Overview

Length of stay metrics can be found for many provider organizations in many different tables and on different pages throughout Marketscape Insights. In this article, we will show how the Average Length of Stay (ALOS) and Median Length of Stay (MLOS) metrics are calculated and where these metrics can be found throughout Marketscape Insights

Although all length of stay metrics are calculated the same way, there are numerous different length of stay metrics throughout Marketscape Insights. The names of the metrics sometimes change to indicate this difference. For example, "Hospice ALOS" indicates that the count in the column is taken from patient stays at a hospice.

Sometimes, we count specific "types" of days in averages that end up with different names.

For example, in Marketscape Insights for Skilled Nursing on the Skilled Nursing Explore page, the Average Length of Stay metric is called "Average Medicare Days per Stay.

The reason for this specific metric is that Medicare only pays for the first 100 days of SNF care, so we only count those days in the average.

Every length of stay metric in Marketscape Insights is listed below along with details about each metric.

Our naming convention for length of stay metrics is not consistent. Sometimes the same metric has a different name, and sometimes different metrics have the same name. As a rule of thumb, consider the page the table is on or the type of provider listed in the table to guide you in identifying what type of stay is being displayed in the length of stay column.

Finally, any time you see a state or county length of stay metric in a table, the average is calculated for all providers of the same type as the provider type listed in the table.

In the example to the right, the header indicates that the average is being calculated for a hospital. Therefore, the county and state averages come from all hospitals in the same county or state as the selected hospital.

Line of Business

Although each module of Marketscape Insights focuses on a different line of business, all length of stay metrics are calculated the same way in all modules. In this article, we will show how the metrics are calculated for any post-acute organization. Details for each line of business will be included in the section below that describes where the metrics can be found in each line of business.

Understanding the Metrics

A length of stay is the count of days from admission to discharge for a specific patient at a specific organization. The index event we use to include the stay in a specific metric is a patient discharge reported on a claim that took place in the reporting period. Depending on the metric, the reporting period will either be the most recent year or a quarter of data for trended metrics.

From the discharge date on the claim, we count back to find the matching admission claim up to two years for a maximum of 730 days, or 731 days if a leap year is included in the counting period.

Average and Median

Once we have compiled counts for all patients discharged during the reporting period, we can calculate two metrics - a mean average and a median average.

Average Length of Stay (ALOS) - mean average

To calculate an ALOS metric, we count the total number of days for all stays discharged during the reporting period and divide by the number of stays. The formula is below.

Median Length of Stay (MLOS) - median average

The median is calculated by counting the number of days for each stay discharged during the reporting period. Then we identify the number of days for the stay in the "middle" of all stays, that is, where half of the remaining stays are longer and half the stays are shorter.

Counting the days

To get a count of the number of days in a specific stay, we identify a claim with a patient discharge from a post acute facility. We then look back to find the respective admission claim for the same stay. This allows us to count the length of stay in days for the one stay. We will examine three examples from the image below from top to bottom.

The top stay ends in the third month of the one-year reporting period. In this case, we look back into the previous year of data to find the admission.

The middle stay ends in the 8th month of the one-year reporting period, and the admission is two years or more earlier than discharge. A stay that is two years or longer will only be counted as 730 days (731 days if there is a leap year).

The bottom stay ends in the eleventh month of the one-year reporting period and the admission is in the same reporting period. Notice that we would count the length of the top and bottom stays in the same way - moving into a different years of data does not limit the count.

Quarterly Trended

The quarterly trended length of stay metrics are calculated in the same way. The only difference is the reporting period in which the patient discharge occurs.

You can see that in the top timeline, the stay ends in the third quarter of the reporting period and the length of stay is counted back from there. Only stays that end in the same quarter are counted for the average in the quarterly metric.

In the bottom timeline, the discharge is in the 4th quarter of the reporting period. For this stay we count back up to two years. Any stay 2 years or longer will be counted as 730 for the average (731 days if there is a leap year).

Where to find Length of Stay Metrics

The location of each length of stay metric is shown below for each line of business.

