Even the best can’t compete with M&R
Even the best can’t compete with M&R
Pediatric LOS higher in virtually all categories
Milliman & Robertson, the Seattle consulting firm, acknowledges that its goal length of stay (GLOS) guidelines are based on treating the ideal patient. But even the best performers in a recent study don’t come close to real life. The study, by the medical information company HCIA Sachs in Baltimore, now known as Solucient, found that in only one of 36 conditions, neonatal sepsis, did Milliman & Robertson’s GLOS exceed what the 100 top hospitals averaged. (See table, below.)
Pediatric LOS Comparison for Selected Conditions | ||||
Condition | Avg.
LOS 100 Top Hospitals |
Avg.
LOS Nonwinners |
M&R Goal LOS | %
of Winners Exceeding GLOS |
|
||||
Appendectomy, complicated |
5.1 | 5.3 | 3 | 68 |
Appendectomy, uncomplicated |
2.0 | 2.2 | 1 | 64 |
Asthma | 2.2 | 2.2 | 1 | 67 |
Bronchiolitis | 2.6 | 2.7 | 1 | 76 |
Burn, major | 7.1 | 8.8 | 2 | 83 |
Cellulitis | 2.7 | 2.9 | 1 | 81 |
Croup | 1.5 | 1.6 | 1 | 35 |
Gastroenteritis | 1.8 | 1.9 | 1 | 55 |
Neonatal sepsis | 3.4 | 3.2 | 5 | 12 |
Pneumonia | 2.6 | 2.7 | 2 | 4 |
Pyelonephritis | 2.8 | 3.0 | 2 | 54 |
Sickle cell crisis | 3.6 | 3.7 | 1 | 84 |
|
||||
Source: HCIA-Sachs Institute/Solucient, Baltimore. |
The 100 top hospitals series of studies is based on 1998 data from more than 3.5 million pediatric discharges from short-term general U.S. hospitals. HCIA Sachs used only uncomplicated cases where at least 5% of the baseline case number had the lowest severity level as defined by the all patient refined diagnosis related group severity scale.
The study shows that while the 100 top hospitals outperform nonwinners, they don’t do so by much — usually about 0.1 to 0.2 days. But the difference between even the best performers as a group and the GLOS is significant. More than half the uncomplicated cases among the 100 top hospitals had LOS that exceeded the M&R GLOS. The percentage of cases that had LOS in excess of M&R varied, but in six conditions, it was two or more days difference. The report states that "results indicate that the Milliman & Robertson guidelines are very aggressive for many conditions. . . ."
The report goes on to express concern over potential negative impact on outcomes if the GLOS were adhered to stringently. "We also are concerned that these guidelines will be inappropriately applied to more complicated cases, which constitute over 25% of the cases."
It is a concern shared by officials at some of the top 100 hospitals as well. "We think that M&R is quite aggressive," says Brenda Totty, MBA, director of hospital services at the 275-bed Maury Regional Hospital in Columbia, TN. "We are aware of them, but we base our decisions . . . on patient needs and quality of care."
Maury administrators say they are considered so aggressive that nearly 100% of denials based on exceeding M&R GLOS guidelines are appealed. Totty says she is pretty sure she knows why Maury is among the best performers in the study: Pediatricians at the hospital do two rounds per day and will discharge in the morning or evening. "I think it’s uncommon around the country, and few of our other physicians do it," she notes.
Another reason might be that critical care patients, such as those with major burns, are sent to Nashville and are not treated at Maury. Knowing how the hospital measures up — both against others and against the M&R guidelines is important, Totty says. "We focus continually on improvement, and we look for patterns and trends. But outcomes are more important than M&R guidelines. There is a real balancing act between cutting your length of stay and maintaining quality of care," she adds.
[For more information, contact:
• Brenda Totty, Maury Regional Hospital, MBA, Registered Health Information Administrator, Director of Hospital Services, 1224 Trotwood Ave., Columbia TN 38401. Telephone: (931) 380-4021.]
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