Managed Care - July 2008 - (Page 43) How Long Is Too Long? Leapfrog’s revised length-of-stay measure is an early and welcome attempt to measure hospitals’ efficiency By Tom Reinke Leapfrog’s efforts signal new challenges to hospital chief medical officers to improve care and new opportunities for health plans to work with hospitals on cost and quality. The revised measure was developed by researchers at the University of Wisconsin, using data from the National Hospital Discharge Survey. Jim Robinson, PhD, deputy director of the Center for Health Systems Research and Analysis, says the challenge was identifying the statistically significant risk factors or comorbidities that extend the LOS and recommending an approach for handling outlier cases — admissions with extremely long stays. For the outlier cases, Robinson found that the length of stay can easily be two or three times the average length of stay, and when the number of cases is small, outliers can skew the average stay for all cases. As a result, instead of reporting the simple arithmetic LOS, hospitals will use a statistical measure called the log LOS or geometric mean LOS. The geometric mean LOS is used by Medicare in its reports of DRG (diagnosis-related groups) ealth care purchasers have been interested in adding efficiency measures to their reporting on the quality of doctors and hospitals, but attempts to do that have been stymied by resistance from providers and criticism of the methods used to measure efficiency. When efficiency measures are used in payfor-performance programs, providers have said that bonuses often do not adequately compensate them for the savings they give to payers. As a nationwide coalition of health care purchasers, the Leapfrog Group is confronting these objections by adding a credible efficiency measure to its Hospital and Quality Survey. Leapfrog has used an efficiency measure for several years, but the 2008 version, released in April, dramatically revamps it. The resource utilization measure, as Leapfrog prefers to call it, is the average length of stay (LOS), adjusted for severity. Readmissions within 14 days are also required to be included in adjusting the length of stay for an admission. “We did What Leapfrog wants watched not want to appear to be [encouraging] hospitals to discharge patients early, so we inLeapfrog’s length-of-stay adjustment model for acute cluded readmissions in the formula for calmyocardial infarction culating the length of stay,” says Leapfrog’s director of measures, Barbara Rudolph. Risk factors for severity adjustment H Four categories The LOS measure applies to four categories of admissions: coronary artery bypass graft, percutaneous coronary intervention, acute myocardial infarction, and pneumonia. It will be used to rank hospitals in the public reports that Leapfrog issues to help purchasers and consumers choose providers. The measure will also be used in the Leapfrog Hospital Rewards Program, a pay-for-performance initiative. • • • • • • • • Coronary artery bypass graft Congestive heart failure Stroke or transient ischemic attack Chronic renal disease Age ≥55 Cancer Chronic liver disease Percutaneous coronary intervention Source: Center for Health Systems Research and Analysis. Development of Severity-Adjustment Models for Hospital Resource Utilization Data. University of Wisconsin. March 19, 2008. JULY 2008 / MANAGED CARE 43
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