In the list below, calculation nuances that set specific metrics apart are highlighted in blue.

Skilled nursing is immediately below, but you can click on the following links to jump to the location of the metrics for hospice or home health.

Hospice
Home Health

Skilled Nursing
Medicare only pays for the first 100 days of SNF care. In Marketscape Insights for Skilled nursing, any length of stay metric calculated for a skilled nursing facility is limited to these 100 days. To identify this nuance in how the metric is calculated the metric name includes the word "Medicare."
Location - Details	Image
*Physicians Explore* page** - Medicare Days per Stay This metric is the average of Medicare-covered days spent in a SNF for patients discharged during the one-year reporting period who were treated by the listed physician within three months prior to the SNF admission. We forgot to add the word "average" to the header for this metric, but it is an average nevertheless and matches the other Average Medicare Days per Stay metrics.
*Hospitals and Agencies Explore* page** - Medicare Days per Stay This number is the average of Medicare-covered days spent in a SNF for patients discharged during the one-year reporting period who were discharged from the listed hospital/agency and admitted to a SNF within 30 days We forgot to add the word "average" to the header for this metric, but it is an average nevertheless and matches the other Average Medicare Days per Stay metrics.
*Skilled Nursing Explore* Page** - Average Medicare Days per Stay This metric is the average of Medicare-covered days spent at the listed SNF for patients who completed stays during the one-year reporting period.
*Physician Analyze* Page** > Sales Spotlight tab > How Do I stand Out? section - Average Medicare Days per Stay tile This metric is the average number of days spent in the selected “My Agency” that provided skilled nursing care for patients discharged during the one-year reporting period for patients who were previously discharged from the selected facility within 30 days of admission to skilled nursing care. This metric pertains to the selected "My Agency" chosen for the Sales Spotlight tab for patients treated by the selected physician. For more information about this tile see, Physician Sales Spotlight - Understanding the Metrics
Physician Analyze Page > Destinations tab - FFS SNF Destinations table - Medicare Days per Stay This metric is the average number of Medicare covered days spent in the listed SNF for patients discharged during the one-year reporting period who were treated by the physician (Attended, 3 Months Prior, and Last Claimed) prior to their SNF admission
*Hospital & Agencies Analyze* page** > Sales Spotlight tab > How Do I Stand Out? section - Average Medicare Days per Stay tile This metric is the average number of Medicare days per stay at the selected "My Agency" that provided skilled nursing care for patients discharged during the one-year reporting period who were patients previously discharged from the selected facility within 30 days of admission to skilled nursing care. This metric pertains to the selected "My Agency" chosen for the Sales Spotlight tab for patients treated by the selected hospital or agency. For more information, see Hospitals & Agencies Sales Spotlight - Understanding the Metrics
*Hospital & Agency Analyze* page** > Utilization and Quality tab > Patient Diagnostic Mix table - This Hospital / Agency ALOS For the selected hospital/agency - This metric is the average number of Medicare days per SNF stay, for patients that had a primary diagnosis code within the listed Trella diagnostic group and who received skilled nursing care within 30 days of discharge from the selected facility. Includes only those skilled nursing patients discharged during the one-year reporting period. Limited to 100 Medicare days of care. County and state averages come from all hospitals or agencies of the same type that are located in the same county or state as the selected hospital/agency.
