By Debbie Bunch
Unpacking Length of Stay
Respiratory therapists know “length of stay” or “LOS” means the number of days a patient remains in the hospital prior to discharge. But bedside RTs who spend their days treating those patients may not realize how LOS figures in to the financial side of health care.
To those in charge of the purse strings, LOS is a key performance indicator that hospitals use to gauge the efficiency and effectiveness of care. Shorter stays are often associated with lower costs and increased profitability. But LOS can be affected by many factors, from the patient’s comorbidities and disease acuity, to staffing levels, hospital quality, discharge destination, and insurance status.
Here are four things to know about length of stay and how it impacts your organization —
- According to data collected from 4,405 U.S. hospitals in 2023 by Definitive, the average LOS is 4.5 days, with South Dakota and Utah having the lowest LOS at 3.3 days and Maryland and Washington, DC, having the highest at 6.1 and 6.5 days, respectively.
- Lowering LOS by just one day can have a major impact on a hospital’s bottom line. A study conducted by Kauffman Hall found a 425-bed hospital that lowered its average LOS from six days to five days would save $20 million in operating costs. Assuming an average margin of $4,500 per admission, it would also gain about $20 million in additional margin over one year due to its expanded ability to admit more patients.
- Managing LOS is a complex process involving coordination between patient status tracking, utilization management, care transitions, and discharge planning.
- Delayed discharges caused in part by insurance bureaucracy and emergency room boarding resulting from a lack of hospital beds have been cited as factors that promote longer LOS.
- Efforts to reduce LOS were hampered by the COVID-19 pandemic, when the average LOS soared by 19%.
Clearly, reducing LOS is a priority for those on the financial side of health care, but experts warn that trade-offs exist for patients and care teams, and facilities need to take a multifaceted approach to reducing LOS that can help avoid any unintentional consequences.
That fact was emphasized by a 2021 study conducted by investigators from the University of Pennsylvania and published by JAMA.
The investigators found no evidence that any of eight measures instituted to reduce LOS in high risk populations — discharge planning, geriatric assessments, medication management, clinical pathways, multidisciplinary care, case management, hospitalist services, and telehealth — were effective in doing so on their own. Read More
CMS Releases Overall Hospital Quality Star Ratings for 2024
Every year, the Centers for Medicare and Medicaid Services (CMS) rates hospitals based on a number of factors. The 2024 ratings are out now, and according to a recent article in Becker’s Hospital Review, 381 hospitals — 102 fewer than last year — received the highest rating of five stars. You can see them here.
Becker’s also published a list of the hospitals that received the lowest rating of one star. Overall, 276 hospitals — 29 more than last year — made that list.
How did your hospital fare? You can find out by visiting Medicare’s Find Healthcare Providers: Compare Care Near You webpage. Just put in your location and the site will generate a list of providers in your area, along with both their quality star rating and their patient survey rating.
How does CMS grade hospitals? According to the government agency, ratings are assigned using data supplied to CMS by hospitals themselves and a detailed, multi-step process is used to select, standardize, and calculate results based on these publicly reported measures scores.
For the 2024 report, CMS selected 46 of the hospital quality measures publicly reported on Medicare.gov and divided them into these five measure groups —
- Mortality
- Safety of Care
- Readmission
- Patient Experience
- Timely & Effective Care
Importantly for RTs, the death rate for COPD and pneumonia patients were key measures under “Mortality,” and the rate of readmission for COPD and pneumonia patients were key measures under “Readmission.”
You can find detailed information on all of the measures included in the five groups on the CMS Overall hospital quality star rating page.
The Evidence for E-Cigarettes Mounts
More evidence that e-cigarettes may help people quit smoking combustible cigarettes was published by JAMA Open Network earlier this month. But the type of e-cigarette matters.
The investigation, which was a team effort by researchers from the Roswell Park Comprehensive Cancer Center, University of Waterloo School of Public Health Sciences, and the Medical University of South Carolina, involved an analysis of data from the Population Assessment of Tobacco and Health Study. Overall, 1,985 adults were tracked to see whether e-cigarettes can help people stop smoking traditional cigarettes.
The study spanned the years 2014-2021 when e-cigarette options were changing. Results linked daily use of e-cigarettes to higher overall rates of quitting combustible cigarettes than nondaily use, 12.8% vs. 6.1%, and adults who used e-cigarettes in 2019 were more likely to stop smoking traditional cigarettes than those who used them in 2014-2015, 12.0% vs. 5.3%.
Flavor and device type had only limited effects on the likelihood a person would quit smoking traditional cigarettes.
The authors believe people may have been more likely to quit smoking traditional cigarettes in the later years of their study because by then, e-cigarettes contained more nicotine than they had previously. “Our findings are consistent with earlier evidence that sufficient nicotine replacement can be helpful for quitting smoking,” said study author Karin Kasza, PhD, from Roswell Park.
Still, the authors emphasize using e-cigarettes to quit smoking traditional cigarettes is just one step in the process of quitting. “Since there is no safe tobacco product, eventual abstinence from all tobacco products is the end goal,” said senior study author Andrew Hyland, PhD, also from Roswell Park. Read Press Release Read Full Paper
