Main description:

One focus of every hospital case management department or utilization management team is patient length of stay (LOS). Hospitals get paid by Medicare and most Medicaid and third party payers based on a formula that includes a number of elements. The formula is specific to categories of diagnoses referred to as Diagnosis Related Groups (DRG's).

The payment for the DRG's are predetermined and the amount doesn't change regardless of the cost of care. The only way for hospitals to make a profit is to provide care for the patient in a manner that is medically appropriate and gets the patient well enough to get safely out of the hospital, but at the same time keeping costs below the amount of the DRG payment. If costs exceed the payment, then the hospital will lose money on that patient.

For hospitals to know how they're doing, they need a standard for comparison. Medicare generally tracks and reports length of stay as a "Geometric Mean Length of Stay" or GMLOS which uses a statistical application that is calculated by multiplying all of the lengths of stay and then taking the nth root of that number (where n=number of patients). Most hospitals measure their own length of stay as an "Average Length of Stay" or ALOS which is a simple arithmetic mean or average.

This book focuses on the next generation of initiatives to improve LOS (length of stay) performance in hospitals. In the last 20 years many organizations have significantly improved the management of labor and non-labor expenses. The new frontier of expense reduction initiatives is in the utilization of clinical services. A one day reduction in LOS in a 500-bed facility represents about $1.5M per month in savings. This book showcases the most innovative solutions that have been implemented in the industry to reduce LOS to the proverbial GMLOS. This book also provides easy, practical solutions that will reduce LOS within 120 days.

Contents:

Preface

Chapter 1: Importance of LOS and how to measure it

Many organizations don't understand the impact of LOS in an organization. Additionally, most organizations don't know how to measure LOS appropriately. Understanding the nuances of what should be and not be included in the measure is critical to knowing how to manage it.

Defining LOS as an opportunity

Common methods of measuring LOS and GLMOS

What items should be included and excluded from the measure

Common mistakes in measuring LOS

Chapter 2: How to create the infrastructure to roll out the changes

Organizations require significant infrastructure in order to roll out a sustainable LOS program in their organizations. Building all the components from the ground up is critical to get the organization firing on all cylinders to keep LOS down.

Developing the steering committee

Developing the working group

Developing the teams

Developing the meeting schedules and project tracking

Chapter 3: Negotiating with payors to improve approvals

If the payers are not cooperating or you are not negotiating well, the organization will never achieve GMLOS. Knowing what to ask for is critical and getting it into the contract even more so.

Collecting performance indicators for approvals

Setting the required standards for approvals

Meeting with the payors

Negotiating the contracts

Chapter 4: Utilizing hospitalist to manage "inlier" patients

The utilization of hospitalist is critical because an organization has control over them. For the first time the priority of an organization can be part of play in getting LOS down to GMLOS.

What are inliers and how to identify them

Significance of managing inliers

Utilization of hospitalist in managing inliers

Specific information required to manage the hospitalists for LOS

Chapter 5: Setting up post-acute care services to manage "outlier" patients

The most expensive place to treat the patient is in the acute care setting. Any other location will by default be less costly. Knowing clinically when to transition the patient to the right level of care is critical.

What are outlier patients and how to identify them

Significance of managing outliers

Negotiating with post-acute care services

Setting up communication forms with post-acute care facilities

Chapter 6: New innovative reports for managing ALOS and its process

A new level of performance requires newer innovative reports. Reports showing utilization patterns of providers, LOS broken down by inliers and outliers, discharge patterns, and operator discharge times are critical to managing every aspect of the discharge.

New processes require new reporting

How to use these reports

Troubleshooting LOS using reports

Ranking opportunities using reports

Chapter 7: Inter-disciplinary review structure that provides the most benefits

Daily reviews are critical to keep tabs on the patient's condition. The escalation is critical to enable the IDR to function effectively.

Do you have all the right people at the table?

What is the expectation of the team?

When and where are they meeting?

Creating an escalation process.

Chapter 8: Getting the benefits of reducing LOS

It's one thing to reduce LOS but it needs to work in conjunction with labor and non-labor to get the benefits. For the department is not staffing to volumes the cost structure will change.

What does LOS mean to resources

Metrics to track for benefits (labor and non-labor)

Tracking readmissions to make sure LOS is not pushing too hard

Quantifying avoidable days

Chapter 9: LOS management is a perpetual process

Sustainability for LOS requires constant vigilance. Infrastructure that is constantly monitoring the metric is critical. These metrics need to be monitored in conjunction with reciprocating metrics such as 30 day re-admissions to make sure LOS is not decreased at the expense of patient condition.

What happens when the team disbands

Components that need to be in place for CQI process

Monitoring at each level of management

Making it part of the culture

Chapter 10: Leadership drives culture and results through proper communication

The most critical part of the book is making sure you have the right leadership in place. What are the characteristics of a good leadership that can drive the culture.

The value of strong leadership

The communication methodology