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MICHIGAN ADVANCE: Dingell and Ann Arbor-area hospital leader hash out concerns over available beds

On Monday, U.S. Rep. Debbie Dingell (D-Ann Arbor) sat down with leaders in the emergency department at Trinity Health Ann Arbor, to discuss the issues troubling the hospital amid an uncertain environment for health care providers.

During the meeting Dingell asked several questions on home and community-based health care, the impact Medicaid cuts would have on the facility, and the factors contributing to crowding and a shortage of beds for patients seeking inpatient and emergency care.

While discussing the lack of beds for patients, David Vandenberg, the chief medical officer for Trinity Health Ann Arbor and Trinity Health Livingston, explained they are seeing more older patients with medical illness versus conditions that can be treated with surgery.

Hospitals would previously run at 75-80% capacity on a busy day, and had no trouble absorbing additional patients, however that’s no longer the case Vandenberg explained.

While the hospital previously saw 240 of its 500 beds full on average, the average number of occupied beds has increased to 400, Vandenberg said.

“It’s the patients who have pneumonia, who come in with complications from diabetes, or, you know, other infections. You know, heart disease, lung disease. And they’re just, they’re staying longer because they have more comorbidities, it takes them a little bit longer to get better, and then they’re often debilitated by the end of their hospitalization and they need skilled care. And then we get stuck,” Vandenberg said.

It’s not a case of not being able to find somewhere for these patients to go following hospitalization, Vandenberg explained, but rather a need for insurance to approve a location, sometimes leaving patients languishing for two to three days.

The longer patients wait for skilled nursing, the more debilitated a patient is likely to become, meaning their stays are extended, feeding into a vicious cycle and contributing to a logjam in available beds, Vandenberg explained.

While the hospital has tried to alleviate its congestion by offering some inpatient care in a home setting, it’s been difficult to get payers to cover the cost, Vandenberg said.

Tarun Abraham, director of acute care flow and care management for several Trinity Health facilities explained their work with Huron Valley Ambulance through their community paramedic programs. While they do not offer home care, the paramedics are able to check in with patients and offer services like administering antibiotics. In order for the program to be more robust, it will need more payment sources to sustain it, Abraham explained.

However, offering care in a home setting also comes with shortfalls, Abraham explained, with family members who were handling care prior to a loved one’s hospitalization now shouldering some of the burden carried by hospital staff.

With congressional Republican’s “Big Beautiful Bill” slated to cut Medicaid spending by $911 billion over the next decade, which the Congressional Budget Office expects this will add 10 million uninsured individuals over the same time frame, Daniel McGillicuddy, an emergency medicine physician, predicted patients would delay seeking care due to costs.

However, under federal law, hospitals must offer care to anyone regardless of insurance or their ability to pay, with hospitals covering the cost of uncompensated care. If individuals delay seeking care, that will likely increase the number of patients that need to be admitted that may not have needed emergency care, leading to more patients in an already overcrowded system. McGillicuddy explained.

While this change won’t be immediate, McGillicuddy noted that 10 years ago, patients typically were not held in the emergency departments awaiting inpatient care, whereas now it’s a daily occurrence.

Additionally, once a hospital hits 85-90% capacity, things begin to take longer, meaning that patients will have longer stays, McGillicuddy explained.

The emergency department at Trinity Health Ann Arbor has 62 beds, Vandenberg explained, with 20 of those spots located in hallways. The hospital is in the process of rebuilding its emergency department, not so they can hold more patients, but so patients can receive proper care.

Katy Hoffman, the chief nursing officer for Trinity Health Ann Arbor and Livingston, explained that they care for more than 100 patients in their emergency departments on most days, but that those patients are cared for in hallways and in upright chairs.

“No matter what the challenges are and no matter what the status of the patient is and what their payer is like, you know, we’re going to continue to provide really great care. The challenge is, how much of it is going to be uncompensated, that as an organization, we’re going to struggle with,” Hoffman said.

As the health system works to navigate these difficulties, Dingell repeatedly offered her help in resolving issues on the policy side.

“You’ve got to come back at me on things that you think we should be thinking about. I’m good at casework, and my team will tell you, I do the casework myself,” Dingell said.