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September 17, 2002

Report: Upstate hospitals could save up to $86 million with average lengths of stay

Upstate New York hospitals could have saved $47 million to $86 million last year if their average length of stay for adult patients merely tracked national average and benchmark figures, according to an analysis reported today by Excellus Health Plan.

The average length of state in upstate hospitals is 5.5 days, the report said; nationally, the figure is about one to 1.5 days shorter.

The Excellus Health Policy Report, "Average Length of Stay in Upstate New York Hospitals: Opportunities for Savings," examines the average lengths of stay among 82 upstate hospitals. The data were adjusted for differences in the sickness of patients in various hospitals, and the analysis was restricted to medical patients, such as those hospitalized for medical conditions like congestive heart failure, pneumonia, or AIDS. It did not include surgical, obstetrical, pediatric, psychiatric and alcohol or substance abuse treatment patients.

"Upstate New York hospitals have made considerable progress in reducing patients' length of stays, which can show both clinical benefits and cost savings," said Ron Lagoe, executive director of the Hospital Executive Council in Syracuse, which provided data for the report.

The average length of stay for adult medical patients across 36 upstate counties declined 18 percent between 1994 and 1997, and another 7.5 percent between 1997 and 2000. "When you adjust for risk, we've made a lot of progress, but we still have room to go," Lagoe said.

Hospitals in New York have said that their job is made more difficult by the lack of subacute care units, which are facilities that take care of patients whose needs fall between those of a hospital bed and a nursing home bed. The Excellus Health Policy Report recommends that access to all types of post-hospital care be assessed.

The report also notes that appropriate management of length of stay is important not only in hospitals, but also in post-acute settings.

Length-of-stay data were calculated by the Syracuse-based Hospital Executive Council from discharge data that hospitals submit to the New York Department of Health's Statewide Planning and Research Cooperative System (SPARCS). Data from mid-2000 to mid-2001 were used.

Local figures were then compared to the national average as well as the average in Minneapolis/St. Paul (4.0 days) and Sacramento (4.1 days), two national benchmarks for hospital average length of stay.

Upstate hospitals typically have had a better track record on shorter lengths of stay than New York City hospitals, but most New York state hospitals throughout all regions have longer lengths of stay than national averages and national benchmarks.

The latest report by Excellus tracks earlier studies on lengths of stay reported by the Department of Housing and Urban Development on the hospital industry in the Buffalo-Niagara region, as well as studies done by the Syracuse-based Hospital Executive Council.

"Lowering hospital expenses without compromising patient care is vital to efforts at containing escalating health coverage costs," said Jerry Vasile, executive vice president of health care affairs for Excellus. In a previous Health Policy Report, Excellus found that the growth in hospital expenses accounted for 34-42 percent of the increase in health care premiums between 1998 and 2001.

The primary findings of the Excellus Health Policy Report on hospital lengths of stay are as follows:

. New York hospitals have made considerable progress in reducing lengths of stay. The average length of stay for adult medical patients across 36 counties in the Excellus service area declined 18 percent between 1994 and 1997 and another 7.5 percent between 1997 and 2000.

. The average length in 2000-2001 in upstate New York was 5.5 days for adult medical patients. After adjusting for differences in how sick patients are, this compares to 4.7 days nationally and around 4 days in best practice benchmark areas such as Minneapolis/St. Paul and Sacramento.

. There are also significant variations across hospitals, with some having average lengths of stay of a little more than 3 days, and others around 7 days. Several hospitals that treat more complex patients are toward the short end of this distribution. This shows that lower lengths of stay are achievable in upstate New York.

. Reducing lengths of stay for adult medical patients in upstate New York to the national average would lower hospital costs by up to $47 million. Even greater savings could be achieved by reducing lengths of stay closer to the best practice benchmarks.

. Reducing hospital lengths of stay has been an important means for hospitals to increase their efficiency over the last decade or more. Keeping people in the hospital too long may have adverse health status effects, as well as increase costs. Hospital patients may be exposed to infections or harmed by medical errors. Furthermore, most patients prefer to recuperate at home and may recover their mobility more quickly at home or in a nursing home. The goal should therefore be to keep patients in the hospital as long as clinically necessary, and to discharge them to a safe setting as soon as they are ready.

. Hospitals, physicians, home care agencies, nursing homes, and insurers need to work together to ensure that patients are not kept in the hospital longer than is clinically necessary.

The report can be found at at www.excellusbcbs.com.