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Cost of Length of Stay

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  • #25782

    Schuette
    Participant

    Hi –
    I’m new to the healthcare industry and am trying to figure out if there are heuristics out there to help quantify the impact of Length of Stay – in part to aid with project selection. 
    I’m also interested in knowing if there are standards or best practices for how this is calculated (e.g. what fixed and variable costs go into a patient day).
    Thanks for any input.
     
    Jim

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    #62444

    Roger Noble
    Member

    There are few standards out there reflecting accurate/validated industry benchmarks, but some groups are working to change that. AHRQ is a government agency focused on gathering this type of information and making it available for the industry to start benchmarking against top performers and industry means (I believe CMS, Blue Cross, and Kaiser Permanente are working with them on this). Many for-pay private companies are selling this type of benchmarking information but thus far, I haven’t found where it is validated to level that it should be in order for it be worth the purchase price and to base any evaluation on.
    That’s where the simple part stops and the notorious “healthcare is special” situation creeps in. There is no standard length of stay expense since each patients care is tailored for them (or at least you hope it would be!). In general, there are overhead expenses that can be factored specifically for a facility for the inpatient stay such as the inpatient room’s daily share (really should at least be broken down by by 8 hour shifts, patients are typically discharged once per shift). Pediatric care is more costly to a facility than adult care. Compounded diagnosis is more costly to provide care than a single diagnosis (ie: diabetes plus a stroke) since compounded diagnosis require multiple specialties to consult on the patient. The best solution to use instead the industry is up to speed with cost benchmarking, is to put patients into tier categories based upon the type of care they require. If you want to start with averages for single diagnosis (though I would recommend you don’t if you can avoid it) adult daily inpatient cost of care of $4500 and pediatric cost of care of $7500. This does not include any surgical or anesthesia services just the inpatient in room services. For every additional diagnosis, just so you can understand the impact, you can multiple that by 1.35.

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    #62445

    Schuette
    Participant

    This is helpful, thanks.  Are there other measures (with benchmarks) you would recommend for calculating the cost benefit of improving flow through an ED?  I imagine I may be able to put some conservative estimates around the portion of patients who leave without being seen and the amount of overtime required to staff these situations, but I wonder if there’s anything more commonly measured in these cases.

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    #62446

    Roger Noble
    Member

    This is where I have to say “welcome to the world of healthcare!”. No, unfortunately there are not readily available PROCESS benchmarks out there, yet. The focus on recent years has been on the development of the clinical benchmarks which still aren’t utilized to their fullest ability yet.
    I’d hate to say this, but the best model I have been able to present for the issues facing ER’s has to do with their trauma categories and prioritizations. My solution, they should staff a less skilled family practice unit or “doctors walk in clinic” within the hospital and route the non-urgent care cases there. That will considerably improve the flow right there. often the issue is not with the hospital process as much as it is with the patient case mixes that arrive at the ER. The majority are not ER qualifying cases and thus bog down the process and system. I haven’t had much luck selling this in healthcare though.
    One measure that I have sold pretty well across all departments, not just the ER is the idea of “patient idle time”. patient comes to hospital to see a clinician. Any time not spent in front of a clinician is considered patient idle time. This is real wait time in the eyes of the patient. Once hospitals redefine wait time to this perspective, it gets their attention and  process changes occur. It will also help you to see what’s going on or at least wrong across the units.

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