Medicare patients stay in hospital too long

Study: 55% of inpatient days unnecessary

More than 55% of all Medicare inpatient hospital days were potentially unnecessary in 1996, according to Milliman & Robertson's Length of Stay Efficiency Index and Admission Appropriateness Index. The indices developed by the Seattle-based company measure the efficiency of individual hospitals relative to the actual length of stay and admission experience of the most efficient hospitals.

At 1996 levels, the average Medicare length of stay could be reduced from 6.4 days to 4.1 days if all care were provided at the most efficient levels, and admissions could be reduced by more than 43%, according to Milliman and Robertson. "The 55% figure is based on potentially unnecessary days due to longer than necessary inpatient lengths of stay and treatment that could have been provided outside the acute hospital environment," says John Cookson, the Milliman & Robertson principal who compiles these indices.

The study found wide regional variance in hospital efficiency, notes Cookson. Utah, with 34% unnecessary hospital days; Washington, with 35%; and Oregon, with 37%, were the only states where Medicare days could have been reduced by less than 40%. Mississippi and New York, with 68% unnecessary hospital days, and New Jersey, with 65%, showed the greatest potential for utilization savings. In total, 37% of Medicare inpatient days are potentially unnecessary due to longer than necessary length of stay, and 18% of the days are avoidable due to admissions identified as potentially avoidable.

"The regional differences have shown up consistently in the indices," says Cookson. "A single explanation for these differences is difficult to pinpoint, but aggressive health care management is more deeply entrenched in the West, and it's likely that this is one of the reasons for greater efficiency as you move geographically from East to West." (For more on the Length of Stay Efficiency and Admission Appropriateness indices visit the Milliman & Robertson Web page at http:www.op.net/~jcookson/.)