541 had an appointment still pending
  • 221 received 920 letters about preventative care such as flu shots or screenings
  • 166 received 226 mailed correspondence
  • 158 had 184 orders placed for vaccines and other care
  • 88 medications were authorized 

That’s a serious amount of wasted outreach for healthcare workers that don’t exactly have extra slack in their workflows, and the authors point out that addressing just this issue would provide immediate benefit to staff (at least at one California academic health system).

It’s worth noting that California prohibits death file information from being shared with any party except for financial institutions, so the issue varies state to state.

The Takeaway

Not knowing which patients are dead isn’t ideal for provider operations, hindering everything from effective rev cycle processes to quality improvement programs. We’ve covered countless studies related to burnout caused by administrative tasks, but this is the first research we’ve seen that suggests a decent chunk of that burden could be alleviated by simply knowing which patients are still alive.

A Hospital Sector Under Siege

Flare Capital’s Michael Greeley and Dr. Gary Gottlieb published a stellar breakdown of the current challenges barraging US hospitals, unpacking how the convergence of cost pressures and workforce issues is creating a perfect storm of financial distress.

It’s a thorough overview to say the least, but most of the issues fit into a few main buckets that are worth considering when mapping out how to best partner to help tackle them:

  • The median debt-to-EBITDA ratio for US hospitals stands at approximately 3.9x (up from 2.5x in 2021), and 60 health systems have seen their debt ratings downgraded this year. The looming restructuring negotiations are going to be painful.
  • CMS hospital star ratings for 2023, which measure performance along five key areas (mortality, safety of care, readmission, patient experience, timely/effective care), showed slight declines across the board. That directly translates to worse reimbursement.
  • Over 600 of the country’s 1,800 rural hospitals are at risk of closing, and mostly in states with a large number of disenrolled Medicaid members. The upcoming spike in disenrolled patients that no longer have health coverage could be the tipping point for many of these hospitals due to increased bad debt and charity cases.

One “promising shiny penny” for avoiding hospital closures has been the broader adoption of technology to reduce clinical and administrative costs.

  • In today’s environment, hospitals need a clear ROI from their vendors. The writeup makes the case that a more patient-centric care delivery system might sound seductive, but could also actually increase a provider’s overall cost structure. That might give solutions that directly drive better star ratings an edge in the current market.

The Takeaway

Hospitals are a customer base that’s under siege from a ton of angles. It’s tough to solve these problems without first identifying their root causes, and this article is a great tool for honing in on those underlying issues.

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