Our country is in the midst of multiple crises and it is difficult to imagine if, or when we will return to something resembling normal. However, there is hope that we are at least seeing the beginning of the end.
Now is the time to consider what impact the events of 2020 had on Key Performance Indicators (KPI) of hospitals and healthcare systems. Sooner than you might expect, healthcare administrators will be contacting their physician advisors, directors of utilization management, and revenue-cycle directors, expecting an answer for “why is our (KPI du jour) so bad?”
To be forewarned is to be forearmed, and so today, we will look at a KPI that may have been impacted by the events of 2020. I don’t claim to have a crystal ball, and it is unlikely that any individual has a full grasp of all of the ramifications of the past year, but several of these areas were likely affected at your facility.
WHAT TO DO?
The best course of action will depend on the specifics of your facility. However, there are several general steps that will be helpful:
- Proactively review your LOS for 2020 and 2021 and ensure that there is ongoing education regarding the key metric of length of stay. This data is only useful if you understand why it is being measured, and what information can be derived from the measurement. No single number can provide a clear understanding of system performance, and LOS must be viewed in relationship to other KPI.
- Confirm that reports include a comparison of the actual vs. expected LOS. The expected LOS is derived from the patient’s Diagnostic Related Group (DRG). If the Actual / Expected is < 1.0, then patients are discharged earlier than expected, and the system is performing well regardless of the absolute LOS.
- Ensure that data is reported with both the arithmetic LOS (A-LOS), and geometric LOS (G-LOS). The G-LOS, can be used to exclude outlier (long) LOS patients, and gives a better understanding of how the system is performing with the typical hospitalized patient. Consider the LOS for all patients hospitalized with simple pneumonia, and an expected LOS of 4 days. The A-LOS is 7 days (bad), and G-LOS is 3.5 (good). This tells us the system is doing well with most patients hospitalized for pneumonia. The A-LOS is skewed by a few patients with really long stays. If the G-LOS was 5 days, then there may be a system issue contributing to prolonged stays in many of the pneumonia patients.
- Utilize service-line data. Inpatient hospitalizations can be divided into medical and surgical groups,, with a subdivision into “service-lines.” Typical service lines include general medicine, general surgery, orthopedics, orthopedic surgery, neurology, neurosurgery, cardiology, cardiothoracic and vascular surgery, and others. Subdividing the general patient population, allows a clear understanding of where there may be issues with excessive LOS. Consider a hospital with the KPI goal of an average length of stay <3.5 days. For issues of simplification, let’s assume they have equal numbers of hospitalizations for cardiac issues, and general surgery procedures. Their average LOS for hospitalized patients with cardiac issues might be 3 days, while those with general surgery may be 6 days. If these populations are lumped together, the result would be an average length of stay of 4.5 days. So, which group should improve their performance? This is a trick question, as there is inadequate information to make this determination. Adding in another metric, such as the actual/expected LOS, will bring clarity to the performance of each group.
- Confirm that your facility is correcting the DRG weight for patients diagnosed with COVID-19, and that all cases are captured.
As of September 01, 2020, the Inpatient Prospective Payment System section of the CARES Act directs the Secretary of Health and Human Services to increase the weighting factor of the assigned Diagnosis-Related Group by 20% for an individual diagnosed with COVID-19 discharged during the COVID-19 public health emergency. Failing to capture all cases of COVID-19, or to apply the 20% adjustment, will not only impact the hospital finances, it will falsely lower the expected LOS for these patients. There have been concerns that some Revenue Cycle Groupers may not be adjusting the DRG weight of COVID-19 cases. For more information regarding reimbursements and groupers, check out Appeal Academy’s Finally Friday show on 2/5/2021 titled “What’s in YOUR Grouper” where Deborah Gardner-Brown reveals concerns on calculations for the 20% Bonus for COVID-19 patients.
As always, reach out to your Physician Advisor and knowledge experts for additional insights and tips. Tune into the upcoming webinar, March 4th at 1pm EST on EPAS Live titled “The Effects of COVID-19 on Denials, Physician Advisors & KPIs” for additional insights.
Please feel free to comment and add your own experiences, opinions, and observations.