*Hospital & Agency Analyze* page** > Utilization and Quality tab > Inpatient MS-DRG Breakout table - Average Length of Stay (Inpatient) The first metric is the average length of stay (in days) spent in the selected hospital/agency for patients who had the MS-DRG listed on an inpatient claim during the one-year reporting period. County and state averages come from all hospitals or agencies of the same type that are located in the same county or state as the selected hospital/agency.
*Hospital & Agency Analyze* page** > Utilization and Quality tab > BPCI Groups table - ALOS (Inpatient) The first metric is the average length of stay (in days) spent in the selected hospital/agency during the one-year reporting period for patients whose inpatient claim aligns with the listed BPCI group. The state average comes from all hospitals or agencies of the same type that are located in the same state as the selected hospital/agency.
*Hospital & Agency Analyze* page** > Utilization and Quality tab > Readmission Groups table - ALOS (Inpatient) Two average length of stay metrics for each readmission group listed in the table The first metric is the average length of stay (in days) spent in the selected hospital/agency during the one-year reporting period for patients whose inpatient claim aligns with the listed Readmission Group. The state average comes from all hospitals or agencies of the same type that are located in the same state as the selected hospital/agency.
*Skilled Nursing Analyze* page** > Insights tab - Average Medicare Days per Stay tile The metric on this tile is the average of Medicare-covered days spent at the selected SNF for patients who completed stays during the one-year reporting period.
*Skilled Nursing Analyze* page** > Quality tab > BPCI Groups table - ALOS (SNF) This is the average number of days per stay for patients discharged from the selected skilled nursing facility during the one-year reporting period. Two average length of stay metrics for each BPCI group listed in the table.
*Skilled Nursing Analyze* page** > Quality tab > Length of Stay by Trella Diagnostic Group table The metrics in the table in the "This SNF" column are the average (mean/median) number of days patients with a primary diagnosis in the listed Trella diagnostic group were cared for by the selected SNF. This entire table shows ALOS and MLOS metrics for each Trella Health Diagnostic Group. County and state averages are calculated from all skilled nursing facilities from the same county and state as the selected skilled nursing facility	Click on the image to enlarge it
*Skilled Nursing Analyze* page** > Quality tab > Length of Stay & Readmission Rates - by Clinical Group (MS-DRG, Readmission Group, or BPCI) The metrics in the table in the "This SNF" column are the average (mean and median) number of days spent in skilled nursing care for patients discharged from the selected skilled nursing facility during the one-year reporting period who had a diagnosis that aligns with the MS-DRG, Readmission group of BPCI listed in the row. Two sections of comparative length of stay metrics (in box in image)	Click on the image to enlarge it Change clinical grouping with selector
*Skilled Nursing Analyze* page** > Operational tab > SNFs Summary table - Average Medicare Days per Year This metric is the average of Medicare-covered days spent at the selected SNF for patients who completed stays during the one-year reporting period. This matches the tile on the Insights tab, the only difference is that under the operational tab we provide this metric to one decimal place instead of rounding
*Skilled Nursing Analyze* page** > Sources tab - FFS Hospital and Agency Sources table - Average SNF Medicare Days This metric can be found in the small section of metrics pertaining to the SNF selected for the Analyze page only. This metric is the average number of Medicare-covered days spent in the SNF for patients discharged during the on-year reporting period who were discharged from the listed hospital/agency and admitted to the selected SNF within 30 days after discharge.
*Skilled Nursing Analyze* page** > Sources tab - FFS Physician Sources table - Average SNF Medicare Days This metric is the average number of days the listed physician's patients spent in the selected SNF, for patients discharged from skilled nursing care during the one-year reporting period who were treated by the physician within 3 months prior to SNF admission.

