[HSF] Fast tracking

[Ajit Damle]

Mark,

 

I put a posting sometime ago on this subject.

 

The Medicare has changed rules. Medicare correctly suspected, that hospitals
achieved lower LOS by shifting care to another facility (home nursing care,
nursing homes, rehab units, transitional care units etc). Medicare then
ended up paying both for the hospital and the skilled care facility. On
paper LOS was lower, but hospitals and the skilled care facilities profited
more and more, increasing the total costs.

 

Therefore, now Medicare has a proscribed LOS for each patient that comes to
surgery. If the patient is discharged from the hospital to any skilled care
facility before the proscribed LOS, Medicare will cut the DRG payment to the
hospital by a proportionate amount. This can be huge, anywhere from 5 to
30%. If the patient is discharged home early without the need for skilled
care, then the payment is full.

 

At our hospital, we have a very effective case management system, and our
LOS for CABGs were very low, 5.1 days, (all patients). We now have
deliberately increased our LOS to avoid loss of revenue from early
discharges. Earlier, to encourage surgeons to cut costs, LOS was associated
with a good care "Bench Mark". Implicitly, if your patients had higher LOS,
it was because you had more complications. Sometimes, but of course not
always, true.

 

Keeping the patients in longer is not excessively expensive for the
hospital, unless there is a bed crunch. Ninety percent of a heart surgical
cost is incurred on the first day (OR and ICU). The next one is the day of
discharge, whenever that is, with all the flurry of activity and take home
meds.

 

Ajit Damle

 

 

 

 

 

.

 

 

 

 

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Mark Levinson
Sent: Monday, September 03, 2007 9:04 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Fast tracking

 

 

On Aug 24, 2007, at 9:43 PM, Tea Acuff wrote:

 

> I agree with your sentiments. However, this is the number that  

> comes back from my STS data

 

Tea:

 

I watch my bi-annual STS reports, and I have noticed that the average  

(mean) LOS for CABG has not changed

in 12 years!     It was 7 days in 1995 and still today....Curious.

 

I know that many of us are trying hard to get patients out of the  

hospital early, but the average does not budge (nationwide).

So, my fealing is that we are succeeding in the younger patients, and  

this is offset by longer LOS in the increasingly

older and sicker elderly patients.     For the sake of calculating  

the mean, these older patients erase the gain we can

achieve in the younger.

 

In order to get patients out earlier than day 3, we must educate them  

prior to surgery that we expect them to go

home on day 2 or day 1.     Their response to that information will  

quickly determine if you are going to succeed

or fail...the patient that wants to go home early often does.        

More typically, the patient that does *not* want to go

home early never will!

 

Mark

 

Mark M. Levinson, MD

Founder, Editor-in-Chief,

The Heart Surgery Forum

WWW: <http://www.hsforum.com>

Email: <mmLevinson at hsforum.com>

 

 

 

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