Hospice

Location - Details

Image

Physician Explore page - Hospice ALOS

This metric is the average count of days in hospice care for patients discharged from hospice during the one-year reporting period who were treated by the listed physician within three months prior to hospice admission.

Facilities Explore page - Hospice ALOS

This metric is the average count of days in hospice care for patients discharged from hospice during the one-year reporting period who were discharged from the listed facility and admitted to hospice care within 30 days

Hospices Explore page > ALOS (Days)

The average number of days per stay for patients discharged from hospice care at the listed hospice during the one-year reporting period.

Physician Analyze page > Sales Spotlight tab > Get to Know this Physician section - Hospice ALOS tile

The state average comes from all hospices located in the same state as the selected hospice.

Physician Analyze page > Utilization tab > Hospice Length of Stay and Mortalities table - Hospice ALOS (Mortalities)

Average length of stay for hospice patients who died during the one-year reporting period; limited to patients treated by the physician within six months prior to the death date

Physician Analyze page > Destinations tab > Hospice Destinations table - Hospice ALOS

This metric is the average number of days spent in the listed hospice for patients discharged during the one-year reporting period who were treated by the physician prior to hospice admission (Attended, 3 Months Prior, and Last Claimed patients)

Facility Analyze page > Utilization and Quality tab > Hospice Length of Stay Post-Discharge table - ALOS

This quarterly metric is the average number of days patients discharged from the selected facility spent in hospice, for patients discharged from hospice during the specified quarter and treated by the hospice within 30 days of discharge from the selected facility.

The state and county averages are calculated based on all discharges from all facilities of the same type in the same county/state as the selected facility.

Click on image to enlarge it

Facility Analyze page > Utilization and Quality tab > Patient Diagnostic Mix table - Average Length of Stay (Days) - This Facility

For the selected facility - This metric is the average number of days per hospice stay, for patients who had a primary diagnosis code within the listed Trella diagnostic group and who received hospice care within 30 days of discharge from the selected facility. Includes only those hospice patients discharged during the one-year reporting period.

The state and county averages are calculated based on all discharges from all facilities of the same type in the same county/state as the selected facility.

Facility Analyze page > Utilization and Quality tab > Inpatient MS-DRG Breakout table - Average Length of Stay (Inpatient)

The first metric is the average number of days spent in the selected facility for patients who had the MS-DRG listed on an inpatient claim and who were discharged during the one-year reporting period.

County and state averages come from all facilities of the same type that are located in the same county or state as the selected facility.

Facility Analyze page > Utilization and Quality tab > BPCI Groups table - ALOS (Inpatient)

The first metric is the average number of days spent in the selected facility during the one-year reporting period for patients whose inpatient claim aligns with the listed BPCI group.

The state average comes from all similar facilities located in the same state as the selected facility.

Facility Analyze page > Utilization and Quality tab > Readmission Groups table - ALOS (Inpatient)

The first metric is the average number of days spent in the selected facility during the one-year reporting period for patients whose inpatient claim aligns with the listed Readmission Group.

The state average comes from all similar facilities located in the same state as the selected facility.

Facility Analyze page > Destinations tab > Hospice Destinations table - Hospice ALOS

This metric is the average number of days spent at the listed hospice for patients discharged during the one-year reporting period who were discharged from the selected facility and admitted to the hospice within 30 days.

Facility Analyze page > Destinations tab > SNF Destinations table - Average Medicare Days per Stay

This metric is the average number of Medicare-covered days spent in the listed SNF for patients discharged from SNF during the one-year reporting period who were discharged from the selected facility and admitted to the listed SNF within 30 days of facility discharge.

Hospice Analyze page > Quality and Operational tab > Trended LOS table

This table includes ten different length of stay metrics pertaining to the selected hospice. Each row displays an annual metric and four quarters of trended metrics.

Click on the to the left of a row to open a definition for the length of stay in that row.

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Hospice Analyze page > Quality and Operational tab > Length of Stay by Trella Diagnostic Group

These metrics are the average (mean and median) number of days spent in hospice for patients discharged from the selected hospice during the one-year reporting period who had a diagnosis that aligns with the Trella Health diagnostic group listed in the row.

The county and state averages come from all hospices located in the same county or state as the selected hospice.

Click on image to enlarge it

Hospice Analyze page > Quality and Operational tab > Length of Stay & Readmission Rates - by Clinical Group (MS-DRG, Readmission Group, or BPCI)

The metrics in the table in the "This HOS" column are the average (mean and median) number of days spent in hospice for patients discharged from the selected hospice during the one-year reporting period who had a diagnosis that aligns with the MS-DRG, Readmission group of BPCI listed in the row.

The county and state averages come from all hospices located in the same county or state as the selected hospice.

Click on image to enlarge it

Change clinical grouping with selector

Hospice Analyze page > Sources tab > Facility Sources - Hospice ALOS

This metric is the average number of days completed at the selected hospice for patients discharged from hospice care during the one-year reporting period who were discharged from the listed facility and admitted to the selected hospice within 30 days after discharge.

Hospice Analyze page > Sources tab > Physician Sources - ALOS

This metric is the average number of days the physician's patients spent in the selected hospice, for patients discharged from hospice during the one-year reporting period and treated by the physician within 3 months prior to hospice admission

Home Health

Location - Details

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Physicians Explore page - Home Health ALOS

This metric is the average number of days spent in home health care for patients discharged during the one-year reporting period who were treated by the physician within three months prior to the home health admission.

Facility Analyze page > Sales Spotlight tab > How Do I Stand Out? section > HHA Average Length of Stay tile

This metric is the average number of days spent in the selected "My Agency" that provided home health care for patients discharged during the one-year reporting period who were previously discharged from the selected facility within 30 days of admission to home care.

In this case, the main metric in the tile pertains to the chosen "My Agency" for the Sales Spotlight tab.

Facility Analyze page > Utilization & Quality tab > Home Health Agency Length of Stay Post-Discharge table - trended ALOS

These metrics are the average number of days patients spent in home health services, for patients discharged from home health during the specified quarter and treated by the HHA within 30 days of discharge from the selected facility

The county and state averages come from all home health agencies located in the same county or state as the selected facility.

Click on image to enlarge it

Facility Analyze page > Utilization and Quality tab > Patient Diagnostic Mix table - Average Length of Stay (Days)

For the selected facility - This metric is the average number of days per home health stay, for patients who had a primary diagnosis code within the listed Trella diagnostic group and who received home health care within 30 days of discharge from the selected facility. Includes only those home health patients discharged during the one-year reporting period.

The state and county averages are calculated based on all discharges from all facilities of the same type in the same county/state as the selected facility.

Facility Analyze page > Utilization and Quality tab > Inpatient MS-DRG Breakout table - Average Length of Stay (Inpatient)

The first metric is the average number of days per home health stay spent in the selected facility for patients who had the MS-DRG listed on an inpatient claim during the one-year reporting period.

County and state averages come from all facilities of the same type that are located in the same county or state as the selected facility.

Facility Analyze page > Utilization and Quality tab > BPCI table - ALOS (Inpatient)

The first metric is the average number of days per home health stay spent in the selected facility during the one-year reporting period for patients whose inpatient claim aligns with the listed BPCI group.

The state average comes from all similar facilities located in the same state as the selected facility.

Facility Analyze page > Utilization and Quality tab > Readmission Groups - ALOS (Inpatient)

The first metric is the average number of days per stay spent in the selected facility during the one-year reporting period for patients whose inpatient claim aligns with the listed Readmission group.

The state average comes from all similar facilities located in the same state as the selected facility.

Home Health Analyze page > Quality tab > Length of Stay by Trella Diagnostic Group

These metrics are the average (mean and median) number of days spent in home health for patients discharged from the selected home health agency during the one-year reporting period who had a diagnosis that aligns with the Trella Health diagnostic group listed in the row.

The county and state averages come from all hospices located in the same county or state as the selected hospice.

Click on image to enlarge it

Home Health Analyze page > Quality tab > Length of Stay & Readmission Rates - by Clinical Group (MS-DRG, Readmission Group, or BPCI)

The metrics in the table in the "This HHA" column are the average (mean and median) number of days spent in home health for patients discharged from the selected home health agency during the one-year reporting period who had a diagnosis that aligns with the MS-DRG, Readmission group of BPCI listed in the row.

The county and state averages come from all home health agency located in the same county or state as the selected home health agency.

Click on image to enlarge it

Change clinical grouping with selector

Home Health Analyze page > Sources tab > FFS Facility Sources - This HHA - HHA ALOS

This metric is the average number of days per stay for home health patients discharged from the selected home health agency during the one-year reporting period who were discharged from the listed facility and admitted to the HHA within 30 days after facility discharge

Home Health Analyze page > Sources tab > FFS Physician Sources - ALOS

This metric is the average number of days the physician's patients spent in this HHA, for patients discharged from HHA during the one-year reporting period and treated by the physician within 3 months prior to HHA admission

Length of Stay